Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment. According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home. He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments. He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old. On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time.
Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job.
Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication.
Mr. Deliver is 5'11" and his weight is 165 lb. He takes a men’s multivitamin daily, HCTZ at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years.
What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?
Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?
Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?
Full Answer Section
Some of the most commonly prescribed stimulant medications for ADHD in adults include:
- Methylphenidate (Ritalin, Concerta): This is a short-acting stimulant medication that is typically taken once or twice a day.
- Amphetamine (Adderall, Dexedrine): This is a long-acting stimulant medication that is typically taken once a day.
- Lisdexamfetamine (Vyvanse): This is a long-acting stimulant medication that is typically taken once a day.
Pharmacological treatment for ADHD in children
The current recommendation for pharmacological treatment for ADHD in children is stimulant medications. Stimulant medications work by increasing the levels of dopamine and norepinephrine in the brain. These neurotransmitters are involved in attention, impulse control, and motivation.
Some of the most commonly prescribed stimulant medications for ADHD in children include:
- Methylphenidate (Ritalin, Concerta): This is a short-acting stimulant medication that is typically taken once or twice a day.
- Amphetamine (Adderall, Dexedrine): This is a long-acting stimulant medication that is typically taken once a day.
- Lisdexamfetamine (Vyvanse): This is a long-acting stimulant medication that is typically taken once a day.
In addition to stimulant medications, there are also a number of non-pharmacological treatments for ADHD. These treatments include:
- Behavioral therapy: Behavioral therapy can help children and adults with ADHD to learn how to manage their symptoms.
- Cognitive-behavioral therapy: Cognitive-behavioral therapy can help children and adults with ADHD to change their thinking patterns and behaviors.
- Social skills training: Social skills training can help children and adults with ADHD to develop better social skills.
Treatment for Thomas, a 13-year-old male with ADHD
The treatment for Thomas would be similar to the treatment for Mr. Deliver, with some adjustments. Because Thomas is a child, he would likely start with a lower dose of stimulant medication and the dose would be increased gradually as needed.
In addition to stimulant medication, Thomas would also benefit from behavioral therapy and social skills training. Behavioral therapy can help Thomas to learn how to manage his symptoms of ADHD and social skills training can help him to develop better social skills.
It is important to note that the treatment for ADHD is individualized and the best treatment plan for Thomas would be determined after a comprehensive assessment.
Sample Answer
Screening tools for ADHD
There are a number of screening tools that can be used to affirm a diagnosis of ADHD. These tools include:
- The Conners' Adult ADHD Rating Scales (CAARS): This is a self-report questionnaire that is used to assess symptoms of ADHD in adults.
- The Wechsler Adult Intelligence Scale-IV (WAIS-IV): This is a comprehensive intelligence test that can be used to assess cognitive functioning in adults.
- The Millon Clinical Multiaxial Inventory-III (MCMI-III): This is a personality assessment tool that can be used to assess a variety of psychological disorders, including ADHD.
Pharmacological treatment for ADHD in adults
The current recommendation for pharmacological treatment for ADHD in adults is stimulant medications. Stimulant medications work by increasing the levels of dopamine and norepinephrine in the brain. These neurotransmitters are involved in attention, impulse control, and motivation.