How can you recognize adult ADHD symptoms. What are the diagnostic criteria for adult ADHD. How to discuss ADHD concerns with your doctor. What are the differences between childhood and adult ADHD. How does untreated ADHD impact daily life.

Understanding Adult ADHD: Prevalence and Impact

Attention Deficit Hyperactivity Disorder (ADHD) is not just a childhood condition. In fact, it affects a significant portion of the adult population, with estimates suggesting that 8 to 9 million Americans struggle with adult ADHD. This neurodevelopmental disorder can have far-reaching consequences, impacting various aspects of an individual’s life.

Adult ADHD can manifest in numerous ways, ranging from mild inconveniences to severe difficulties that can disrupt relationships, careers, and overall quality of life. J. Russell Ramsay, PhD, codirector of the Adult ADHD Treatment and Research Program at the University of Pennsylvania, emphasizes the potential severity of untreated ADHD: “Some people with adult ADHD have a tapestry of difficulties so severe they end relationships and jobs, cause driving difficulties, and lead to legal and financial problems.”

Recognizing the Signs and Symptoms of Adult ADHD

Identifying adult ADHD can be challenging, as symptoms may differ slightly from those observed in children. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) outlines 18 symptoms that could indicate ADHD in adults. These symptoms are divided into two main categories: inattention and hyperactivity-impulsivity.

Inattention Symptoms

• Difficulty paying attention to details or making careless mistakes
• Trouble maintaining focus on tasks or activities
• Appearing not to listen when spoken to directly
• Failing to follow through on instructions or complete tasks
• Difficulty organizing tasks and activities
• Avoiding or disliking tasks requiring sustained mental effort
• Frequently losing items necessary for tasks or activities
• Being easily distracted
• Forgetfulness in daily activities

Hyperactivity and Impulsivity Symptoms

• Fidgeting or squirming
• Leaving seat when remaining seated is expected
• Feeling restless or “on the go”
• Difficulty engaging in quiet leisure activities
• Talking excessively
• Blurting out answers before questions are completed
• Difficulty waiting for one’s turn
• Interrupting or intruding on others

For adults 17 years or older, a diagnosis of ADHD requires the presence of at least five symptoms from either category. It’s important to note that these symptoms must have been present for at least six months and occur in multiple settings, such as work, home, or social situations.

Adult ADHD vs. Childhood ADHD: Key Differences

While the core symptoms of ADHD remain consistent across age groups, their manifestation can differ between children and adults. Dr. Lenard A. Adler, director of the adult ADHD program at NYU Langone, explains: “For example, hyperactivity in adults is much more felt rather than manifest — they feel it rather than climb like kids do. It’s more the mind being restless.”

Another notable difference is the prominence of certain symptoms. Dr. Adler notes that “several studies, including ours, show inattentive symptoms become more prominent as you move into adulthood.” This shift in symptom presentation can make adult ADHD more challenging to recognize, both for individuals and healthcare providers.

The Impact of Untreated Adult ADHD on Daily Life

Undiagnosed and untreated adult ADHD can have significant consequences across various aspects of life. Some common challenges faced by adults with untreated ADHD include:

1. Difficulty managing time and meeting deadlines
2. Struggles with organization and prioritization
3. Impulsive decision-making
4. Relationship difficulties due to inattention or impulsivity
5. Career setbacks or job instability
6. Financial problems due to impulsive spending or difficulty managing finances
7. Increased risk of accidents, particularly while driving
8. Low self-esteem and feelings of underachievement

Dr. Adler highlights some common scenarios that might indicate untreated ADHD in adults: “If you have trouble being patient with your kids, feel like you can’t stay on top of everything, can’t seem to get to anything on time, lack the motivation to get things done, have a child with ADHD and see some of your own personality traits in the child, or remember having trouble concentrating and studying in high school or college, these could all be potential consequences of having untreated ADHD.”

Types of Adult ADHD: Adult Onset vs. Adult Presentation

When discussing adult ADHD, it’s crucial to distinguish between two types: adult onset and adult presentation. Adult onset ADHD, where symptoms first appear in adulthood, is relatively rare. Dr. Adler notes, “A minority of people have adult onset ADHD, but it’s not common.”

The more prevalent form is adult presentation ADHD, where symptoms have been present since childhood but may have gone undiagnosed. Dr. Adler explains, “Most high-functioning adults that come into my office were not diagnosed in childhood. They’ve gotten by, and are bright and found a way to get around symptoms until life became more complex.”

This distinction is important for both diagnosis and treatment, as it can provide insight into the individual’s history with the disorder and help tailor management strategies accordingly.

Seeking a Diagnosis: How to Discuss ADHD with Your Doctor

If you suspect you may have adult ADHD, it’s essential to discuss your concerns with a healthcare professional. However, many adults hesitate to bring up ADHD due to the stigma surrounding the disorder or fears of overdiagnosis. Dr. Ramsay encourages individuals to overcome this hesitation: “But if your ADHD symptoms are in any way interfering with your quality of life, it’s worthwhile to bring them up to your physician.”

