Well it has been a long time coming but this morning, while at the APA meeting in San Francisco, I learned that adults can now be diagnosed (DSM-V) as having ADHD. This is a milestone for our discipline of medicine. For a long time we had removed the (H) out after an individual became and adult, but this is no longer the case. It is also important to note, that symptoms no longer have to be present by the age of 7, either. We have now changed the criteria to include individuals who may not have experienced symptoms until around middle school, the age of 12. This is very important because middle school is really the time when issues like, procrastination, losing things and failure to academically progress become more and more apparent. Also, we have to keep two things in mind as we further evaluate adults with this disorder, (A) The effort it takes them to complete a task and (2) The impact that a person’s errors has on his/her’s life.
I will still do an extensive work-up on all new patients presenting with this medical complaint, but I will now closer monitor patients for there progress. There are still a couple of hints at possible stimulant/abuse such as; (1) Reporting that you feel better rather than reporting an improved ability to focus and complete task. (2) Excessive phone-calls and or concerns about the possibility of missing a dose. (3) Pushing me for an increase dosage when not really indicated and (4) Physician gut. Sometimes you can pick-up on patients that may be abusing the medication. Yes, we are expanding our diagnostic criteria but we are also becoming much better at making the correct diagnosis and monitoring patients for compliance.
It is also important to mention that a number of patients with ADHD have co-morbid psychiatric illnesses. It is important to monitor patients with this brain disease for other disorders like anxiety-related conditions, mood disorders and of course substance use/dependence disorders. After all, a good practitioner has to recognize that many adults may choose to use the calming affects of alcohol or marijuana as opposed to those medications prescribed by their psychiatrist.
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