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2024</time></div><h1 class="text-[26px] font-medium leading-8">Insights Into the New CDC Data on Adult ADHD</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/greg-mattingly-md">Greg Mattingly, MD</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Insights Into the New CDC Data on Adult ADHD" aria-label="facebook" class="react-share__ShareButton" 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style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%27141.30662983425415%27%20height=%2751%27/%3e"/></span><img src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" class="shrink-0" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F26247b67aea8d721571a106630ad62fec7990ad5-2006x724.png%3Ffit%3Dcrop%26auto%3Dformat&w=256&q=75 1x, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F26247b67aea8d721571a106630ad62fec7990ad5-2006x724.png%3Ffit%3Dcrop%26auto%3Dformat&w=384&q=75 2x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F26247b67aea8d721571a106630ad62fec7990ad5-2006x724.png%3Ffit%3Dcrop%26auto%3Dformat&w=384&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a></div></div><div class="w-full flex flex-col px-4 py-4 border-t border-b border-solid border-gray-400 my-4 "><h3 class="text-primary text-xl font-semibold">Key Takeaways</h3><ul class="list-disc px-8"><li class="py-2 "> Over 50% of adults with ADHD were diagnosed in adulthood, with a higher prevalence in women compared to men. </li><li class="py-2 "> Patients face significant challenges in obtaining ADHD medication due to shortages, impacting treatment adherence. </li><li class="py-2 hidden"> Dr. Mattingly emphasizes the importance of telehealth in addressing ADHD treatment barriers. </li><li class="py-2 hidden"> The CDC report provides critical insights into ADHD prevalence, diagnosis trends, and treatment challenges in adults.</li></ul><span class="text-xs font-bold text-primary underline cursor-pointer mt-2 ml-4">SHOW MORE</span></div><p class="py-2 mb-2 text-sm italic text-gray-600">Explore the most recent data on adult ADHD with the president of the American Professional Society for ADHD and Related Disorders.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class="relative"><div class="brightcove-fluid" autoplay=""></div></div><p class="pb-2">Greg Mattingly, MD, the president of the American Professional Society for ADHD and Related Disorders (APSARD), shares more information on the new data from the CDC. The Morbidity and Mortality Weekly Report provides a deep dive into the prevalence, diagnosis, and treatment of adults with ADHD—a hot topic.<sup class="text-inherit">1</sup> This data shows that more than 50% of adults with ADHD were diagnosed in adulthood, with larger discrepancies for woman than men. Additionally, many patients reported difficulty obtaining their ADHD medication due to a shortage. Mattingly, alongside Ann Childress, MD, responded to this data.<sup class="text-inherit">2</sup> </p><p class="pb-2"></p><p class="pb-2">Learn more about the report and Mattingly and Childress' response <a target="_blank" href="https://www.psychiatrictimes.com/view/new-cdc-data-highlights-the-need-for-guidelines-on-adult-adhd">here</a>. </p><p class="pb-2"></p><p class="pb-2"><strong>Dr Mattingly </strong><em>is associate clinical professor at Washington University; president of the Midwest Research Group; and president of the American Professional Society for ADHD and Related Disorders.</em></p><p class="pb-2"><em></em></p><p class="pb-2"><strong>References</strong></p><p class="pb-2">1. Staley SB, Robinson LR, Claussen AH, et al. <a rel="nofollow noreferrer noopener" target="_blank" href="https://www.cdc.gov/mmwr/volumes/73/wr/mm7340a1.htm?s_cid=mm7340a1_w">Attention deficit/hyperactivity disorder diagnosis, treatment and telehealth use in adults – National Center for Health Statistics Rapid Surveys System, United States, October – November 2023.</a> <em>MMWR Morb Mortal Wkly Rep</em>. 2024;73(40).</p><p class="pb-2">2. Mattingly G, Childress A. <a rel="nofollow noreferrer noopener" target="_blank" href="https://www.psychiatrist.com/jcp/implications-adult-adhd-diagnostic-trends-treatment-barriers-telehealth/">Clinical implications of attention-deficit/hyperactivity disorder in adults: what new data on diagnostic trends, treatment barriers, and telehealth utilization tell us.</a> <em>J Clin Psychiatry</em>. 2024;85:4.</p></div></div><div class="flex items-center lg:w-3/4 mb-4 pb-12"></div><div class="jsx-19ede9f0a5a45918 py-4 relative bg-primary md:px-8 -ml-6 xs:ml-0 w-screen xs:w-auto"><div class="jsx-19ede9f0a5a45918 px-4 sm:px-0"><div class="flex justify-between items-center py-1 space-x-4 border-0 select-none sm:border-b border-secondary"><div class="text-3xl text-white text-lg sm:text-3xl">Related Videos</div></div></div><div style="scroll-snap-type:none" class="jsx-19ede9f0a5a45918 flex items-start overflow-x-auto space-x-4 py-4 relative mx-auto w-full pl-4"><a id="" class="w-[200px] h-fit 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The Morbidity and Mortality Weekly Report provides a deep dive into the prevalence, diagnosis, and treatment of adults with ADHD—a hot topic.1 This data shows that more than 50% of adults with ADHD were diagnosed in adulthood, with larger discrepancies for woman than men. Additionally, many patients reported difficulty obtaining their ADHD medication due to a shortage. Mattingly, alongside Ann Childress, MD, responded to this data.2 \n\n\n\nLearn more about the report and Mattingly and Childress' response here. \n\n\n\nDr Mattingly is associate clinical professor at Washington University; president of the Midwest Research Group; and president of the American Professional Society for ADHD and Related Disorders.\n\n\n\nReferences\n\n1. Staley SB, Robinson LR, Claussen AH, et al. Attention deficit/hyperactivity disorder diagnosis, treatment and telehealth use in adults – National Center for Health Statistics Rapid Surveys System, United States, October – November 2023. MMWR Morb Mortal Wkly Rep. 2024;73(40).\n\n2. Mattingly G, Childress A. Clinical implications of attention-deficit/hyperactivity disorder in adults: what new data on diagnostic trends, treatment barriers, and telehealth utilization tell us. J Clin Psychiatry. 2024;85:4.","description":"Explore the most recent data on adult ADHD with the president of the American Professional Society for ADHD and Related Disorders.","author":[{"@type":"Person","name":"Greg Mattingly, MD"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-5V9L5PL" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class="w-full bg-primary flex flex-col items-center justify-center"><div class="container w-[1340px]"><div id="footerInnerWrap" class="bg-primary w-full py-12"><div class="py-4 pl-4 flex flex-row items-center"><div class="flex 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Psychiatry","_id":"pst_taxonomy_89_childadolescentpsychiatry","_updatedAt":"2024-02-28T20:56:30Z","identifier":"topics/child-adolescent-psychiatry","_rev":"Y3MLYgF1Z7QuWKLEbdmVmR","pixelTrackingCode":null}],"summary":"In this podcast, we speak with a psychiatrist about topics ranging from what prompted her to pursue a career in child psychiatry to treatment strategies and common conditions comorbid with ADHD.\n","url":"treating-adhd-children-concerns-controversies-safety-measures","factCheckAuthors":null,"thumbnail":{"_type":"mainImage","caption":"smikeymikey1/shutterstock","asset":{"_ref":"image-882c03d79aad20809abba7ed419641756c66f364-3000x3000-jpg","_type":"reference"}},"_rev":"d4ilsE5q4PRpxUPL61lL5N","published":"2020-07-10T04:00:00.000Z","factCheckAuthorMapping":null,"documentGroup":null,"body":[{"uploadAudio":{"_type":"file","asset":{"_ref":"file-2de5ec35bb71e7383b2c7cf7dfa0d657ddab287a-mp3","_type":"reference"}},"_type":"audio","_key":"c89f3e12e0b1"},{"_key":"b1e89f60509b","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"PSYCHPEARLS","_key":"b1e89f60509b0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"In this podcast, we speak with Dr. Leela R. Magavi, Regional Medical Director for ","_key":"5b621f182f6f0"},{"_type":"span","marks":["8db6b66718ab"],"text":"Community Psychiatry","_key":"5b621f182f6f1"},{"_type":"span","marks":[],"text":", in Newport Beach, CA.","_key":"5b621f182f6f2"}],"_type":"block","style":"normal","_key":"5b621f182f6f","markDefs":[{"blank":true,"_type":"link","href":"https://www.communitypsychiatry.com/providers/leela-magavi-m-d/","_key":"8db6b66718ab"}]},{"_key":"36ac25f77d65","markDefs":[],"children":[{"_key":"36ac25f77d650","_type":"span","marks":["em"],"text":"Transcript abbreviated and edited and clarity. Listen to the podcast for complete information. Identities of patients discussed are obscurred and do not point to any one individual. They are for illustrative purposes only. -Ed"}],"_type":"block","style":"normal"},{"_key":"e3308c4bbecf","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Laurie Martin (LEM): Welcome, Dr. Magavi. Tell us about yourself.","_key":"e3308c4bbecf0"}],"_type":"block","style":"normal"},{"style":"normal","_key":"7eb239fa975c","markDefs":[],"children":[{"marks":["strong"],"text":"Leela Magavi, MD:","_key":"7eb239fa975c0","_type":"span"},{"_type":"span","marks":[],"text":" Thank you for inviting me to speak today. I am a child, adolescent, and adult psychiatrist and regional medical director for Community Psychiatry, a California-based company committed to providing affordable, compassionate and evidence-based care to individuals of all backgrounds. I completed my adult psychiatry residency at Georgetown University, and my child psychiatry fellowship at Johns Hopkins. I currently practice in Newport Beach, CA, but my patients reside in various parts of California, from San Francisco to San Diego. As