When preparing to discuss ADHD with your doctor, consider the following steps:

1. Document your symptoms: Keep a journal of your symptoms, noting their frequency and impact on your daily life.
2. Reflect on your history: Try to recall if you experienced similar symptoms in childhood or adolescence.
3. Gather information: If possible, obtain school records or reports that might indicate early signs of ADHD.
4. Prepare questions: Write down any questions or concerns you have about ADHD and its treatment.
5. Be honest: Provide your doctor with a comprehensive and truthful account of your experiences and challenges.

Remember, seeking help for potential ADHD is not a sign of weakness but a proactive step towards improving your quality of life.

Beyond the Diagnostic Criteria: Additional Challenges of Adult ADHD

While the DSM-5 provides specific diagnostic criteria for ADHD, it’s important to note that adults with ADHD often face additional challenges that may not be explicitly included in these criteria. Dr. Adler emphasizes, “These include executive function deficits and trouble with organization, prioritization, planning, procrastination, and time management.”

These executive function difficulties can significantly impact an individual’s ability to manage daily responsibilities and achieve long-term goals. Some common executive function challenges associated with adult ADHD include:

• Difficulty initiating tasks
• Poor working memory
• Trouble with emotional regulation
• Challenges with self-motivation
• Difficulty shifting between tasks or adapting to new situations

Understanding these additional challenges is crucial for both diagnosis and treatment, as addressing these issues can greatly improve an individual’s overall functioning and quality of life.

The Importance of Early Diagnosis and Treatment for Adult ADHD

Recognizing and addressing adult ADHD is crucial for several reasons. Early diagnosis and treatment can:

1. Improve overall quality of life
2. Enhance work performance and career prospects
3. Strengthen relationships and social interactions
4. Reduce the risk of associated mental health issues, such as anxiety and depression
5. Improve self-esteem and self-confidence
6. Enhance ability to manage daily responsibilities
7. Reduce the risk of substance abuse and other risky behaviors

Dr. Adler emphasizes the importance of addressing ADHD symptoms, even if they seem mild: “Even if symptoms are not severe, they can still significantly impact your life. Seeking help can lead to substantial improvements in various areas of functioning.”

Treatment for adult ADHD typically involves a combination of medication, psychotherapy, and lifestyle modifications. The specific treatment plan will depend on the individual’s symptoms, preferences, and overall health status.

By recognizing the signs of adult ADHD and seeking appropriate diagnosis and treatment, individuals can take control of their symptoms and work towards achieving their full potential in both personal and professional realms.

Could You Have Adult ADHD? How to Discuss It With Your Doctor

Between work, kids, and social activities, everyone feels a little overwhelmed from time to time. But if you can’t concentrate long enough to get through a movie or flip through a whole magazine, you’re constantly late, or you’re impatient with people to the point that it’s interfering with your life, you may be one of the 8 to 9 million Americans with adult attention deficit hyperactivity disorder, commonly known as ADHD.

“Some people with adult ADHD have a tapestry of difficulties so severe they end relationships and jobs, cause driving difficulties, and lead to legal and financial problems,” explains J. Russell Ramsay, PhD, the codirector of the Adult ADHD Treatment and Research Program and an associate professor of psychology in psychiatry at the University of Pennsylvania in Philadelphia.

Signs and Symptoms of Adult ADHD

ADHD has the stigma of being overdiagnosed, so many adults who suspect they may have the disorder suffer in silence. “But if your ADHD symptoms are in any way interfering with your quality of life, it’s worthwhile to bring them up to your physician,” Dr. Ramsay says.

According to the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), 18 symptoms could indicate that you have ADHD. There are two groups of symptoms: inattention, with nine symptoms; and a combined hyperactive and impulsive group, with six hyperactive and three impulsive behaviors.

The symptoms for adults are same as they are for children, but there are some subtle differences, says Lenard A. Adler, MD, director of the adult ADHD program at NYU Langone in New York City. “For example, hyperactivity in adults is much more felt rather than manifest — they feel it rather than climb like kids do,” he explains. “It’s more the mind being restless. And several studies, including ours, show inattentive symptoms become more prominent as you move into adulthood.”

The 18 symptoms are as follows:

Inattention

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
• Often has trouble holding attention on tasks or play activities
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e. g., loses focus, gets sidetracked)
• Often has trouble organizing tasks and activities
• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
• Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
• Is often easily distracted
• Is often forgetful in daily activities

Hyperactivity and Impulsivity

• Often fidgets with or taps hands or feet, or squirms in seat
• Often leaves seat in situations when remaining seated is expected
• Often runs about or climbs in situations when it is not appropriate (adolescents or adults may be limited to feeling restless)
• Is often unable to play or take part in leisure activities quietly
• Is often on the go, acting as if driven by a motor
• Often talks excessively
• Often blurts out an answer before a question has been completed
• Often has trouble waiting their turn
• Often interrupts or intrudes on others (e. g., butts into conversations or games)

Individuals 17 years old or older require five out of nine symptoms in one group and/or the other to confirm a diagnosis of ADHD, says Dr. Adler. In addition, a number of symptoms that go along with ADHD but are not in the diagnostic criteria are also important and can be quite impairing, he adds. “These include executive function deficits and trouble with organization, prioritization, planning, procrastination, and time management,” he explains.

