Quick Answer: There are five ways we can improve diagnosis and treatment of ADHD in adults. Most changes we need to make involve education and awareness among clinicians, healthcare providers, and policymakers.
The Five Ways:
- Enhance clinician knowledge of best diagnostic practices.
- Educate clinicians on the latest, evidence-based treatments for adult ADHD.
- Expand collection, sharing, and accessibility of data related to adult ADHD.
- Increase awareness of the risks and benefits of stimulant medication for ADHD.
- Implement systems for communication and collaboration between public and private healthcare providers, individuals, families, and the public.
For details from a new study on adult ADHD, see the full article below.
Can Adults Be Diagnosed With ADHD?
If you ask a random person on the street what they know about attention-deficit hyperactivity disorder (ADHD), they’ll probably say it’s something – a disorder or a condition – that happens most often during childhood or adolescence, and they probably won’t know that adults can develop ADHD, too – and we need to develop an effective diagnosis and treatment strategy for ADHD among adults.
Here’s something all adults need to know:
ADHD can and does occur in adults.
That’s something we didn’t accept 20 years ago, but now – with an increase in data and a decrease in stigma around treatment and support for mental and behavioral health issues – we understand and accept the fact of adult ADHD. However, since the phenomenon of adult ADHD is relatively new to the research and treatment communities, we are currently on the back foot with regards to diagnosis and treatment of ADHD among adults.
In a new publication called ‘Diagnosing and Treating ADHD in Adults: Balancing Individual Benefits and Population Risks” released recently by the Journal of the American Medical Association (JAMA), a pair of doctors, experts on ADHD, discuss how we can address and improve the current state of treatment for ADHD in the adult population.
We’ll report the salient points of their publication below.
ADHD Treatment for Adults: New Directions
The two physicians, Dr. Carlos Blanco and Dr. Craig B. H. Surman, MD, identify five issues we need to address to improve support for adults with ADHD: diagnosis, treatment, data, risk/benefit of medication, and collaboration.
Here’s a summary of their view on how we can address each of these five issues.
Issue #1: Diagnosis
Our clinicians need to learn more about ADHD in order to diagnose it accurately. Clinicians need to understand that:
- ADHD is a neurodevelopmental disorder that can impair function basic daily activities.
- It’s now known that ADHD can persist beyond childhood and adolescence, and into adulthood.
- A total of 4.4% of US adults have an ADHD diagnosis, with a lifetime prevalence of 8.1%
- Current criteria for ADHD diagnosis in adults are derived from pediatric criteria, which may underestimate the role of executive function and emotional regulation in ADHD. This may lead to under- and/or misdiagnosis of ADHD in adults.
- Lack of clarity around diagnosis for adults may contribute to reluctance many adults express in engaging in treatment.
If we work to improve diagnostic criteria for adult ADHD – which implies expanding understanding of adult ADHD among clinicians – we can increase diagnostic accuracy, improve public-facing information about adult ADHD, and reduce hesitancy around treatment and support.
Issue #2: Treatment
Treatment for adult ADHD outside of specialized clinics may not align with the evidence around treatment for ADHD.
- Research on the relative risks and benefits of ADHD medication includes an abundance of short-term studies, but very few long-term studies.
- Most clinicians consider stimulant medication superior to nonstimulant medication, but – as we mention above – very few studies exist that directly compare the two types of medication.
- For adults, gaps in research and guidelines include:
- Absence of what constitutes an adequate trial of medication
- How long to maintain treatment before reassessing or discontinuing
- How to choose between variations of the same medication
- What role nonstimulants have in ADHD treatment
- What role behavioral therapy has in ADHD treatment
- How to sequence treatment
- What complementary supports improve outcomes
When we evaluate and refine treatment guidelines for adult ADHD, we can improve outcomes for patients and overall public health by increasing the availability of evidence-based treatment and reducing risk of medication diversion or misuse.
Issue #3: Data Collection and Availability
Health care organizations, payers, and providers can increase participation in clinical and public health decision-making processes. For example:
- Organizations with nationwide data on outpatient care can study treatment trends, analyze adherence to and efficacy of medication, and identify factors that can predict adverse treatment outcomes or response.
- Organizations can create databases of patients observed over time to determine risk of stimulant misuses and identify the presence of stimulant use disorder, which can help determine safe medication protocols.
- Healthcare systems can incentivize evidence-based care, including nonpharmacological and nonstimulant treatment
It’s important to understand that treating ADHD with stimulant medication is associated with reduced risk of substance use disorders (SUD). However, data on treatment risk is largely nonexistent, which means we need both public and private organizations to expand research into ADHD medication. We can combine new research with existing data to examine trends in stimulant use disorder. Understanding prevalence of stimulant misuse among people in treatment – and in the general public – can help us allocate resources to prevent the negative consequences of diversion and disordered use.
Issue #4: Balancing Individual Benefit and Public Risk
Overall, we need to strike a balance between individual benefit and risk to the general population. To achieve this goal, we can advocate for the following:
- Making the health and wellbeing of individuals and the general population the primary goal of all providers and health organizations.
- Reducing the number of prescriptions for stimulant medication for at-risk individuals.
- Screening for substance use disorder at point of care
- Improving collaboration between clinicians
- Expanding capacity for monitoring and long-term surveillance
- Examining the impact of telehealth on:
- Treatment access
- Continuity of care
- Adherence to care
- Quality of care
- Risk of diversion
- Risk of stimulant use disorder.
Most importantly, all therapeutic modalities must promote a person-first approach and focus on equitable systems that are acceptable to patients and their families.
Issue #5: Collaboration Across Sectors
We can improve outcomes for individual patients and the general population by fostering more and better collaboration between all treatment-side stakeholders, including policymakers, regulatory agencies and officials, medication manufacturers, medication distributors, and local entities such as pharmacists/pharmacies.
In particular, public officials can work with private companies to:
- Address medication shortages caused by supply chain issues, which have a negative impact on:
- Treatment access
- Continuity of care
- Incentivize the research and development of specific treatment for adult ADHD that minimizes risk of stimulant misuse and improves patient health without placing public health at risk.
When we look at the big picture, we see a conundrum, which we’ll illustrate with this question:
How do we balance the undertreatment of adults with ADHD and the misuse overuse of stimulant medication?
This is an important dilemma to unravel, because ADHD is associated with considerable physiological and psychiatric comorbidity and can cause significant distress and disruption for individuals and their families. Our current treatments work, but the diversion, misuse, and disordered use of stimulant medication is a real problem. However, if we increase cooperation between all relevant parties, including patients, clinicians, payers, regulators, and policymakers, we can improve ADHD treatment among adults while ensuring the safety and wellbeing of individual patients and the general population.