Regional Medical Director, I have the opportunity to work closely with several physicians and clinicians practicing throughout Southern California. In my spare time, I enjoy watching movies, eating my husband’s amazing, home-cooked meals, and spending time with my parents and younger sister.","_key":"7eb239fa975c1"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: What prompted you to pursue a career in child psychiatry? And why do you think medical students and residents should consider pursuing this field?","_key":"d9f37315f0560"}],"_type":"block","style":"normal","_key":"d9f37315f056"},{"_key":"1992690c8ef4","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"1992690c8ef40"},{"_type":"span","marks":[],"text":" I would highly recommend that medical students and residents consider pursuing a career in child psychiatry. I thoroughly enjoy practicing child and adolescent psychiatry. Other than my unwavering love for children, the reasons are countless.","_key":"1992690c8ef41"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"My father always says, “Everything you need to know you learned in kindergarten.” I always laugh, but I found truth in this statement throughout medical school and residency. I strive to comprehend the origin of patients’ fears. I have realized that many conflicts are rooted in people’s childhoods, and I focus on this during sessions. Lamentably, some patients have never received psychiatric care, although they desperately needed it. I hope to provide early, preventative care to as many children as I can, a privilege that I wholeheartedly embrace. My training in child and adolescent psychiatry has helped me provide better, comprehensive care for my adult patients. Furthermore, I enjoy the team approach warranted to help children and adolescents. When parents, teachers, physicians and members of the community come together, these children do get better, which is an irrefutably beautiful thing.","_key":"0e3a1f4daf9e0"}],"_type":"block","style":"normal","_key":"0e3a1f4daf9e"},{"children":[{"text":"LEM: ADHD is used so casually in pop culture and the media, and in some areas of the country, having a child with ADHD is almost akin to having an Honors Student. What are your thoughts regarding this?","_key":"0720f1dd917e0","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"0720f1dd917e","markDefs":[]},{"children":[{"text":"Leela Magavi, MD:","_key":"3c3de410752e0","_type":"span","marks":["strong"]},{"text":" ADHD, like many psychiatric disorders such as OCD and bipolar disorder, are used very loosely in day-to-day dialogue. You may be walking down the street, and overhear someone say, “My ADHD is so bad! I can’t stop scrolling through Instagram during my Zoom team meeting!” or someone else say “My mood is all over the place! I’m probably bipolar or something.” Many individuals have intermittent, waxing, and waning symptomatology, which does not cause any distress or decline in functionality. The truth is, all of us have times during which we experience inattentiveness. In fact, during this podcast, our listeners may have already lost their focus, or we may lose our train of thought, but this is simply normal human tendency, and it does not mean we have a clinical diagnosis such as ADHD. In training, it is important to learn and understand normal human behaviors and tendencies to avoid pathologizing normal human behavior or medicating unnecessarily. ","_key":"3c3de410752e1","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"3c3de410752e","markDefs":[]},{"_key":"2a16805e6a46","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: How often do you see patients who don’t necessarily meet the diagnostic criteria of ADHD? Do they have other diagnoses, and if so what are these? How do you counsel these parents and patients and address these concerns?","_key":"2a16805e6a460"}],"_type":"block","style":"normal"},{"_key":"3d443d9f8d46","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"3d443d9f8d460"},{"_type":"span","marks":[],"text":" I enjoy evaluating and treating individuals with various psychiatric diagnoses, but particularly enjoy working with children and adults with autism, ADHD, mood and anxiety disorders. Many children present with a chief complaint of ADHD. Quite a few children and adolescents who carry a diagnosis of ADHD from prior assessments or appear to have symptoms of ADHD do not, in fact, have ADHD. ","_key":"3d443d9f8d461"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"I have encountered many situations in which parents have unrealistic expectations. However, this is a product of systemic changes that have promoted a very competitive schooling atmosphere. It is no longer enough to earn straight A’s or ace the SATs. Let me give you an example. Mary comes home from school and needs to complete a few hours of homework and studying followed by swim practice followed by piano practice followed by a few more homework assignments. Mary repeats this schedule on a daily basis, and becomes demoralized and frustrated. She begins to avoid her friends and family. Her inattentiveness becomes evident to her parents and teachers, and her grades begin to plummet, and her school refers her family to me. In situations like these, I discuss expectations and counsel the family to support the child or teen’s wellness. Mary may be demoralized or depressed. Providing a stimulant may only exacerbate her anxiety, and thereby, worsen her depression. The treatment would involve therapy and possibly an SSRI if warranted. This may even involve redistributing tasks, taking a break from an extracurricular activity, and prioritizing sleep and wellness activities.","_key":"3dbcc7cfd48d0","_type":"span"}],"_type":"block","style":"normal","_key":"3dbcc7cfd48d"},{"markDefs":[],"children":[{"marks":["strong"],"text":"LEM: What are some other prevalent disorders you often see?","_key":"1f3e29a860350","_type":"span"}],"_type":"block","style":"normal","_key":"1f3e29a86035"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"ec0e6f5f57c60"},{"text":" Oppositional defiant disorder is a prevalent condition. For example, Charlie, presents with verbal aggression and sometimes physical aggression when his father asks him to turn the television off or when his baseball coach gives him feedback. Charlie fares well in school, but is very oppositional toward multiple authority figures. Charlie would benefit from behavioral therapy or parent management training for oppositional defiant disorder. Charlie does not have ADHD, and a medicine would not be helpful. In such cases, when I have shared this information with patients, they have sometimes expressed sadness or frustration about the diagnosis. ","_key":"ec0e6f5f57c61","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"ec0e6f5f57c6"},{"markDefs":[],"children":[{"text":"Many parents present to me hoping their children have ADHD when they do not. You may wonder why they would hope this were the case. Parents, understandably, can experience burnout and fatigue, and look to us physicians to expedite change and provide help. Therapy can take time to work, and medicine sometimes seems like a quick fix. I have open and candid discussions with parents to set expectations and reiterate that there is no magic pill or instant solution.","_key":"d2e32606db8d0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"d2e32606db8d"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"What I explain to parents is that medicines do not change behavior. Likewise, medicines do not make homework seem more interesting than Fortnite or Call of Duty. Medicine does not simply result in improved grades. Overall, it is pivotal that we have open conversations, and answer questions about the avenues of treatment and the risk of medicating when medication is not warranted.","_key":"acd556d0a4980"}],"_type":"block","style":"normal","_key":"acd556d0a498"},{"children":[{"text":"LEM: What can you say about anxiety in children?","_key":"1375beb4d98c0","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"1375beb4d98c","markDefs":[]},{"_key":"5adf36c7ecad","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"5adf36c7ecad0"},{"_key":"5adf36c7ecad1","_type":"span","marks":[],"text":" Anxiety is often misdiagnosed as ADHD as the features overlap. In fact, anxiety is what child and adult psychiatrists see the most in clinic. I evaluate individuals of all ages, and most of my patients see me for anxiety. Anxiety can present as inattentiveness, restlessness, impulsivity and irritability. For example, Sheila presents with restlessness and perfectionistic tendencies. She procrastinates and puts off tasks due to fear of failure. She appears fidgety and nervous in class, and asks her teachers and parents to repeat themselves. "}],"_type":"block","style":"normal"},{"style":"normal","_key":"50177eac1453","markDefs":[],"children":[{"_key":"50177eac14530","_type":"span","marks":[],"text":"Sheila has generalized anxiety disorder. Once her anxiety is treated, these symptoms resolve, and her school performance improves. Other kids like Sheila may present with concerns about ADHD, but actually are experiencing symptoms of depression, which can cause increased processing speed and impaired working memory, and thus, affect cognition and academic performance. Similarly, after treating depression, inattentiveness and what appeared to be ADHD symptoms, improve."