There are two types of adult ADHD: adult onset and adult presentation. A minority of people have adult onset ADHD, but it’s not common, says Adler. The majority of cases have some symptoms that go back to childhood. “Most high-functioning adults that come into my office were not diagnosed in childhood. They’ve gotten by, and are bright and found a way to get around symptoms until life became more complex,” he explains.

If you have trouble being patient with your kids, feel like you can’t stay on top of everything, can’t seem to get to anything on time, lack the motivation to get things done, have a child with ADHD and see some of your own personality traits in the child, or remember having trouble concentrating and studying in high school or college, these could all be potential consequences of having untreated ADHD, says Adler.

To confirm a diagnosis of adult presentation ADHD, symptoms must have begun before you were 12 years old and must have continued for more than six months. Symptoms must also occur in two or more settings — such as home, school, work, or social situations — and cause some impairment. Finally, your healthcare provider must confirm that your symptoms are from ADHD and not something else, such as depression, bipolar disorder, anxiety, or substance abuse.

Who You Should Talk To: What Doctors and Specialists Help Diagnose ADHD in Adults

Adler recommends visiting the website ADHD in Adults and taking the six-question ADHD screener. You can bring it to your regular primary care doctor, and they can score it for you. A psychologist, psychiatrist, neurologist, or nurse practitioner could also do it for you, he adds.

How to Talk to Your Doctor About ADHD

Although ADHD cannot be cured, it can be treated. “In most cases, people wait too long to bring their ADHD symptoms up to their physicians,” says Ramsay. His suggestion: “Trust yourself enough and err on the side of bringing it up.”

People with ADHD symptoms may hesitate to mention their worries about the condition to their doctor because they fear they’ll be labeled a hypochondriac. Ramsay points out that although ADHD is underrecognized in the medical community, he doesn’t deny that the popular claim that ADHD is overdiagnosed has some merit. “The real problem is actually misdiagnosis, not overdiagnosis,” he says. “There’s an overdiagnosis of ADHD in people who want to take medication to enhance their academic performance but an underdiagnosis of ADHD in people who truly have it.”

Once you’ve made the decision to discuss your ADHD symptoms with your doctor, it’s good to have a plan for how you will address the issue. Here are some suggestions on how to talk to your doctor about ADHD.

Step 1: Don’t Worry About Your Doctor Labeling You

Put away your fears about being labeled a hypochondriac. Trust your instincts if you think you have the condition or have had it for a long time.

Step 2: Make a Specific Appointment to Discuss Your ADHD Symptoms

State ADHD as your reason for seeing the doctor when you make your appointment. Don’t just bring it up at the end of an appointment for something else. Instead, make an appointment specifically to discuss ADHD.

Step 3: Explain Your Symptoms of ADHD With Real-Life Examples

Discuss your ADHD symptoms with your doctor and give examples of how they interfere with your daily life.

Step 4: Be Honest With Your Doctor If You’ve Tried Someone Else’s ADHD Medication

If you’ve self-diagnosed ADHD and tried medication (such as your child’s ADHD medication), tell your doctor. Although it’s never a good idea to take medication that hasn’t been prescribed to you by your doctor, it’s important to be honest, and it may even be useful for a proper prescription.

Questions to Ask Your Doctor About ADHD

Do You Only Prescribe Adderall for ADHD, or Are There Other Medication Options for Treatment Available?

Once you confirm a diagnosis of ADHD, you can use medicine or one of the psychosocial treatments, mostly cognitive behavioral therapy. “Most commonly for adults, medication plays a role, but cognitive behavioral therapy is quite helpful,” says Adler.

Adderall (amphetamine and dextroamphetamine) is only one of the many medications for ADHD, and it should not be the only one used for adults, he notes. Currently for adults, there is one approved nonstimulant, Strattera (atomoxetine), and five approved sustained-release stimulants — two of which are Ritalin-based (methylphenidate) and three that are amphetamine-based (including Adderall). “Treatment plans are made in partnership with your doctor to find the right medications that are the best fit for you,” explains Adler.

Healthy lifestyle modifications can also be beneficial. Adler says that people with ADHD can benefit from a balanced, healthy diet; adequate hydration; getting enough sleep; and moderating caffeine if you’re on medication. Some mindfulness therapies can be quite helpful in terms of relaxation techniques, he adds.

How Can I Best Keep Track of My Progress With ADHD?

You can track your ADHD symptoms by scaling the 18-item self-report checklist that is an extension of the ADHD screener. “You can do this before treatment and repeat during your treatment to see where you’re at,” says Adler. If treatment is effective, you would want to see at least a 30 percent improvement in your overall symptoms, he notes.

Can ADHD Get Worse As I Age?

ADHD doesn’t occur in a vacuum, explains Adler, and symptoms will change and flux over time. “For women, menopause can sometimes worsen ADHD,” he says. “Sometimes life changes, such as moving from a more structured to a less structured job, or being promoted and needing to manage others, will have an effect on ADHD symptoms. Or having a child diagnosed with ADHD and recognizing your own symptoms.”

