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Primary Care Physicians in the Evaluation and Treatment of Adult ADHD

Primary care physicians (PCPs) remain the gatekeepers of medicine and are on the front-lines of diagnosis, evaluation, and treatment of a plethora of conditions. Adult attention-deficit / hyperactivity disorder (ADHD) is diagnosed systematically and the initial tool for diagnosis is a 6-item screening questionnaire, the Adult ADHD Self-Report Scale (ASRS-v1.1). Should their responses warrant further clinical inquiry, a complete physician evaluation must be performed, specifically determining symptoms, duration, origin and other important parameters leading to a diagnosis. Although PCP’s can successfully treat many patients, those afflicted with multiple co-morbid conditions may require referral to a specialist for evaluation and treatment.

While psychosocial treatments including cognitive behavioral therapy have demonstrated efficacy, several FDA-approved pharmacological therapeutic options exist for the treatment of adult ADHD including: stimulants (methylphenidate / amphetamine), and non-stimulants (atomoxetine). The majority of adult ADHD patients are not appropriately diagnosed and treated, while the presence of co-morbid conditions further confound treatment results, rendering them clinically ineffective.

Click here to review ADHD self-assessment tools from NYU Langone Health.

Lenard A. Adler, MD
Professor of Psychiatry and Child and Adolescent Psychiatry / Director, Adult ADHD Program
NYU School of Medicine

References:

Gentile JP, Atiq A, Gillig PM. Adult ADHD Diagnosis, Differential Diagnosis, and Medication Management. Psychiatry (Edgmont). 2006 Aug; 3(8): 25-30.
PMCID: PMC2957278.

Gibbins C, Weiss M. Clinical recommendations in current practice guidelines for diagnosis and treatment of ADHD in adults. Curr Psychiatry Rep. 2007 Oct;9(5):420-6. Review. PubMed PMID: 17915083.