}],"_type":"block"},{"_type":"block","style":"normal","_key":"221670c2894c","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: What are some common comorbidities, and how would you tackle these concerns in the clinic?","_key":"221670c2894c0"}]},{"_type":"block","style":"normal","_key":"2e33d01eacf0","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"2e33d01eacf00"},{"_type":"span","marks":[],"text":" ADHD often presents with various comorbid disorders inclusive of anxiety, depression and bipolar disorder. In these cases, once the mood and anxiety disorder is stabilized, and if ADHD symptoms continue to impair functionality, a medication for ADHD can be started. In cases where kids have ADHD and ODD, kids would benefit from a combination of therapy and stimulants. In cases where kids have ADHD and tic disorder, they may benefit from habit reversal therapy, an alpha agonist for tics, impulsivity and hyperactivity, and possibly a stimulant as well. ","_key":"2e33d01eacf01"}]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM","_key":"3e87a74e23aa0"},{"text":": ","_key":"3e87a74e23aa1","_type":"span","marks":[]},{"_type":"span","marks":["strong"],"text":"Any take-home messages about how ADHD presents in real-world experience that show how treatment can make a significant difference in a child’s life?","_key":"3e87a74e23aa2"}],"_type":"block","style":"normal","_key":"3e87a74e23aa"},{"_key":"d4281f85406a","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"d4281f85406a0"},{"text":" The take-home is when a child truly has ADHD and he or she receives treatment, the results are evident and life-changing for everyone involved. I have had the invaluable opportunity to treat Mark, a seven-year-old boy suffering from ADHD. During play therapy, I have learned that the reason he often gets angry at school is because he is tired of other children teasing him about “not reading good.” During another session, he used toy cars to share his goal with me, exclaiming, “I want to be a police officer one day!” As Mark improved with weekly therapy and treatment with Focalin extended release or dexmethylphenidate, a stimulant medication, he gained confidence. This experience was particularly memorable and rewarding.","_key":"d4281f85406a1","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"df49158136850","_type":"span","marks":["strong"],"text":"LEM: Older adolescents and young adults have been known to abuse ADHD medications to help improve their studying stamina and grades. Besides being illegal, what are some of the dangers associated with this practice?"}],"_type":"block","style":"normal","_key":"df4915813685"},{"style":"normal","_key":"93a337bc2faf","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"93a337bc2faf0"},{"_type":"span","marks":[],"text":" Each year, academic expectations build. The competition is real and appears to be increasing relentlessly. It is harder and harder to get into colleges. Even kindergarten and first grade seem harder than they ever used to be. Teens and young adults often use their peers’ ADHD medications, or illegally purchase them to gain a competitive advantage, or use them recreationally. Some individuals even take stimulants solely to stay up later because they have so much to finish and so little time.","_key":"93a337bc2faf1"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The truth of the matter is, when someone does not have ADHD, they may not benefit significantly from taking a stimulant. They may feel more energetic, but the data from pilot studies have suggested that cognition itself may not improve. We do not completely understand the dangers associated with use of stimulants in someone who does not have ADHD as ethical concerns limit our ability to study this. Some of my patients who have admitted to using stimulants without a diagnosis of ADHD have experienced concerns including weight loss, anxiety, depression, psychosis, insomnia, hypertension, and other cardiac concerns. I want to encourage all listeners to spread awareness and encourage friends and loved ones to be evaluated by a physician prior to trying medications.","_key":"fbbe113551250"}],"_type":"block","style":"normal","_key":"fbbe11355125"},{"_type":"block","style":"normal","_key":"bc181e29b22a","markDefs":[],"children":[{"_key":"bc181e29b22a0","_type":"span","marks":[],"text":"Stimulants can cause myocardial infarction, cardiomyopathy, and even sudden death. Although the risk is low, it is not worth taking. Patients with a personal or family history of cardiac events may require further work-up prior to initiating medications. Due to addiction concerns, some parents do not want their children who have ADHD to take medications. As opposed to those who do not have ADHD, for kids who do have ADHD, we have large, validated studies which indicate the significant and helpful effect of stimulants. Long-term studies suggest that treating ADHD reduces unemployment, divorce and addiction concerns longitudinally."}]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: ADHD treatment options have come a long, and now include various formulations, long-acting dosing, patches, and even a video interface. How should clinicians decide what medications to prescribe to their patients?","_key":"3ebca9ee93aa0"}],"_type":"block","style":"normal","_key":"3ebca9ee93aa"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Leela Magavi, MD:","_key":"f0c525ee36750","_type":"span"},{"marks":[],"text":" It is important to comprehensively assess the child and learn about his or her genetic predisposition, temperament, behavior and life story prior to selecting a medication. There are many options, and new agents continue to gain approval. For children who are young and primarily impulsive and hyperactive, and if really warranted due to functional impairment, I may consider using an alpha agonist such as clonidine extended release also known as Kapvay, or guanfacine extended release also known as Intuniv. These are blood pressure medications. I often use these alongside stimulants as it allows the use of lower stimulant doses.","_key":"f0c525ee36751","_type":"span"}],"_type":"block","style":"normal","_key":"f0c525ee3675"},{"children":[{"_type":"span","marks":[],"text":"Alpha agonists do not target inattention as well as stimulants do, and I explain this to parents who prefer nonstimulant options. Other nonstimulant options are Wellbutrin also known as bupropion, which is an antidepressant, and atomoxetine also known as Strattera, which is a selective norepinephrine reuptake inhibitor, also helpful for anxiety. The common stimulant families are methylphenidates and amphetamines. I always start with methylphenidates, and then transition to amphetamines if warranted due to side effect profiles. I use long-acting agents and add on immediate release if warranted for longer duration of action. Patches, liquid formulations and some capsules are helpful when kids have difficulty swallowing. Lisdexamfetamine or Vyvanse is an option for those who have a history of substance use as this medication is metabolized differently, and decreases addiction potential.","_key":"561fd504fbce0"}],"_type":"block","style":"normal","_key":"561fd504fbce","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I think it’s wonderful that we are learning more and more about the brain and medications that could help these children. I’m very grateful to my colleagues who are partaking in research and helping us answer these questions. Most recently, which I am delighted to share with parents and listeners, we have learned that a videogame called Endeavor Rx, has been FDA approved for kids between ages 8 and 12 who have been diagnosed with ADHD. For those who are interested, you may join the online waitlist, made available by the developing company, Akili Interactive.","_key":"6605964aab220"}],"_type":"block","style":"normal","_key":"6605964aab22"},{"_key":"740d652723b8","markDefs":[],"children":[{"marks":["strong"],"text":"LEM: Are there concrete tools or scales to help diagnose ADHD?","_key":"740d652723b80","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Leela Magavi, MD:","_key":"c781ce68a6970","_type":"span"},{"_type":"span","marks":[],"text":" ADHD is a clinical diagnosis and symptoms need to be present in more than one setting. Scales and tools such as the Child Behavior Checklist, Conners-Wells, Vanderbilt, Swanson Nolan and Pelham are helpful, but not necessary for diagnosis. I view them as additional pieces of information, and occasionally, to monitor progress.","_key":"c781ce68a6971"}],"_type":"block","style":"normal","_key":"c781ce68a697"},{"_key":"15f14613a2d6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"I personally use the Vanderbilt scale most often. I find it interesting to ask mom and dad to complete the Vanderbilt scale independently and compare their responses with the teachers. When the numbers align and are high, this is more indicative of ADHD. If the teacher’s scores are very high, but the parents’ scores are low, this may mean that the teacher needs more help in the classroom setting due to high student to teacher ratio, among other things. If the teacher’s scores are low, and the parents’ scores are high, it may mean that the child is exhibiting behavioral concerns at home for particular reasons. Sometimes, only one parent scores high, which may be due to a mismatch in temperament and personality traits.","_key":"15f14613a2d60"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"cf421e336077","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: Are CT, PET, EEG, and MRI reliable diagnostic tools for children?","_key":"cf421e3360770"}]},{"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"b18578dd856d0"},{"_type":"span","marks":[],"text":" Brain imaging is not warranted for the diagnosis of ADHD. I rarely ever order it unless necessary for another reason. I may consider an EEG or MRI if I am concerned about epilepsy presenting like ADHD or absence seizures during which the child may appear to be staring into space when they are in fact having a seizure. Brain imaging may also be helpful in post-concussion syndrome in which individuals may have difficulty with inattentiveness and mental