For older adults with ADHD, the symptoms and presentation are slightly different, but there’s not a huge amount of literature on the topic, Adler notes. “With retirement, there is less structure, and symptoms may come forward. There is a small amount of literature showing that hyperactive-impulsive behavior may come forward again as people age. But you have to make sure it’s ADHD and not another cognitive disorder.” If you’re not sure whether you have ADHD or another condition, talk to your doctor. “I think if individuals are worried that they have ADHD, they should make an appointment with their doctor and get evaluated,” says Adler.

Additional reporting by Jennifer D’Angelo Friedman.

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11 Steps for Prescribing It Effectively

The most recent Practice Parameters update on attention deficit disorder (ADHD or ADD) from the American Academy of Child and Adolescent Psychiatry (AACAP) recommends medication as a primary therapy for ADHD because it shows detectable, lasting benefit over multi-modal treatment. In other words, ADHD medication works. Yet, 93% of psychiatry residencies don’t mention ADHD in four years of training, and a full 50% of pediatric residencies don’t mention ADHD, despite its prevalence in the U.S. So how is a physician supposed to understand and adjust treatment plans without a rich background in ADHD? That’s where the following guidelines come in.

1: Share the Facts About Medication and Its Alternatives

Medication is the primary treatment of choice for ADHD. It is not the treatment of last resort when a person has tried literally everything else they can think of. Or at least it shouldn’t be — except for someone who has very recent or unstable substance abuse problems, or a medical condition including uncontrolled seizures, untreated cardiovascular disease, or an unmanaged mood disorder. However, once these conditions are under control, medication is the treatment of choice.

This is not to say that alternative therapies and behavior management techniques can’t help, or that coaching isn’t valuable. Those strategies offer non-specific benefits. Anyone – with our without ADHD – would do better in a structured, predictable environment than they would in a random, chaotic one. Yet the AACAP reviewed 82 studies that treated ADHD without medication, and none were able to demonstrate a detectable, lasting benefit on the core symptoms of ADHD: inattention, impulsivity, and hyper-arousal.

2: Test One Methylphenidate and One Amphetamine

All of the 29 first-line FDA-approved formulations are just different ways of delivering only two molecules: methylphenidate and amphetamine. There is no evidence to indicate that one molecule is intrinsically better than the other. So how do physicians know which medication to prescribe? How can they be sure to match each patient with the best treatment possible?

One of the things that best informs the decision is a statistical calculation called effect size. It allows physicians to compare clinical experience and research done at different times, in different places. Effect size combines this information into a ratio that indicates how well this particular treatment works compared to all the others we might have tried.

[Free Download: Choosing the Right Professional to Treat ADHD]

Most medications have an effect size between 0.4 (barely but consistently detectable results) and 1.0 (quite robust effectiveness). The effect size of stimulant medications in research is pretty close to 1.95, and in research, again, the dose is usually not fine-tuned to the individual. In dose-optimization studies when the stimulants are fine-tuned, they come in at 1.7 or above. In other words, what patients can expect from stimulant medications is nothing short of, “Wow, life changing and better than any other treatment in all of medicine.”

The side effect profiles are the same. Nothing can predict who will respond better to which medication, but most people have a preference for one. Which molecule works best does not appear to run in families (e. g., if a child or sibling does well on methylphenidate, it doesn’t mean a relative is any more likely to respond to methylphenidate.) Patients just have to try both options and see which is more effective.

In my practice, I give a trial of both medications to make sure we have the best possible result. At the end, I have patients rate which medication they feel is best on a scale of one to ten. One is a nasty experience with no benefits and lots of side effects. Ten is the best result the patient can imagine. Anything six or below is a treatment failure, and physicians should keep looking for a better medication. Seven is acceptable, but the goal is between eight and ten.

It doesn’t make sense to have multiple trials of different kinds of methylphenidate or amphetamine. One trial of the best medication of each kind is enough to determine which will work best for the patient.

3: Choose the Smoothest Formulation

Extended-release formulations are preferred, if available and covered by insurance, because people with ADHD generally have a poor sense of time. 85% of adults and 95% of late adolescents with ADHD don’t own a watch. It’s much more convenient and easier for them to remember to take one pill that releases medication throughout the day than it is to take three pills throughout the day.

Additionally, extended-release medications allow for privacy and confidentiality for kids who might otherwise have to take a second dose at school. In addition, patients report a more consistent, stable benefit: Extended-release formulations smooth out the rebound, the sudden drop off in medication levels that can make people weepy or irritable when taking an immediate-release formulation.

When stimulants medications are abused, 95% of the time it’s the immediate-release format; just one more reason to use extended-release.

[Use This Checklist to Assess ADHD Doctors and Clinicians]

4: Tailor the Dose to the Individual

No test can predict what dose will give a patient the optimal level of benefits with no side effects. Every patient’s dose is determined by trial and error.

Genetic testing to measure alleles that metabolize a medication cannot predict the dose a person will need. Many pediatricians are trained to give a certain number of milligrams per kilogram of a patient’s body mass, but there is no evidence that dose is affected by size, age, gender, scale scores, or severity of impairment.

Here is what does determine dose:

• How it’s absorbed by the GI tract (this changes constantly for kids under 16, so meds should be adjusted once a year in August just prior to the beginning of school).
• How efficiently that molecule crosses the blood-brain barrier (from the blood into the brain).
• The rate at which medications are metabolized or eliminated in urine.
• Vitamin C and citric acid block absorption of medication – so they shouldn’t be taken with juice or soft drinks.

