NORTH MIAMI – Attention-deficit/hyperactivity disorder (ADHD) in adults is a condition that must be treated around the clock, not only during work or school hours, attendees at the Psych Congress Regional Meeting here were told.
“It is completely illogical to cover the symptoms of ADHD for few hours at a time,” said Psych Congress co-chair Rakesh Jain, MD, MPH, Clinical Professor, Department of Psychiatry, Texas Tech Health Sciences Center School of Medicine, Midland, Texas. “Where did we come up with this idea that ADHD is only a school-based or work-based disorder?”
He urged the audience of more than 100 mental health clinicians to consider patients’ “entire clock,” not only 4-hour or 8-hour blocks, when formulating treatment approaches,
“This is the direction we’ve got to be going. Wall-to-wall coverage is incredibly necessary,” he said. “Work is incredibly important but that is not the central focus of life. Your family, your social life, ability to parent, all of those are incredibly important.”
Dr. Rakesh Jain pointed to car accidents as another reason why around-the-clock symptom improvement should be a treatment goal. Many accidents happen in the evening and nighttime hours, he said, and research has shown that people with ADHD are at greater risk overall of being involved in serious car accidents.
“ADHD should now be thought of as a lethal condition,” he said.
Dr. Rakesh Jain, who has been an investigator on ADHD medications, said many new pharmacological treatments—including longer-acting agents—have come on board in the past 18 months, and more are thought to be arriving in the next 3 years.
Saundra Jain, MA, PsyD, LPC, a Psych Congress Steering Committee member and Adjunct Clinical Affiliate, University of Texas at Austin, School of Nursing, Austin, Texas, said nonpharmacologic steps can also be used to help treat ADHD in adults. Cognitive behavioral therapy, exercise, and mindfulness have all been shown to be effective augmentation strategies for at least some ADHD symptoms, she said.
ADHD often co-occurs with substance abuse and other mental health disorders, and causes impairments in domains such as employment and education, Drs. Jain said.
“ADHD, particularly in adults, does not exist by itself,” Dr. Rakesh Jain said. “Adult ADHD never knocks on your door and says ‘I’m adult ADHD.’ It comes in various disguises.”
Adults with ADHD may also have feelings of shame, guilt, stress, and loss, Dr. Saundra Jain said.
“There is harm done to a person’s overall well-being when they suffer from this disorder,” Dr. Saundra Jain said.
Drs. Jain encouraged the attendees to use free 6-question Adult Self-Report Scale to screen patients for ADHD and the 18-question ADHD Rating Scale to assess their symptoms. ADHD is the most treatable disorder in the DSM-5, and “missing it is a tragedy,” Dr. Rakesh Jain said.
Psych Congress co-chair Charles L. Raison, MD, said ADHD in adults is one of the areas in psychiatry that has had an “eternal mystery” around it.
“We used to think that everybody grew out of it. Now we know that’s definitely not true,” Dr. Raison said.
— Terri Airov
“Adults with ADHD: Current Approaches to Diagnosis and Management.” Presented at the Psych Congress Regional Meeting: Nov, 19, 2016; Sunny Isles Beach, FL.