fatigue, and may benefit from a stimulant although they do not have ADHD.","_key":"b18578dd856d1"}],"_type":"block","style":"normal","_key":"b18578dd856d","markDefs":[]},{"style":"normal","_key":"071fafa784b5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Nevertheless, brain imaging has helped us learn a lot about ADHD. Converging evidence from various imaging studies has helped us assess differences in brain volume, diffusion properties of white matter tracts, and cortical features in typically developing children compared to those with ADHD. Psychoradiology is a developing field and may help guide our treatment planning in the future.","_key":"071fafa784b50"}],"_type":"block"},{"_type":"block","style":"normal","_key":"a825cba3465b","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: Do you transition patients out of your care to a general psychiatrist?","_key":"a825cba3465b0"}]},{"_type":"block","style":"normal","_key":"3ac92d5f299c","markDefs":[],"children":[{"text":"Leela Magavi, MD:","_key":"3ac92d5f299c0","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" Some child psychiatrists only evaluate and treat children, but I treat individuals of all ages and enjoy this diversity. I provide a mixture of medication management and therapy, and establish strong bonds with my patients. I always tell my adolescents that there’s no magic button that turns on and makes an eighteen-year-old instantly an adult. Every individual transitions into adulthood at a different pace. Being an adult is tough, and I evaluate patients at all ages who struggle with this transition. For this reason, I do not think child psychiatrists necessarily need to transition their patients to an adult psychiatrist.","_key":"3ac92d5f299c1"}]},{"_type":"block","style":"normal","_key":"437543176f8f","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: We used to hear that children “grow out of” ADHD. Now, data show that adults can and do have the disorder. Is it possible to outgrow ADHD?","_key":"437543176f8f0"}]},{"style":"normal","_key":"e739231bca74","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"e739231bca740"},{"_key":"e739231bca741","_type":"span","marks":[],"text":" ADHD is essentially a neurodevelopmental disorder, which can affect individuals at any age. It is chronic in nature, but presentations vary at different life stages. The frontal lobe is the last to develop and mature, and there are many changes that occur with brain plasticity. For example, children display a decrease in symptoms of hyperactivity and impulsivity as they mature. Many children with ADHD still have the condition as adults, and are highly susceptible to other psychiatric disorders. I do evaluate adults who have never been diagnosed with ADHD as children who present to see me for the first time. Some of them experience impulsivity and have difficulty with relationships and work for this reason. Others who were diagnosed as children have relayed that their ADHD symptoms have evolved over time. It is pivotal for physicians to titrate down on medications as warranted and consider discontinuing medication if individuals are faring well off of them and when symptoms no longer affect functionality. In these cases, I like to take a conservative approach and recommend daily exercise, sleep hygiene techniques, and other behavioral strategies."}],"_type":"block"},{"_key":"c4a1175098ca","markDefs":[],"children":[{"_key":"c4a1175098ca0","_type":"span","marks":[],"text":"Finally, every individual with ADHD whom I have had the pleasure of treating has something special to offer. For my kids who ask me if this diagnosis means they are not smart, I remind them that this is not the case. Albert Einstein was suspected to have ADHD and as were other notable people, such as Walt Disney, and Michael Jordan. It is an honor to help kids struggling with ADHD as they grow to recognize their strengths and reach their full potential."}],"_type":"block","style":"normal"}],"contentCategory":{"_rev":"snQqhhB4O8T5bi1viURsgs","_type":"contentCategory","name":"Podcasts","_id":"93d57b69-2d72-45fe-8b8a-d18e7e7e5f20","_updatedAt":"2020-02-25T09:31:48Z","_createdAt":"2020-02-25T09:31:48Z"},"_type":"article","title":"Treating ADHD in Children: Concerns, Controversies, Safety Measures","_createdAt":"2020-07-10T21:50:41Z","documentGroupMapping":null,"targeting":{"content_placement":["topics/adhd","topics/child-adolescent-psychiatry"],"document_url":["treating-adhd-children-concerns-controversies-safety-measures"],"document_group":null,"rootDocumentGroup":[],"issue_url":"","publication_url":""},"relatedArticles":[{"title":"Multidisciplinary Inpatient Care for Medically Compromised Youth and Young Adults With Eating 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Reflections"}],"ExcludeFromPubMedXML":false,"summary":"It’s time to address adult ADHD. ","_id":"f342d221-1cb4-4d1a-b967-dc97ae542521","authorMapping":[{"biography":[{"_type":"block","style":"normal","_key":"c1db3f5b242a","markDefs":[],"children":[{"_key":"9158fad88e2a0","_type":"span","marks":["strong"],"text":"Dr Parikh "},{"_type":"span","marks":["em"],"text":"is a faculty member at Weill Cornell Medical College and Second Arc Psychiatric Associates in White Plains, New York.","_key":"9158fad88e2a1"}]}],"_updatedAt":"2024-10-25T19:06:44Z","url":{"current":"parinda-parikh-md","_type":"slug"},"displayName":"Parinda Parikh, MD","_createdAt":"2024-10-25T19:06:44Z","_rev":"VUkuE34wajTefC0u4bZBF0","_type":"author","_id":"53b26b44-11c0-4263-83ea-dc2a4dbb016b"},{"url":{"current":"chujun-chen-md","_type":"slug"},"displayName":"Chujun Chen, MD","_createdAt":"2024-10-25T19:07:26Z","_rev":"HZIB0LLkBhvyiAmq6rj8Zy","_type":"author","_id":"06e75d85-dc0f-4a49-a76b-1256d76a7bfe","biography":[{"markDefs":[],"children":[{"text":"Dr Chen ","_key":"ef7f47f0f9560","_type":"span","marks":["strong"]},{"marks":["em"],"text":"works in the Department of Psychiatry at Second Xiangya Hospital of Central South University in Changsha, China.","_key":"ef7f47f0f9561","_type":"span"}],"_type":"block","style":"normal","_key":"0acc2b784204"}],"_updatedAt":"2024-10-25T19:07:26Z"},{"_rev":"VUkuE34wajTefC0u4bZUO1","_type":"author","_id":"8fa3907a-b3e0-420d-a57f-db832f60f370","biography":[{"_type":"block","style":"normal","_key":"e5c3c7b9fcd9","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Patel ","_key":"65bf7c688a5b0"},{"_type":"span","marks":["em"],"text":"works at the Government Medical College and New Civil Hospital in Gujarat, India.","_key":"65bf7c688a5b1"}]}],"_updatedAt":"2024-10-25T19:08:55Z","url":{"current":"smit-jayeshkumar-patel-md","_type":"slug"},"displayName":"Smit Jayeshkumar Patel, MD","_createdAt":"2024-10-25T19:07:55Z"}],"documentGroup":null,"documentGroupMapping":null,"_createdAt":"2024-10-25T19:05:56Z","gptTakeaways":"• ADHD in adults is underdiagnosed, often masked by comorbid conditions, leading to significant psychosocial impairments.\n\n• Accurate diagnosis requires comprehensive history-taking, standardized tools, and functional assessments to differentiate from other psychiatric disorders.\n\n• ADHD prevalence in adults is 2.5%, with high comorbidity rates with bipolar disorder, major depressive disorder, and substance use disorder.\n\n• Early identification and treatment of ADHD can significantly improve long-term psychiatric and functional outcomes.","body":[{"disableTextWrap":false,"imgcaption":[{"_key":"b548d309db26","markDefs":[],"children":[{"_type":"span","marks":[],"text":"1STunningART/AdobeStock","_key":"5de4f3c538b60"}],"_type":"block","style":"normal"}],"alignment":"left","_key":"2e09c71be811","_type":"figure","asset":{"_type":"reference","_ref":"image-480b7b29f69d9743ec4d45ba543c1fc8e7aa932f-6000x3375-jpg"},"widthP":50,"disableLightBox":true,"alt":"ADHD"},{"_type":"block","style":"normal","_key":"e6c9b9f0e836","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"CLINICAL REFLECTIONS","_key":"11f9c42e020e0"}]},{"style":"normal","_key":"8183bcc74619","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Case Vignette","_key":"4d32cd6e40330"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"“Simon,” a 21-year-old man, presents for an evaluation of treatment-resistant anxiety. He experiences psychological anxiety, which interferes with his focus and concentration, causing difficulties with initiating and sustaining tasks. A review of his past psychiatric history reveals that he began seeing a therapist for panic attacks and severe anxiety that seemed to come out of nowhere when he was in middle school. He had consulted 3 different psychiatrists but had not found any of their treatments effective. He denies any history of mania or psychosis.","_key":"9cd90f73486b0","_type":"span"}],"_type":"block","style":"normal","_key":"c79ba3cedd87"},{"_key":"5cdf5dee1872","markDefs":[],"children":[{"text":"","_key":"8272b37840170","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"525aaccca0460","_type":"span","marks":[],"text":"He received cognitive behavior therapy and was subsequently treated with various psychiatric medications, including buspirone, fluoxetine, escitalopram, phenelzine, mirtazapine, bupropion, aripiprazole, quetiapine, olanzapine, pregabalin, clonazepam, lorazepam, valproate, lamotrigine, lithium, and ketamine. However, Simon reports no psychological improvement with these medications. On the contrary, he experienced multiple adverse effects, including a panic-like electric shock reaction with phenelzine, a dystonic reaction with antipsychotics, and 2 grand mal seizures with bupropion. At the time of evaluation, Simon was taking buspirone 30 mg twice daily, pregabalin 150 mg, lamotrigine 200 mg, lithium 450 mg at night, and mirtazapine 30 mg. Simon came in frustrated, requesting to discontinue all his medications. After a thorough evaluation, including a review of his developmental history, it was found that he had exhibited characteristics of inattention and hyperactivity since elementary school. A subsequent Jasper/Goldberg Adult ADD Screening Examination indicated undiagnosed attention-deficit/hyperactivity disorder (ADHD). Simon was therefore started on viloxazine 100 mg, titrated to 200 mg over 1 week while continuing lamotrigine 200 mg and tapering off all other medications."