Think about ADHD medications as you would eyeglasses. I wear glasses because I can’t focus my vision, in the way that someone with ADHD can’t focus their attention span and impulse control. You and I cannot exchange glasses. We each need our prescription, the one that’s right for us. The notion of a high-dose prescription glasses versus a low-dose is pretty nonsensical. What we want is the right dose for us, and when we have the right prescription for us as unique individuals, then we see 20/20, virtually without side effects.

5: Learn to Recognize the Wrong Dose

There is a tremendous variability of optimal dose. The dosage range approved by the FDA covers only about half of all people. About 6-8% of children, adolescents, and adults optimize at doses lower than the lowest dosage sizes made. As many as 40% of people optimize at doses higher than those studied and approved by the FDA.

Physicians have to stop looking at dosing from a high vs. low dose perspective, and focus on fine-tuning dose to the unique individual. By putting Vyvanse in water, for example, or using liquid formulations such as Quillivant XR, you can adjust the dose to lower than the lowest dose made if someone responds well to a small amount.

Where Dosing Goes Wrong: Patients expect that they should feel stimulated or different in some way.

The Rule: The right molecule at the right dose should return a person to normative levels of functioning, not to some artificial amped-up state, and without side effects.

If a person feels different, the dose is too high or too low. When the dose is off, hyperactive people tend to slow down to a crawl that’s known as zombie syndrome. Other people get stimulated with the wrong dose, and this is called the Starbucks syndrome. If a patient is experiencing personality changes or feels revved up or slowed down, the dose is typically too high and needs to be decreased. Traditionally, physicians were trained to give the highest dose that a person could tolerate. Now research shows that this “highest dose” is too high; the optimum is typically is at least two dosage strengths weaker than this threshold.

6: Work with the Patient to Fine-Tune

Fine-tune the medication according to target symptom response. Doctors should educate their patients about how the medication can alleviate impairments of ADHD. Remember, these patients have always been ADHD. The way they are is their normal. They have no idea what is possible with medications, so it’s important to tell them what to look for, what will change, what won’t change, and what they get out of taking it.

Physicians can sit down with patients and say, “Let’s make a list of the things about ADHD that you want to get rid of, that you don’t like.” There are lots ADHD characteristics that people do like — the cleverness, the problem-solving, the creativity, the wacky, zany sense of humor — and the nice thing is, all of those things stay when medication gets rid of the things that a person doesn’t like. Then ask, “What is it about ADHD that bothers you the most?” The impairments that respond to medication are procrastination, distraction, finding it hard to stick with boring tasks, impatience, impulsivity, and restlessness. Symptoms that are not as affected by medication include disorganization, argumentativeness, and oppositional behavior.

Stimulant medications, with the exception of Concerta, are effective within one hour – including all of the benefits and all of the side effects. There are no late-appearing side effects. Stimulants are fast-acting, so adults can change the dose every day if the doctor and patient wish. Children and some adolescents who cannot communicate the effects of medication need a week between dosage adjustments. In these cases, if you have to choose one person to give feedback, pick the child’s teacher. She knows what typical second-grade behavior looks like, and can help evaluate a child who is too young to report on how the medication works.

7: Find the Lowest Possible Dose

Emphasize that you will fine-tune to the lowest dose possible. Physicians can say, “Look at your target symptoms. Each time, when we raise the dose, you should see a clear, dramatic improvement in all your target symptoms, and no side effects other than a mild, transient loss of appetite.” So long as you see things getting better and better, without side effects, physicians can keep raising the dose.

At some point though, physicians will raise the dose and the patient will say, “There weren’t any further improvements. Every other time we raised the dose I could clearly see improvement. This time, this dose and the previous dose seem exactly the same to me.” At that point, the previous dose is the very lowest dose that gives the patient 100% of what that medication has to offer. If the person is over the age of 16, that dose should work for the rest of their life. Tolerance is very rare to the benefits of these medications; tolerance develops very quickly to their side effects.

8: Don’t Increase Dose to Boost Duration

Don’t increase the dose just to increase the duration of the medication. Accept whatever duration of action is at that person’s optimal stimulant dose. Increases past that will often push a person beyond her “sweet spot” dose to the point where she starts to have side effects. The increase in how long it lasts is very marginal.

Remember that even though extended-release is marketed as once-a-day or 24-hours, the longest duration is 10-11 hours of effectiveness, with the exception of Daytrana. Most times, insurance will only cover one extended-release dose per day, so to have evening coverage many people use an immediate-release format for the second dose.

9: Put It in Writing

Write everything down for your patient. There is too much information to remember accurately and most people aren’t really listening. Even people without ADHD have trouble remembering all the information needed to maintain a treatment plan. Remember that the parent accompanying a child could have ADHD, too.

Good medication outcomes require written, simplified instructions that the patient can follow step-by-step. I have developed forms for clinicians for such a purpose on a CD-ROM. If you would like a copy, contact me at [email protected] and I will mail a copy to physicians for free.

