Clinicians of all types are failing to diagnose the majority of adult patients with Attention Deficit Hyperactivity Disorder (ADHD). To improve the situation, we must screen ALL patients whom we see for possible ADHD. Why are clinicians reluctant to do that? There are some legitimate concerns. But, we can address these concerns while also identifying and treating those persons with ADHD who need our help.
1. “Everybody has difficulty with concentration. Even I feel distracted at times.”
Yes, but that’s like saying that there is no major depressive disorder because we all feel sad at times. Or that there is no bipolar disorder because we all have had times when we were very happy and times that we were sad. Psychiatric disorders, in general, are extreme versions of experiences that everyone has from time to time. To the clinician who has learned about ADHD, the disorder is not difficult to distinguish from normal — by the nature of the symptoms, their severity and pervasiveness, their lifelong duration, and the types of impairment they cause.
2. “So many people are misdiagnosed with ADHD. They just claim to have difficulty concentrating and get diagnosed with ADHD by careless clinicians.”
Yes, but that is not the fault of patients with ADHD, is it? It just means that we should not misdiagnose people — with ADHD or anything else. But there is a pressing need for clinicians to learn a lot more about how to screen for ADHD, get a history of ADHD, confirm the diagnosis, etc.
3. “So many people (especially college students) abuse stimulants.”
Yes, but I think this refers to people who don’t have ADHD but misuse stimulants. Our patients with ADHD will need to be counseled to be careful that their medication does not get stolen by others who abuse them. Same as our patients for whom we prescribe benzodiazepines or hypnotics.
(People who really have ADHD don’t usually abuse stimulants. There is some research data to suggest that treatment with stimulants reduces substance abuse. That is totally understandable: people who don’t get diagnosed and treated tend to self-medicate. This is similar to patients with untreated clinical depression tend to abuse alcohol.)
We shouldn’t waste our time learning about things that probably won’t help any patients. Learning to screen for, diagnose, and treat adult ADHD is one of the most high-impact things that mental health clinicians can do. If we fail to do so, large numbers of people will continue to suffer and fail to live up to their potential.
Four C’s for dealing with ADHD (YouTube Video)
Things that can masquerade as ADHD (YouTube Video)
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