}],"_type":"block","style":"normal","_key":"ca10fc119f89"},{"children":[{"_type":"span","marks":[],"text":"","_key":"bb5724cb4f960"}],"_type":"block","style":"normal","_key":"5c96a878ada8","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"ADHD in Adulthood","_key":"67af674718dd0"}],"_type":"block","style":"normal","_key":"f02e34b2ab1b","markDefs":[]},{"_key":"23f1ee651316","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/adhd","_key":"0ebb173e14ae"}],"children":[{"_type":"span","marks":[],"text":"ADHD is a multifactorial and clinically heterogeneous disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. It can impose significant financial burdens and stress on families and is also associated with adverse academic and vocational outcomes. Although ","_key":"78a017fee66f0"},{"text":"ADHD","_key":"f8e297773415","_type":"span","marks":["0ebb173e14ae"]},{"_type":"span","marks":[],"text":" is recognized as a childhood-onset neurodevelopmental disorder, its prevalence in adults should also be acknowledged.","_key":"ecfc26ed7d46"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"36bd1d4a41520"}],"_type":"block","style":"normal","_key":"238e8f7abe85","markDefs":[]},{"_key":"e1a7b30a06fa","markDefs":[],"children":[{"_type":"span","marks":[],"text":"A recent meta-analysis has reported that the prevalence of ADHD in children and adolescents is estimated to be 5.29%, the prevalence of ADHD in adults aged 19 to 45 years is estimated to be 2.5%. Approximately 15% children with ADHD will persist into their adulthood, with 40% to 60% partially remitted.","_key":"25eb3d79731e0"},{"_type":"span","marks":["superscript"],"text":"1","_key":"0bd8b8e8e0dc"},{"_type":"span","marks":[],"text":" In some cases, adults remain undiagnosed until they reach their 30s or 40s, only discovering they have ADHD after their children are diagnosed. A national wide investigation done in an East-Asian country indicated a percentage of 34.7% in first year university students presented with symptoms suggestive of probable ADHD.","_key":"a480c25ea38f"},{"_type":"span","marks":["superscript"],"text":"2","_key":"e73e40299743"},{"marks":[],"text":" Even in European countries, where ADHD should have been better recognized and treated, the prevalence of undiagnosed ADHD in adult psychiatric patients was 9.27%, and “hidden” ADHD is associated with an increased suicide risk among these patients.","_key":"bc920d345818","_type":"span"},{"_type":"span","marks":["superscript"],"text":"3","_key":"f0b2b80b90d6"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"532e81209b0a0"}],"_type":"block","style":"normal","_key":"cbcd2085b330","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Previous review has emphasized that ADHD can persist throughout one's lifespan and often presents as a chronic condition. If left untreated, the symptoms of ADHD can lead to significant psychosocial impairment,","_key":"8d729e80228e0"},{"_type":"span","marks":["superscript"],"text":"4","_key":"452034749254"},{"_type":"span","marks":[],"text":" and leading to maladaptive behaviors including self-medicating by using recreational drugs, alcohol, and nicotine.","_key":"359c09da26bb"},{"_type":"span","marks":["superscript"],"text":"5","_key":"10e0e2b351fa"}],"_type":"block","style":"normal","_key":"eacec2cb260b"},{"_type":"block","style":"normal","_key":"cf0973b9e993","markDefs":[],"children":[{"marks":[],"text":"","_key":"b36459dadc4a0","_type":"span"}]},{"_key":"4a7db3e1935f","markDefs":[],"children":[{"marks":[],"text":"Diagnosing adult ADHD is challenging due to limited guidelines and consensus. Once seen as a childhood disorder, ADHD is now recognized to persist into adulthood, but this shift has outpaced clinical approaches, leading to inconsistent diagnosis.","_key":"9b74d7adc0f20","_type":"span"}],"_type":"block","style":"normal"},{"style":"normal","_key":"03860cff7bbf","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"4f4a5178680d0"}],"_type":"block"},{"_key":"c6a425e4bf6b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Key challenges in adult ADHD diagnosis include:","_key":"6554366bb06a0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"2d2a75c4c95a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"1. Symptom overlap. ADHD symptoms in adults (eg, inattention, impulsivity) often overlap with conditions like depression and anxiety, complicating diagnosis.","_key":"c6e4072329b00"}]},{"style":"normal","_key":"4f2b2387a2d5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"2. Retrospective diagnosis. Adult diagnosis relies on evaluating childhood symptoms, which may have been undiagnosed or misunderstood.","_key":"7d957495a9210"}],"_type":"block"},{"_key":"c7934544f797","markDefs":[],"children":[{"_key":"45b6b967de1e0","_type":"span","marks":[],"text":"3. Cultural/societal differences. ADHD prevalence varies by region due to stigma and health care differences, leading to \"hidden\" cases."}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"8cfd9cf42b2e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"4. Gender bias. Women are often underdiagnosed as their symptoms are less hyperactive and more inattentive, sometimes mistaken for stress or mood disorders.","_key":"d8fb0e223c240"}]},{"style":"normal","_key":"0085e39bcd22","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b931066961220"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"These are some of things a clinician should keep in mind while considering a patient to be suffering from adult ADHD. These include:","_key":"c417be1200a90"}],"_type":"block","style":"normal","_key":"0bcaaf7a00a1"},{"_type":"block","style":"normal","_key":"c99bc4f07b74","markDefs":[],"children":[{"_type":"span","marks":[],"text":"1. Comprehensive history. Gather detailed information on childhood behavior, academic issues, and coping strategies. Family history of ADHD may provide further insights.","_key":"976d069f63960"}]},{"style":"normal","_key":"d8e9c8806d64","markDefs":[],"children":[{"_type":"span","marks":[],"text":"2. Use diagnostic tools. Employ standardized tools like the Adult ADHD Self-Report Scale (ASRS) to assess symptoms.","_key":"cf7a641929ad0"}],"_type":"block"},{"children":[{"_key":"8244155701b30","_type":"span","marks":[],"text":"3. Assess developmental milestones. Examine the developmental trajectory, noting if symptoms persisted into adulthood even with coping strategies."}],"_type":"block","style":"normal","_key":"94992a513d96","markDefs":[]},{"style":"normal","_key":"376535c5d94e","markDefs":[],"children":[{"text":"4. Evaluate functional impairment. Diagnose ADHD only if symptoms impair major areas of life (work, relationships, etc).","_key":"ccf2bee5a24a0","_type":"span","marks":[]}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"5. Rule out other conditions. Conduct differential diagnoses to exclude psychiatric conditions with similar symptoms.","_key":"ee9bd28033710"}],"_type":"block","style":"normal","_key":"8d1af34d086b","markDefs":[]},{"_key":"df92cee40474","markDefs":[],"children":[{"_type":"span","marks":[],"text":"6. Psychoeducation and collaboration. Educate patients on ADHD as a lifelong condition and collaborate with other specialists for comprehensive care.","_key":"c8813cf9c7a20"}],"_type":"block","style":"normal"},{"style":"normal","_key":"864805faa4ed","markDefs":[],"children":[{"_type":"span","marks":[],"text":"7. Consider subtle symptoms. Watch for less overt symptoms in adults, like procrastination, emotional dysregulation, or chronic lateness.","_key":"82342300658a0"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"95941b2297b40","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"54ca78332806"},{"style":"normal","_key":"7250d2b03270","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Improving global ADHD guidelines and diagnostic consistency requires cross-cultural studies and refinement of tools like the ","_key":"d8e70cdb938e0"},{"_type":"span","marks":["em"],"text":"DSM-5","_key":"d8e70cdb938e1"},{"_type":"span","marks":[],"text":". Clinicians should combine thorough history-taking, structured tools, and functional assessment to accurately diagnose and treat adult ADHD. Education and addressing the stigma are also key to bridging the gap in adult ADHD diagnosis and care.","_key":"d8e70cdb938e2"}],"_type":"block"},{"style":"normal","_key":"cf13f9ac2eb7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"676ca03b21bc0"}],"_type":"block"},{"_key":"792124e6595b","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Psychological Burden","_key":"bb2f1b7a29b70"}],"_type":"block","style":"normal"},{"style":"normal","_key":"0d798da204dd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The underlying ADHD symptoms experienced by adults can lead to functional impairments, affecting their academic and vocational performance, daily activities, and social interactions. These impairments may further contribute to a significant psychological burden.","_key":"1e1e5f32be250"}],"_type":"block"},{"_type":"block","style":"normal","_key":"39efd0ef5625","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"adb72b84db910"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In today's fast-paced modern society, patients' procrastination, inattentiveness, and disruptive behaviors, if unnoticed and untreated, can place them in difficult situations, leading to significant psychosocial stress, which