10: Cover the Patient’s Entire Day, Consistently

After the age of 14, many people need 16 hours of coverage per day. This requires multiple doses of medication throughout the day. Patients should use medication at all times and in all situations where there is impairment from ADHD, including bedtime. It’s more than just for school. Medication helps us to be social, get along with family, do homework at night, and drive a car safely.

Most clinicians don’t offer a follow-up dose because they are worried it’s going to keep patients awake, but we know that a nighttime dose can help people with ADHD slow down, and calms the chatter in their minds. After you’ve found the right dose, ask the patients to take a no-risk trial nap in the afternoon on their optimal stimulant dose to prove that evening doses will not keep them awake. 95% of people can nap on medication. When that happens, you know your patient can take a second dose to cover all the time they need.

There is no basis for a medication vacation. For children and teens, I recommend that they take the medication very consistently. Since medication is completely effective in one hour, adults don’t have to take medication all day every day. They can use it for a specific task, if that’s what they want.

However, it is worth noting that people who have ADHD and don’t take medication have a higher risk of developing a substance abuse problem, being in an injury-producing accident severe enough to go to the hospital, having an unplanned child, or being involved in the juvenile justice system. On medication, the risks are the same as they are for the general population.

11: Explore Second- and Third-Line Medications

Fifteen percent of people do not respond to or tolerate the two standard molecules of methylphenidate and amphetamine. The second-line medications are Clonidine and Guanfacine. They work for about one in three people. They have a very robust effect size of about 1.3.

The only other FDA-approved medication for ADHD that has an effect size greater than 1.0 is methamphetamine. The mere mention of the drug makes many doctors, pharmacists, and patients uncomfortable, but it’s probably the most effective medication for the treatment of ADHD.

The dosages of methamphetamine that are used to treat ADHD are extremely low. The average dose used to treat a person with ADHD is approximately 1/200 of the dose people abuse. Nonetheless, finding physicians who feel comfortable with the use of methamphetamine is somewhat rare.

The third-line agent is Strattera (atomoxetine). It has an effect size of 0.7 in elementary school-aged children. In high school students and above, and especially in adults, we see a barely detectable effect size of 0.44. Even the barely detectable benefit is found in only about half of people. So that’s why the American Academy of Child and Adolescent Psychiatry put it in a third-line, or alternative category.

There are other medications in the alternative, or off-label, group that include Bupropion (Wellbutrin), and modafinil (Provigil). These are not FDA-approved. They are not studied for ADHD, but there is some literature on their efficacy if everything else has failed.

I’ve never had a patient say, “Gee, I’m glad I waited a couple of extra years before trying medication.” It’s always the exact opposite. It’s, “What would my life have been like if I had known how well these medications worked earlier?” There’s a real period of grief about what might have been.

These medications don’t produce an artificial state. They offer a return to normal functioning, often with no side effects other than maybe a mild loss of appetite that goes away for most people. With these steps, physicians can help more patients have that moment.

[10 Things Your Doctor May Not Have Told You About ADHD Medications]

• What should I consider when developing a comprehensive treatment plan for ADHD?
• What medications and other approaches should I turn to as first-line treatments for ADHD?
• How can I decide which ADHD medication to prescribe first?
• What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
• How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
• What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
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Smart drugs and bad experiences with them

• Benjamin Zand
• Victoria Derbyshire Air Force Program

January 12, 2016

Signature before photo, 9000 8 Many smart pills are conventional medicines

Yes so-called “smart” drugs are becoming more and more popular, especially among students. But how effective and safe are they?

I first learned about these medicines from a friend. “Everyone does it. They’re just pills to help you concentrate,” she said.

It turned out that she needed them to cope with the stress of a particularly important day for her.

Many psychostimulants are conventional drugs used to treat a variety of illnesses or disorders.

So, one of the most popular “smart” drugs – modafinil is used to treat drowsiness caused by narcolepsy, as well as sleep disorders associated with work at different times of the day.

However, more and more people are taking modafinil to work more efficiently.

Side effects

Scientists at Harvard and Oxford called it “the world’s first safe smart drug”, believing that if taken for a short time, the level of risk would be low.

However, this drug has side effects such as insomnia, headaches and potentially dangerous skin rashes. In addition, there is not too much data on what the use of modafinil may turn out to be in the long term.

However, after reading favorable reviews online, including some about how modafinil helped me get good grades in my university degree, I decided to try it out for myself.

British law prohibits the sale of modafinil without a doctor’s prescription, but its purchase is not punishable by law.

There were many sites on the Internet, including those registered in India, where one could order it.

My order arrived in less than a week. The package contained tablets that were not much different from regular paracetamol. After consulting with the doctor, who said that as a young and healthy person, this drug is unlikely to cause any particular harm to me, I decided that it was time to move from words to deeds.

First impressions

I took my first modafinil pill not just anywhere but in the laboratory of the University of Cambridge. A lab worker ran a series of tests to test my mental abilities – attention span, visual-spatial working memory, and episodic memory – before and after taking modafinil.

Professor Barbara Sahakyan was sure that the drug would have an effect on me: “The studies we conducted showed that after taking modafinil, cognitive processes improve, that is, the ability to mentally perceive and process external information. And it was about a variety of personalities – from doctors working night shifts to ordinary people taking tests in a controlled environment.”

