E D I T O R ' S Q U E S T I O N
ADHD is a complex condition that presents differently for everyone . In the US , adult ADHD diagnoses are growing four times faster than diagnoses among children . Despite this increase , ADHD remains underdiagnosed in adults , likely in part due to the current diagnostic process relying on symptomology designed for children .
Undiagnosed ADHD has severe implications for a person ’ s well-being and is a known precursor for comorbid conditions . The overwhelming lack of education and guidance on how to diagnose and treat adult ADHD effectively has played a significant role in the mental health crisis we ’ re seeing today .
There is too great a variability in the standard of ADHD care . Relying solely on subjective assessments , which can be impacted by bias and lack of historical recall , sets the bar far too low for the standard of care , leaving patients vulnerable to misdiagnosis . Incorporating evidence-based , technology-driven objective measurements provides an unbiased perspective that offers transparency and clarity for the provider and patient to understand symptoms better and to help with treatment recommendations and optimisation .
Implementing technology for ADHD diagnosis and management into the care model streamlines and sharpens the process . In my practice , I have implemented a stepped-care model to ensure the right patients are referred promptly and correctly . The process includes a blend of subjective and objective measurements for a comprehensive screening before seeking a complete neuropsychological exam .
The stepped care model : Five steps to identifying adult ADHD
1 . The patient completes an ASRS Self Report Assessment that includes childhood history and assesses current functional impairment of symptoms . If possible , a corroborated report from childhood is encouraged , ideally from a parent , teacher or someone who knew the person as a child or even a report card .
2 . If the findings from step one indicate possible ADHD , the patient will complete an objective assessment , such as QbTest , to measure ADHD symptoms . With both subjective and objective evidence in place , the clinician makes an informed diagnosis and determines appropriate next steps for the patient .
3 . At this point , the patient can be referred to another provider or receive further evaluation if an ADHD diagnosis is ruled out .
4 . If treatment has been initiated , the patient will complete a follow-up objective test within four-six weeks to monitor effectiveness .
5 . Ongoing objective testing is utilised to monitor symptoms and treatment effectiveness at least once per year .
Good public health management , which is how we need to address ADHD , should screen widely , have defined steps for managing positive cases that include objective technology and provide access to specialty care to those who need it . �
DR SARA WEISENBACH
CHIEF OF NEUROPSYCHOLOGY AT MCLEAN HOSPITAL , ASSOCIATE PROFESSOR OF
PSYCHOLOGY IN PSYCHIATRY AT HARVARD MEDICAL SCHOOL
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