may further contribute to the development of other psychiatric disorders. Undiagnosed ADHD can have negative impacts on self-esteem and self-worth,","_key":"a2d69d2b30760"},{"marks":["superscript"],"text":"5","_key":"104b2c45cce6","_type":"span"},{"text":" and is associated with higher rates of current depression, alcohol abuse, and greater emotional and interpersonal difficulties when compared with patients who do not have ADHD.","_key":"16b583c30733","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"6,7","_key":"2e7d8c0cf292"},{"_type":"span","marks":[],"text":" Research has shown that undiagnosed adults with potential ADHD symptoms may have a higher coexistence of mental comorbidities, sleep problems, and physical comorbidities, they also experience greater work productivity impairment, increased health care resource usage, and lower health-related quality of life.","_key":"02d0bfdb04c3"},{"_key":"35c0d7c53e3e","_type":"span","marks":["superscript"],"text":"8"}],"_type":"block","style":"normal","_key":"4274104dc55e"},{"style":"normal","_key":"d6a6463ae4e7","markDefs":[],"children":[{"text":"","_key":"60beb00895ce0","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_key":"f29860f45df20","_type":"span","marks":["strong"],"text":"ADHD and its Comorbidities"}],"_type":"block","style":"normal","_key":"e2be4d7b278e"},{"markDefs":[{"_key":"fbfcb8be7eaa","nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/bipolar"},{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/major-depressive-disorder","_key":"8036786d0e72"},{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F0c19b9683fbb83270537c15f6647d225b38727a0-402x376.jpg%3Ffit%3Dcrop%26auto%3Dformat\u0026w=828\u0026q=75","_key":"9cc5026f6df6","nofollow":true}],"children":[{"_key":"ba85512325ab0","_type":"span","marks":[],"text":"Prevalence of ADHD is 2.5% in adults."},{"text":"1","_key":"27b8d9e61313","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" Individuals with ADHD have symptoms like deficient inhibitions, problems with memory, decision-making, and emotional decision-making, which can lead to a misdiagnose as they are symptoms of other conditions. ADHD shares symptomatology with ","_key":"cd058883908b"},{"text":"major depressive disorder","_key":"4d3fd273e94e","_type":"span","marks":["8036786d0e72"]},{"_key":"ba88112b052c","_type":"span","marks":[],"text":" (MDD; low hedonic tone, irregular sleep, and appetite), generalized anxiety disorder (GAD; fidgeting, irritability), "},{"text":"bipolar disorder","_key":"f968901c4531","_type":"span","marks":["fbfcb8be7eaa"]},{"_type":"span","marks":[],"text":" (episodic fluctuations, excessive talking), and substance use disorder (SUD; social withdrawal) (as illustrated in ","_key":"f22339d7d75d"},{"_type":"span","marks":["strong","9cc5026f6df6"],"text":"Figure","_key":"ba85512325ab1"},{"_key":"ba85512325ab2","_type":"span","marks":[],"text":"). ADHD has an especially high prevalence with bipolar disorder, with rates ranging from 9.5% to 21.2%."},{"_key":"31ec43e5c85a","_type":"span","marks":["superscript"],"text":"9"},{"_type":"span","marks":[],"text":" With MDD, ADHD prevalence has been reported to be between 9% to 16%.","_key":"da0d12c6ae05"},{"text":"10","_key":"6a2f49d86fa7","_type":"span","marks":["superscript"]},{"text":" There is also an increased risk of ADHD in patients of GAD, with risk rising by about 50% more than in the general population.","_key":"370a1aeb62b6","_type":"span","marks":[]},{"marks":["superscript"],"text":"11","_key":"20124d2d6934","_type":"span"},{"_key":"f9ff414ee573","_type":"span","marks":[],"text":" ADHD is more common in patients with social anxiety. Finally, SUD is about twice as likely in patients with ADHD. It is bidirectional, arising due to neurological factors, increased impulsivity, other comorbidities, and any attempts to self-medicate."}],"_type":"block","style":"normal","_key":"26ae4be16984"},{"asset":{"_type":"reference","_ref":"image-0c19b9683fbb83270537c15f6647d225b38727a0-402x376-jpg"},"widthP":50,"alignment":"right","disableTextWrap":false,"imgcaption":[{"_key":"cae505994764","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Figure.","_key":"32413b859ef90"},{"_key":"32413b859ef91","_type":"span","marks":[],"text":" Adult ADHD and Various Comorbid Disorders"}],"_type":"block","style":"normal"}],"_key":"5ae70fa9e25d","blank":true,"disableLightBox":true,"_type":"figure","alt":"Figure. Adult ADHD and Various Comorbid Disorders"},{"_type":"block","style":"normal","_key":"832579b100cd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"bf669a3552060"}]},{"children":[{"_type":"span","marks":[],"text":"ADHD is a common but often underrecognized and undertreated psychiatric disorder in adults, presenting with symptoms from other possible diagnoses. Screening for ADHD in adults presenting with these comorbidities can identify patients who may benefit from targeted management. While ADHD in adults presents variably, it can often be detected with a few key clinical questions and validated assessment scales like Adult ADHD Self-Report Scale (ASRS) or the Conners' Adult ADHD Rating Scales (CAARS). Early and effective treatment of ADHD can significantly improve long-term psychiatric and functional outcomes. When ADHD coexists with other psychiatric conditions, the more severe disorder should be prioritized in treatment. In the coming years, more work on genetic and organic causes of ADHD may help identify new points for targeted treatment and ultimately help the patients.","_key":"737f29683c100"},{"_key":"3ab0c1d8a5a7","_type":"span","marks":["superscript"],"text":"12"}],"_type":"block","style":"normal","_key":"9a658a073593","markDefs":[]},{"_key":"6b7f3c4a43b4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c829a039374f0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Concluding Thoughts","_key":"6c9bd9735a080"}],"_type":"block","style":"normal","_key":"53fb1f8d44cd","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Identifying ADHD correctly is essential, especially when it is hidden by cooccurring illnesses. Properly identifying ADHD, particularly when it is masked by comorbid conditions, plays a significant role in developing an appropriate treatment plan. Such cases have been documented, demonstrating the challenges in diagnosing ADHD when other disorders are present.","_key":"d54e2154e9cf0"},{"_type":"span","marks":["superscript"],"text":"13","_key":"a9bdb0398003"},{"_type":"span","marks":[],"text":" This marks the importance of screening for ADHD, particularly in patients with treatment-resistant anxiety or MDD. In these situations, a misdiagnosis may result in the patient receiving poor treatment and unsuitable medication, worsening their condition. Therefore, a thorough evaluation for ADHD should be a standard component of the diagnostic process in patients who do not respond to conventional therapies for anxiety or MDD. Identifying ADHD early improves the efficacy of treatment and enhances the overall quality of life for the patient by addressing the cause of their symptoms.","_key":"bc7b168a0e90"}],"_type":"block","style":"normal","_key":"249fe31744e8"},{"markDefs":[],"children":[{"_key":"15d3a72d72d50","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"86a89fd89e21"},{"style":"normal","_key":"eaab8e830aed","markDefs":[],"children":[{"text":"Dr Parikh ","_key":"bd830cfa74ef0","_type":"span","marks":["strong"]},{"_key":"bd830cfa74ef1","_type":"span","marks":["em"],"text":"is a faculty member at Weill Cornell Medical College and Second Arc Psychiatric Associates in White Plains, New York. "},{"_type":"span","marks":["strong"],"text":"Dr Chen ","_key":"bd830cfa74ef2"},{"_type":"span","marks":["em"],"text":"works in the Department of Psychiatry at Second Xiangya Hospital of Central South University in Changsha, China. ","_key":"bd830cfa74ef3"},{"_type":"span","marks":["strong"],"text":"Dr Patel ","_key":"bd830cfa74ef4"},{"_type":"span","marks":["em"],"text":"works at the Government Medical College and New Civil Hospital in Gujarat, India.","_key":"bd830cfa74ef5"}],"_type":"block"},{"_key":"1dff7f422fc3","markDefs":[],"children":[{"marks":[],"text":"","_key":"a947f504c5ae0","_type":"span"}],"_type":"block","style":"normal"},{"_key":"092bc44bd0e3","markDefs":[],"children":[{"_key":"10d8d5e397ba0","_type":"span","marks":["strong"],"text":"References"}],"_type":"block","style":"normal"},{"markDefs":[{"href":"https://pubmed.ncbi.nlm.nih.gov/31982036/","_key":"825a89d42ee5","blank":true,"_type":"link"}],"children":[{"text":"1. Posner J, Polanczyk GV, Sonuga-Barke E. 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Diagnosis: a systematic review of ADHD in adult women.","_key":"9ef9d20347441"},{"_key":"1b530b7e0984","_type":"span","marks":[],"text":" "},{"marks":["em"],"text":"J Atten Disord","_key":"9ef9d20347442","_type":"span"},{"_type":"span","marks":[],"text":". 2023;27(7):645-657.","_key":"9ef9d20347443"}],"_type":"block","style":"normal","_key":"6311d6283f99","markDefs":[{"href":"https://pubmed.ncbi.nlm.nih.gov/36995125/","_key":"0eff6e3274d9","blank":true,"_type":"link"}]},{"_type":"block","style":"normal","_key":"ee6397c98ea0","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/16938146/","_key":"ee818a242301"}],"children":[{"_type":"span","marks":[],"text":"6. Able SL, Johnston JA, Adler LA, Swindle RW. ","_key":"1c85b6bdf2470"},{"_key":"1c85b6bdf2471","_type":"span","marks":["ee818a242301"],"text":"Functional and psychosocial impairment in adults with undiagnosed ADHD."},{"marks":[],"text":" ","_key":"dad8e400b6bf","_type":"span"},{"text":"Psychol Med","_key":"1c85b6bdf2472","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". 2007;37(1):97-107.","_key":"1c85b6bdf2473"}]},{"markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/30924712/","_key":"11a23f630e69"}],"children":[{"_type":"span","marks":[],"text":"7. Okumura Y, Yamasaki S, Ando S, et al. ","_key":"3bcf2fea726a0"},{"_type":"span","marks":["11a23f630e69"],"text":"Psychosocial burden of undiagnosed persistent ADHD symptoms in 12-year-old children: a population-based birth cohort study","_key":"3bcf2fea726a1"},{"marks":["em"],"text":". J Atten Disord","_key":"3bcf2fea726a2","_type":"span"},{"_type":"span","marks":[],"text":". 2021;25(5):636-645.","_key":"3bcf2fea726a3"}],"_type":"block","style":"normal","_key":"752f1ea0e3af"},{"markDefs":[{"href":"https://pubmed.ncbi.nlm.nih.gov/34956750/","_key":"0b7a6cdb7540","blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"8. Naya N, Tsuji T, Nishigaki N, et al.","_key":"0b73523e472a0"},{"_type":"span","marks":["0b7a6cdb7540"],"text":"The burden of undiagnosed adults with attention-deficit/hyperactivity disorder symptoms in Japan: a cross-sectional study.","_key":"0b73523e472a1"},{"_key":"4efda6b663e8","_type":"span","marks":[],"text":" "},{"_type":"span","marks":["em"],"text":"Cureus","_key":"0b73523e472a2"},{"_type":"span","marks":[],"text":". 2021;13(11):e19615.","_key":"0b73523e472a3"}],"_type":"block","style":"normal","_key":"ef285a3d96fa"},{"markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/18052572/","_key":"aad42c7ef1c9"}],"children":[{"_type":"span","marks":[],"text":"9. Wingo AP, Ghaemi SN. ","_key":"6d62f0feb5780"},{"marks":["aad42c7ef1c9"],"text":"A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder","_key":"6d62f0feb5781","_type":"span"},{"_type":"span","marks":["em"],"text":". J Clin Psychiatry","_key":"6d62f0feb5782"},{"_type":"span","marks":[],"text":". 2007;68(11):1776-1784.","_key":"6d62f0feb5783"}],"_type":"block","style":"normal","_key":"ed00e6a58db1"},{"markDefs":[{"blank":true,"_type":"link","href":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695217/","_key":"5474a80ebb11"}],"children":[{"_type":"span","marks":[],"text":"10. McIntosh D, Kutcher S, Binder C, et al. ","_key":"0471f3637fc60"},{"_type":"span","marks":["5474a80ebb11"],"text":"Adult ADHD and comorbid depression: a consensus-derived diagnostic algorithm for ADHD.","_key":"0471f3637fc61"},{"_key":"0e7eab1b9325","_type":"span","marks":[],"text":" "},{"_type":"span","marks":["em"],"text":"Neuropsychiatr Dis Treat","_key":"0471f3637fc62"},{"_type":"span","marks":[],"text":". 2009;5:137-150.","_key":"0471f3637fc63"}],"_type":"block","style":"normal","_key":"5d14a5412cc2"},{"style":"normal","_key":"f880459a1de1","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/10405074/","_key":"38d784f7b739"}],"children":[{"_type":"span","marks":[],"text":"11. Mancini C, Van Ameringen M, Oakman JM, Figueiredo D. ","_key":"a51888e602cf0"},{"_type":"span","marks":["38d784f7b739"],"text":"Childhood attention deficit/hyperactivity disorder in adults with anxiety disorders","_key":"a51888e602cf1"},{"_key":"a51888e602cf2","_type":"span","marks":["em"],"text":". Psychol Med"},{"_type":"span","marks":[],"text":". 1999;29(3):515-525.","_key":"a51888e602cf3"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"12. Katzman MA, Bilkey TS, Chokka PR, et al. ","_key":"eeb12fbba9ac0"},{"text":"Adult ADHD and comorbid disorders: clinical implications of a dimensional approach.","_key":"eeb12fbba9ac1","_type":"span","marks":["7075e9ac7b63"]},{"marks":[],"text":" ","_key":"4eb30545d1bf","_type":"span"},{"text":"BMC Psychiatry","_key":"eeb12fbba9ac2","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". 2017;17(1):302.","_key":"eeb12fbba9ac3"}],"_type":"block","style":"normal","_key":"06bd981c10bf","markDefs":[{"blank":true,"_type":"link","href":"https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1463-3","_key":"7075e9ac7b63"}]},{"_key":"dee6bc616989","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/39127589/","_key":"d42816dcbc61"}],"children":[{"marks":[],"text":"13. Toole KP, Frank C.","_key":"cbb2abe2c88e0","_type":"span"},{"text":"Young adolescent with undiagnosed ADHD-inattentive presentation and co-morbid anxiety and depression: a case report.","_key":"cbb2abe2c88e1","_type":"span","marks":["d42816dcbc61"]},{"_key":"d7464c1a79e0","_type":"span","marks":[],"text":" "},{"marks":["em"],"text":"J Pediatr Nurs","_key":"cbb2abe2c88e2","_type":"span"},{"_type":"span","marks":[],"text":". 2024;78:e250-e259.","_key":"cbb2abe2c88e3"}],"_type":"block","style":"normal"}],"thumbnail":{"alt":"ADHD","caption":"1STunningART/AdobeStock","asset":{"_ref":"image-480b7b29f69d9743ec4d45ba543c1fc8e7aa932f-6000x3375-jpg","_type":"reference"},"_type":"mainImage"},"url":"adhd-overlooked-cause-of-persistent-anxiety-and-depression-in-adults","_updatedAt":"2024-10-29T15:08:08Z","gptSummary":"ADHD in adults is often underdiagnosed, leading to significant psychosocial and functional impairments. The disorder's symptoms can overlap with other psychiatric conditions, complicating diagnosis and treatment. Comprehensive history-taking, use of diagnostic tools, and functional assessments are crucial for accurate diagnosis. ADHD's prevalence in adults is 2.5%, with a high comorbidity rate with disorders like bipolar disorder and major depressive disorder. 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The October 10, 2024, Morbidity and Mortality Weekly Report (MMWR) provides crucial updates on the burden of adult ADHD, sharing information specifically on prevalence, treatment barriers, and telehealth.","_key":"cc5abc72dcab0"},{"_type":"span","marks":["superscript"],"text":"1","_key":"5ef59c303293"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"6f9acdc132cc","markDefs":[],"children":[{"_key":"56aa4544ed910","_type":"span","marks":[],"text":""}]},{"markDefs":[],"children":[{"text":"Using the National Center for Health Statistics Rapid Survey System (RSS) data collected from October through November 2023, investigators found that 6% of US adults had a current diagnosis of ADHD, with 8% of US adults reporting a past or present diagnosis. About 7 in 10 of those receiving stimulant pharmacotherapy reported trouble obtaining their ADHD medication due to a shortage. The RSS also reports that more than 50% of adults with ADHD were diagnosed in adulthood, with larger discrepancies for woman than men; 45% of men and 25% of women were diagnosed before 11 years of age, whereas 40% of men and 61% of women were diagnosed in adulthood.","_key":"331528af43010","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"d9c295d7b12d"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b41924b966360"}],"_type":"block","style":"normal","_key":"2350b227c10c"},{"style":"normal","_key":"febcba60b1e9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"On the positive side, telehealth during the COVID-19 pandemic allowed a total of 46% of adults with a current ADHD diagnosis to receive care.","_key":"6f9a656713620"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"6e51ac18e40a0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"225ebd1a5210"},{"markDefs":[],"children":[{"marks":[],"text":"According to Gregory Mattingly, MD, and Ann Childress, MD, these data demonstrate the need for the upcoming American Professional Society of ADHD and Related Disorders’ (APSARD) Adult ADHD Guidelines.","_key":"685336400f6e0","_type":"span"},{"_type":"span","marks":["superscript"],"text":"2,3","_key":"63d3f52b4ca5"},{"marks":[],"text":" A set of guidelines would help improve patient outcomes by standardizing care among all mental health clinicians who see adult patients with ADHD.","_key":"81902b849384","_type":"span"}],"_type":"block","style":"normal","_key":"bd0eff8267b8"},{"_key":"df385ca8774a","markDefs":[],"children":[{"marks":[],"text":"","_key":"d9326793fc410","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"“These will be the first US guidelines for the diagnosis and treatment of adults with ADHD and will provide a valuable framework of treatment for clinicians and families. 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Goodman, MD, an adult psychiatrist, assistant professor in the department of psychiatry and behavioral sciences at Johns Hopkins Hospital School of Medicine, and a clinical associate professor at the State University of New York. Goodman hosted a town hall discussion of the adult ADHD guidelines at the ","_key":"3884c8971e070"},{"marks":["5da33bbe73ee"],"text":"APSARD 2024 Conference","_key":"3884c8971e071","_type":"span"},{"text":".","_key":"3884c8971e072","_type":"span","marks":[]}],"_type":"block"},{"style":"normal","_key":"db95e1ce304f","markDefs":[],"children":[{"text":"","_key":"a5dd722266cf0","_type":"span","marks":[]}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"“We don't have guidelines for adults with ADHD, like we do for children and adolescents. Now there are international guidelines developed in Canada, Europe, South Africa, Australia, and the UK. We've been slow in the United States to address this because it is an arduous and scientific endeavor that requires a number of experts,” Goodman shared. “We're looking to standardize the care of patients with ADHD in adults in the United States. We want clinicians to come up to speed with the clinical practice guidelines and clinical practice of taking care of patients. It also affects patients and their family and the general public. 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","articleType":"News","contentCategory":{"_id":"8bdaa7fc-960a-4b57-b076-75fdce3741bb","_updatedAt":"2020-02-25T09:35:56Z","_createdAt":"2020-02-06T09:15:47Z","_rev":"snQqhhB4O8T5bi1viURsgs","_type":"contentCategory","name":"Articles"},"_createdAt":"2024-09-12T12:39:20Z","_rev":"lgS67lfMwdpyDcxk1RG0KR","body":[{"disableLightBox":true,"asset":{"_ref":"image-4590d34612491b2b096f84b9811071859553b898-5944x3968-jpg","_type":"reference"},"disableTextWrap":false,"_type":"figure","widthP":48,"alignment":"left","alt":"psychosis","imgcaption":[{"style":"normal","_key":"dd67510cab2d","markDefs":[],"children":[{"_key":"a1fe3bee8a4e0","_type":"span","marks":[],"text":"alexkoral/AdobeStock"}],"_type":"block"}],"_key":"19fe6fd6edc8"},{"_key":"28168130c2d2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"A new study of adult emergency department admissions at Mass General Brigham, led by McLean Hospital researchers, found that individuals taking high doses of amphetamine—like Adderall—have a 5-fold increased risk for developing psychosis or mania.","_key":"c49694fc97e40"},{"text":"1,2","_key":"729c8aee094c","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"525574b235dd0","_type":"span"}],"_type":"block","style":"normal","_key":"5bff6c300c3d"},{"_type":"block","style":"normal","_key":"c5d513a17f60","markDefs":[],"children":[{"_type":"span","marks":[],"text":"According to investigators, individuals with past-month prescription amphetamine use had a greater likelihood of new-onset psychosis or mania than individuals without past-month use. The highest risk was seen in patients taking 30 mg or more of dextroamphetamine, which corresponds to approximately 40 mg of Adderall. While previous research linked stimulants to psychosis and mania risk, there was little information on whether dosing impacted risk. With prescribing rates for stimulants to treat attention-deficit/hyperactivity disorder (ADHD) at an all-time high, it is an important issue to note.","_key":"4978a0a18e630"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5d1deb232eea0"}],"_type":"block","style":"normal","_key":"a878366997e0"},{"_key":"cbb158ced763","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“New-onset psychosis or mania is a rare but serious side effect of prescription amphetamines. Currently, US Food and Drug Administration labels do not have recommended upper limits on doses for the most commonly prescribed mixed amphetamine salts (Adderall). Our study found that doses higher than 30 mg dextroamphetamine equivalents, which is 40 mg of the mixed amphetamine salts (eg, Adderall), are associated with a more than 5-fold increase in the risk of psychosis or mania,” Lauren Moran, MD, a pharmacoepidemiology researcher at McLean Hospital and a member of the Mass General Brigham health care system, shared with ","_key":"2c4aed7d75a20"},{"marks":["em"],"text":"Psychiatric Times","_key":"2c4aed7d75a21","_type":"span"},{"_type":"span","marks":[],"text":". “Caution should be exercised when using high dose amphetamines, and we recommend screening for symptoms of psychosis or mania when patients need high doses of prescription amphetamines.”","_key":"2c4aed7d75a22"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"a9c3531b24e20","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"1f7cf7802820"},{"_type":"block","style":"normal","_key":"b03e7a74fd4c","markDefs":[],"children":[{"marks":[],"text":"Investigators reviewed electronic health records of patient encounters at Mass General Brigham between 2005 and 2019, focusing on adults aged 16 to 35. All patients were admitted to McLean Hospital following referrals from other hospitals in the Mass General Brigham health care system. The researchers identified 1374 cases of individuals presenting with first-episode psychosis or mania, compared with 2748 control patients with other conditions like depression or anxiety. They conducted a comparison analysis of stimulant use over the preceding month and accounted for other factors, including substance use, to isolate the effects of stimulants.","_key":"2bf7fc454be20","_type":"span"}]},{"style":"normal","_key":"1299c62de328","markDefs":[],"children":[{"marks":[],"text":"","_key":"f53a375601f10","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"They found the attributable risk percentage among those exposed to any prescription amphetamine was nearly 63% and for high dose amphetamine was 81%. These findings suggest that among individuals who take prescription amphetamine, 81% of cases of psychosis or mania could have been eliminated if they were not prescribed the high dose. While a significant dose-related risk increase was seen in patients taking high doses of amphetamine, no significant risk increase was seen with methylphenidate (Ritalin) use. This is consistent with previous research.","_key":"093f6f184ee00","_type":"span"},{"text":"3","_key":"ad25ee3dbcab","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" Limitations of the study include inconsistencies with how electronic health records are kept. Additionally, the findings may not be generalizable to the entire United states, as the research took place in a psychiatric hospital in the Boston area that sees many patients with psychosis.","_key":"ea3194891333"}],"_type":"block","style":"normal","_key":"85a0c8e3965e"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"63468059872c0"}],"_type":"block","style":"normal","_key":"2a43eaaa0ffc"},{"_type":"block","style":"normal","_key":"3ef68b3c64d2","markDefs":[],"children":[{"text":"Moran shared that the current study was born out of her observations and experiences as an inpatient psychiatrist.","_key":"6b9328acffa10","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1b3a748af4790"}],"_type":"block","style":"normal","_key":"a7d1def29d35"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“As a psychiatrist who treated patients on the schizophrenia and bipolar disorders inpatient unit at McLean Hospital, we were seeing patients admitted for new onset psychosis and/or mania in setting of prescription stimulant use, most commonly on high doses of prescription amphetamines,” Moran exclusively told ","_key":"8484112feaca0"},{"_type":"span","marks":["em"],"text":"Psychiatric Times","_key":"8484112feaca1"},{"_key":"8484112feaca2","_type":"span","marks":[],"text":". “I started doing research on this topic several years ago to raise awareness of this issue and determine what stimulant type was associated with higher risk. In previous work, we found that prescription amphetamine use was associated with a higher risk of psychosis than methylphenidate. The current work builds upon our prior work by finding a dose response effect.”"}],"_type":"block","style":"normal","_key":"7e20cd0257c3"},{"_type":"block","style":"normal","_key":"a78306da1018","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8baa394938640"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Moran has a few ideas as to amphetamine alternatives, which she shared with ","_key":"c2bebc03bc980"},{"_type":"span","marks":["em"],"text":"Psychiatric Times","_key":"c2bebc03bc981"},{"_type":"span","marks":[],"text":": “Alternative strategies include use of methylphenidate, which was not associated with an increased risk of psychosis or mania, or using non-stimulants such as atomoxetine or guanfacine. The totality of evidence in this study (across main and secondary analyses) does not suggest there is an increased risk of psychosis/mania in individuals taking \u003c= 15 mg dextroamphetamine equivalents (equivalent to 20 mg of Adderall). Behavioral strategies in combination with stimulants can be helpful, for example, working with patients on developing better time management skills.”","_key":"c2bebc03bc982"}],"_type":"block","style":"normal","_key":"cff1226fcbb4"},{"_type":"block","style":"normal","_key":"771e796f2b62","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f56bfe6d6c380"}]},{"style":"normal","_key":"482c6c9b6ee4","markDefs":[],"children":[{"marks":[],"text":"While the current study does not prove causality, the investigators note there is a plausible biological mechanism in neurobiological changes that include a release of higher levels of the neurotransmitter dopamine from amphetamines, that parallel dopaminergic changes observed in psychosis.","_key":"51c77cb9190b0","_type":"span"}],"_type":"block"},{"children":[{"_key":"ca74d2e1abab0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"3f5c0dfa4513","markDefs":[]},{"_type":"block","style":"normal","_key":"189b96749792","markDefs":[],"children":[{"_key":"40a8d0c857180","_type":"span","marks":[],"text":"Moran said the findings need not create alarm but should lead to extra caution when these medications are prescribed, especially for those who have risk factors for psychosis and mania."}]},{"style":"normal","_key":"f6fcc00a8912","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3f76c6c16b2b0"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“The risk of psychosis and mania is a rare side effect of stimulants, and there certainly are patients who may benefit from higher doses of amphetamine if they are still having significant impairment from ADHD symptoms. It is likely that individuals who have been on high doses for a long time without any significant side effects are at minimal risk. When using high dose amphetamines, I would recommend screening for symptoms of psychosis or mania. Having patients on high doses of amphetamines sign a release so you can talk to a family member could be helpful, as they can inform you of any concerning behaviors if they arise,” said Moran.","_key":"2d7a55457f910"}],"_type":"block","style":"normal","_key":"18a478bd0d41"},{"children":[{"_type":"span","marks":[],"text":"","_key":"c4de297e932b0"}],"_type":"block","style":"normal","_key":"112e25df66e6","markDefs":[]},{"_key":"0e56b948a2b2","markDefs":[],"children":[{"marks":["strong"],"text":"References","_key":"0e99db4d2d5c0","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[{"blank":true,"_type":"link","href":"https://medicalxpress.com/news/2024-09-high-doses-prescription-psychosis.html","_key":"2b265160bbaa"}],"children":[{"_type":"span","marks":[],"text":"1. High doses of some prescription stimulants tied to increased psychosis risk. News release. September 12, 2024. 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