Before taking modafinil, my data wasn’t that bad. For example, in my ability to concentrate, I was in the top 15-20% of my age group. By taking the pill, I improved my results and was already in the top 5-10% group in this indicator.

I felt much more cheerful and thought less about what might disappoint or upset me. Of course, other factors could have influenced the results of the test.

But the day went on, and my brain continued to work “to its fullest”. I had to travel home to Liverpool for four hours by train, but I did not feel any fatigue.

I have to finish listing the positive sensations from modafinil.

Insomnia and swelling

Photo caption,

Trying to sleep did not lead to anything, I was able to overcome insomnia only in the morning

The next day I had to get on the train again, and I miracle pill. But I was wrong.

First, I became more distracted than usual. Although the drug helped me concentrate, the object of my concentration was not what I needed.

For example, a video game on my smartphone.

After a while I had a severe headache, I lost my appetite and began to go to the toilet quite often, I can say that I hardly left it. My brain was in no hurry to work harder than usual, unlike my bladder.

In the evening I felt the power of modafinil as an anti-drowsiness drug. Attempts to fall asleep did not lead to anything, I was able to overcome insomnia only in the morning.

In addition, I developed a swelling on my leg, which itched a lot. The next day, the same “joy” appeared on my arm.

I seem to be out of luck, unlike, for example, Jason Old, an athlete and entrepreneur from Edinburgh. According to him, after taking modafinil, he feels as if nothing is impossible for him.

“It makes you feel like you’re functioning at 100%, that you’re giving it your all. Under normal circumstances, that seems impossible, but modafinil makes me feel that,” Old says.

Disappointment

After the first dose of the drug, I really felt a surge of energy and a high level of concentration, but at the end I did not feel very well.

My third and final use of modafinil was also disappointing. I had a whole day of editing, and the headaches returned.

I was dehydrated.

Even worse was that my friends constantly pointed out to me the bad condition of my skin. Modafinil kept me awake and I looked terrible.

Caption before photo,

People’s bodies react differently to chemicals and pills

Around eight in the evening, when I least wanted it, the drug finally began to work. Until 11 o’clock I worked in the office as usual – I edited, filmed, wrote and did a lot of everything that previously seemed not to be done at all.

I felt I should keep working, but that doesn’t mean I wanted to.

In general, the negative effects of taking drugs far outweigh the positive ones, and this can be due to a number of reasons.

People and their bodies react differently to chemicals and pills. After talking with my doctor, I found out that, for example, my liver has developed a special enzyme to remove modafinil from my body.

When ordering the drug online, I could have been slipped a counterfeit, although Jason Old assured me that he had already used the services of this supplier.

I was, of course, disappointed that I never experienced the positive effects of modafinil, which I had heard so much about. But to some extent, I was also relieved that I did not lose anything by not using it earlier.

The side effects and lack of performance mean it’s not a miracle drug and I definitely never want to take it again.

Dextroamphetamine and Amphetamine | Memorial Sloan Kettering Cancer Center

Adult Medicine

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This document, provided by Lexicomp ^® , contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Adderall; Adderall XR; Mydayis

Trade names: Canada

Adderall XR; APO-Amphetamine XR; PMS-Amphetamines XR; SANDOZ Amphetamine XR; Teva-Amphetamine XR

Warning

• This drug carries a risk of abuse and misuse. This drug can also be habit-forming with long-term use. Do not use longer than prescribed by your doctor. Use only as directed. Tell your doctor if you have ever abused or been dependent on any drugs or alcohol. Misuse of this drug can cause heart side effects or even sudden death.

What is this drug used for?

• It is used to treat Attention Deficit Hyperactivity Disorder.
• Used to treat narcolepsy.
• This drug may also be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

• If you have an allergy to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergies and how they have manifested.
• If you or a family member has any of the following health problems: Blood vessel disease, high blood pressure, structural heart disease or other heart problems, or Tourette’s syndrome or tics.
• If you have any of the following health conditions: glaucoma, jitters, anxiety, or an overactive thyroid.
• If you have ever had any of the following health problems: drug/drug addiction or stroke.
• If you have kidney disease.
• If you are taking any of the following drugs: acetazolamide or sodium bicarbonate.
• If you have taken medications for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
• If you are taking any of the following drugs: linezolid or methylene blue.
• If you are breastfeeding. Do not breastfeed while taking this drug.

This list of drugs and conditions that may interact with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s advice.

What do I need to know or do while taking this drug?

• Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Avoid driving or doing other tasks or jobs that require alertness or keen eyesight until you know how this drug affects you.
• If this drug is taken for a long time or at high doses, its effectiveness may be reduced and a higher dose may be needed to achieve the same effect. The so-called tolerance to the drug develops. Talk to your doctor if this drug stops working as you want. Do not take the drug in higher doses than prescribed by your doctor.
• Long-term or regular use of this drug may lead to dependence. Sudden discontinuation of this drug may lead to so-called “withdrawal” symptoms. Talk to your doctor before reducing your dose or stopping this drug. You must follow the doctor’s instructions. If you experience any side effects, check with your doctor.
• You may need to have a heart test before you start using this drug. If you have any questions, please consult your doctor.
• This drug may cause high blood pressure.
• Measure your blood pressure and heart rate as instructed by your doctor.
• Perform blood tests as directed by your doctor. Consult with your doctor.
• This drug may affect the results of some lab tests. Tell all your health care workers and laboratory staff that you are taking this drug.
• Do not take antacids with this drug.
• You may need to refrain from drinking alcoholic beverages with certain medications. Ask your doctor or pharmacist if you should not drink alcoholic beverages containing this medicine.
• New or worsening of existing mood and behavior changes, such as changes in thinking, anger and hallucinations, have happened with this drug. If you or someone in your blood family has been diagnosed with a mental or emotional disorder, such as depression or bipolar disorder, or if someone in your family has committed suicide, tell your doctor. If you experience hallucinations, movement disorders, or signs of emotional distress such as depression, suicidal thoughts, nervousness, emotional ups and downs, distorted thinking, anxiety, or decreased interest in life, see your doctor immediately.
• This drug may increase the risk of seizures in some people, including people who have had seizures in the past. Talk to your doctor to find out if your risk of seizures is increased with this drug.
• When this drug is taken with certain other drugs, a bad and sometimes deadly condition called serotonin syndrome can develop. Call your doctor right away if you experience agitation, balance problems, confusion, hallucinations, high fever, tachycardia or abnormal heart rhythms, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , severe headache.
• In some cases, the drug may affect the growth rate in children and adolescents. They may need regular growth rate checks. Consult your doctor.
• Different brands of this drug may be for use in children of different ages. Talk to your doctor before giving this drug to a child.
• Tell your doctor if you are pregnant or plan to become pregnant. The benefits and risks of taking this drug during pregnancy will need to be discussed.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor or get medical help right away if you have any of the following signs or symptoms that could be associated with serious side effects:

• Signs of an allergic reaction, such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly accompanied by fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat.
• Signs of high blood pressure, such as a very severe headache, or dizziness, or loss of consciousness, or blurred vision.
• Signs of a urinary tract infection, including blood in the urine, burning or painful urination, frequent or immediate urge to urinate, fever, pain in the lower abdomen or pelvis.
• Inability to achieve or maintain an erection.
• Change in sex drive.
• Seizures.
• With problems in controlling body movements.
• Anxiety.
• Vision change.
• Frequent or prolonged erections (hardening of the penis).
• Change the color of brushes, feet or other areas. The skin may become pale, bluish, grey, purplish, or red.
• Numbness, pain, tingling, or cold feeling in the hands or feet.
• Any sores or sores on the fingers or toes.
• Pain or weakness in the muscles, dark urine, difficulty urinating.
• Myocardial infarction, stroke, and sudden death have happened in adults who have taken this drug. Sudden deaths have also been reported in children with some cardiac disorders or heart defects. Call your doctor right away if you have a fast, slow, or irregular heartbeat; weakness on 1 side of the body; difficulty speaking or thinking; imbalance; omission of 1 side of the face; changes in vision; chest pain or angina; dyspnea; severe dizziness or fainting.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Contact your doctor or seek medical attention if these or any other side effects bother you or do not go away:

• Nervous tension and agitation.
• Headache.
• Sleep disorders.
• Constipation, diarrhea, abdominal pain, nausea, vomiting, or decreased appetite.
• Feeling dizzy, tired or weak.
• Dry mouth.
• Violation of taste perception. This,
• Weight loss.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report the development of side effects to the national health authority.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

Tablets:

• Take this drug with or without food.
• Take your last daily dose at least 4 hours before bedtime.

Sustained release capsules:

• Take this drug with or without food. Some medications must be taken the same way each time, either with or without food. You must know for sure if this drug is taken with food. If you have any doubts about whether the drug is dependent on food, consult your doctor or pharmacist.
• Take in the morning.
• Swallow whole. Do not chew, break or crush.
• You can sprinkle the contents of the capsule on applesauce. Don’t chew.
• Take the dose immediately after mixing. Do not store for future use.

All forms:

• Talk to your doctor before taking an over-the-counter drug that can raise blood pressure. These drugs include cough and cold medicines, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and some natural products.

What if I miss a dose of a drug?

Tablets:

• Take the missed dose as soon as you can.
• If it’s time for your next dose, don’t take the missed dose and then go back to your regular dosing schedule.
• Do not take 2 doses or an additional dose at the same time.

Sustained release capsules:

• Skip the forgotten dose and return to your regular schedule.
• Do not take the drug later in the day.

How do I store and/or discard this drug?

• Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
• Keep this medicine in a protected place out of sight and reach of children and out of the reach of other people. A box or room that is locked with a key can act as a secure storage place for the drug. Keep all medicines out of the reach of pets.
• Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General information about medicines

• If your health does not improve or even worsens, see your doctor.
• Do not give your medicine to anyone and do not take other people’s medicines.
• Some medicines may come with other patient information leaflets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
• A separate instruction for patients is attached to the drug. Please read this information carefully. Reread it each time you refill your supply. If you have any questions about this drug, ask your doctor, pharmacist, or other health care professional.
• If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient.