Is Your ADHD Untreated?

While many adults with ADHD try to live with their problem, some experts believe that it is really in your best interest to seek treatment.

In the following article, Scott Shapiro, MD, an Assistant Professor at New York Medical College, who specializes in Adult ADHD gives us his thoughts on whether or not adult ADHD needs to be treated...or, just lived with.

What Can Happen When Adult ADHD Goes Untreated?
By Scott Shapiro

When someone tells me they are depressed but every type of treatment in the book, including medications and several trials of different therapies haven't worked, I start wondering if something else is going on. Many times, symptoms of ADHD can masquerade as other diagnoses. People with ADHD often have "mood swings" and difficulty with mood regulation. This isn't in the DSM V criteria, but if you have worked with hundreds of patients with ADHD, you know that ADHD causes mood swings. When someone with ADHD is sad or in a funk, they have a hard time shaking it. And when they are excited, they are really excited. This is one of the gifts and wonderful traits about people with ADHD. They are passionate people, passionate about life and passionate about letting other people know about it. If one doesn't spend the time getting to know the person, might think the person has bipolar disorder. Yes, bipolar disorder and ADHD do have a higher rate of occurring together; however, more often that not, people with ADHD who say they have mood swings really mean "ADHD swings" not manic swings.

Many clinicians were taught that if someone presents with depression and ADHD, first treat the depression and THEN treat the ADHD. In my opinion this is just backward thinking. Very often, the patient feels depressed, frustrated, and has lost interest in work and other activities, but this can be because he has experienced one failure after another or has gone from one job to the next. In our experience at the Hallowell Center, when you treat the ADHD, the person begins to acquire the ability to achieve their goals, improve relationships, meet deadlines, remember to pick up the children, avoid accidents on the road, remember their tickets before driving to the airport and feel a lot more competent, confident and happy.

Unfortunately, when patients are treated for depression with antidepressants, or worse, treated with atypical antipsychotics for bipolar disorder and kept on these medications for months or years, their symptoms often do not improve and might worsen. I have never seen this data in the literature, but during my training at Massachusetts General Hospital, I was taught a VERY IMPORTANT PEARL. Never, never, never take away someone's dopamine. Dopamine gives us zest for life, motivation, and enables us to pay attention. It is the piece of the puzzle people with ADHD may be missing that inhibits and blocks them from reaching their potential. Guess what antidepressants and antipsychotics do? Through a feedback loop, these medications can decrease the function of dopamine in the frontal lobes and limbic system.

Treatment:

Treatment for ADHD must be individualized, as each person is unique. But there are some general guidelines that are helpful to remember. People are complex and their lives are complex. Treatment isn't about writing a prescription and seeing the patient once a year. Treatment is about helping people develop a comprehensive strategy to move on with their lives and achieve full potential.

Here are five ways that we can help our patients:

Many patients are often not diagnosed as children. Thus, by using a simple 5 minute screening tool in the office or waiting room, we can help our patients that may have been misdiagnosed as borderline, chronically depressed, anxious or bipolar disorder.

Here is a site that you can give your patients: http://counsellingresource.com/lib/quizzes/adhd-testing/adhd-asrs/


1. Many patients feel that ADHD is not a "real diagnosis" and thus don't get evaluated or treated. However, by explaining to the patients that SPECT and PET scans show differential blood flow in the prefrontal cortex in ADHD patients versus non-ADHD patients can help reinforce to the patient that this is a "real" issue.

2. Patients with ADHD have difficulty with planning and time management. Thus, they often forget their appointments or are late.

This can be extremely annoying for a busy clinician, in addition, to the patient not getting the necessary care.

Thus, a way of improving the show rate for these patients includes encouraging them to write the appointment in their calendars immediately when the appointment is made, requesting that they show up 30 minutes before their appointments, calling them the morning of their appointments (not the night before) and by charging them for missed appointments.

3. Encouraging your patients to purchase a weekly calendar and to use it on a regular basis instead of relying on post-it notes or on smart phone. Many ADHD patients do better when they see things visually.

4. Help the ADHD patient to see that they have many strengths and that ADHD is just one aspect of who they are. In addition, even though they have compensated for it most of their lives, validate that it may have been a difficult struggle and that it can get better.

5. Help the patient to understand that many of their behaviors such as underperforming at work, engaging in high risk sexual activity, or challenges in their relationships are very common in patients with ADHD and that this can get better over time with treatment, either medications or behavioral treatments.

6. people with ADHD often have difficulty maintaining and focusing on relationships. Social connection is one of the primary pillars of helping someone improve. This MUST be a part of the treatment.

7. Too often, the treatment focus is on deficits or problems. This is how we are all trained-what is the problem and how are we, the treatment provider, going to fix the person?. People come to us with so many gifts, talents and strengths. It is essential to help the person realize their strengths and show them what extraordinary challenges they have already overcome. The best gift we can give our patients is showing them their own power, potential and the possibilities of what CAN be.

Working with patients who have ADHD can be frustrating at times, but can be extremely rewarding. Just like cigarette cessation, it can have a significant impact on a patient's life, but with appropriate diagnosis, treatment, and intervention, a patient's health and well-being can greatly improve.

Scott Shapiro, MD, an Assistant Professor at New York Medical College, specializes in Adult ADHD. He provides assessment, med management, psychotherapy, and cognitive behavioral therapy all in one place. If you would like a consultation with Dr. Shapiro, call 212-631-8010 or visit his website at http://www.scottshapiromd.com.

Dr. Shapiro's approach is warm, collaborative, and effective.

Article Source: What Can Happen When Adult ADHD Goes Untreated?