Managing ADHD across the Lifespan in the Primary Care Setting

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioral condition that affects most patients throughout their lives and is associated with occupational underachievement, psychiatric comorbidity, and substance abuse. Primary care physicians (PCPs) are at the forefront of helping patients with ADHD manage symptoms and overcome functional impairments. In this article, the problems of recognizing and effectively managing ADHD are explored through the presentation of 2 composite patient cases based on real patients in the authors' practices. Both cases highlight maturational changes in ADHD-related problems as patients develop through childhood, adolescence, and into adulthood. The striking differences between the cases serve to illustrate the highly varied clinical presentation and developmental trajectories of ADHD, moderated by family environment, patient characteristics, and life events. Emphasis is placed on understanding the crucial developmental turning points from early childhood through adulthood at which patients with ADHD are most likely to need increased support and specialized behavioral interventions. Diagnosis of adult ADHD is also reviewed, including an overview of potentially clinically relevant patient characteristics that should alert PCPs to the possible presence of ADHD and use of the World Health Organization's rapid 6-item adult ADHD Self-Report Scale as a screening device. The present discussion challenges PCPs to recognize the varied presentations of what ADHD "looks like," and describes the need for PCPs to establish and maintain working partnerships with families, patients, and mental health care professionals in their local communities to successfully treat ADHD across the lifespan.

Attention Deficits in Children With Combined Autism and ADHD

“…The presence of co-occurring ASD and ADHD seems to be critical to recognize because of the impact of associated problems and the exponential risk associated with comorbidity (D. W. Goodman, Lasser, Babcock, Pucci, & Solanto, 2011). To date, however, little is known about the associated features of comorbid ASD and ADHD diagnosis, and whether it represents a qualitatively distinct phenotype separate from the ASD and ADHD group, a more severe form of ASD and ADHD deficits, or merely similar deficits to either one of the individual disorders alone (Rommelse et al, 2010).…”

Perceived Self-Control is Related to Mental Distress in Patients Entering Substance Use Disorder Treatment

“…A screener is a list of symptoms that allows for a brief inquiry, thus raising consideration for more thorough assessment. While such screeners are time efficient and easily can be administered to all patients, reduced specificity can lead to over diagnosing and consequently inappropriate treatment (186). In the current study we do not discuss diagnosis based on results from screening tools.…”

Are Motivation Deficits Underestimated in Patients With ADHD? A Review of the Literature

“…41 Clinicians have an important role in helping families overcome some of these barriers. 40 Despite such perceptions, research has examined the use of cognitive behavioral therapy (CBT) for adolescents and adults with ADHD. [43][44][45] The use of CBT can help equip the individual with organizational skills, such as using a task list to prioritize, gauging attention, and breaking complex tasks into small steps.…”

“…37 Parental Behavioral Training is useful in decreasing disruptive and off-task behaviors in children with ADHD. 38,39,40 Such methods rely on the use of rewards and consequences to shape target behaviors. To reduce cursing, for example, the parent may present adverse consequences (eg, extra chores) or remove something desirable (eg, video games).…”