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adult ADHD international

International Adult ADHD Evaluations with David W. Goodman, M.D.

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There is a tremendous international need for accurate diagnoses of ADHD in adults. With so few clinicians around the world trained in ADHD, people ask me to see them. With telepsychiatry, this now becomes a possibility. Visit us at www.ADDadult.com.

I recently conducted a comprehensive psychiatric evaluation of a 22 year old male residing in the Phillipines via Zoom, a video software. (I’m located in Baltimore, Maryland, U.S.A.-12 hour time difference). For 90 minutes, we were able to cover his life-long history of ADHD symptoms inquiring about other psychiatric symptoms that would indicate other disorders, the medical/developmental history, and the academic and social impairments experienced. With Zoom’s screen sharing, the man could complete the ADHD Rating Scale used to assess childhood symptoms and the Adult Self-Report ADHD Scale indicating current symptoms. As an outside informant, his aunt provided additional developmental history and trajectory of ADHD symptoms since childhood.

His aunt sought me out after hearing my lectures on adult ADHD. Because of advances in technology, the Zoom session went smoothly and allowed for an easy exchange of information.

Most importantly, the man said he was relieved to have had this evaluation and given some direction on how to manage. I did suggest medication would likely be effective and he was receptive.

Most countries have medications available to treat ADHD BUT they are often only used for children. A limited number of clinicians around the world are comfortable using these medications for adults with ADHD.

And so this is the challenge in seeking treatment after you’ve had the evaluation. Since I’m unable to prescribe medication outside the U.S., patients will need to find a clincian in their country and area.

Hopefully, with a full report from me, perhaps a doctor in your area would be reassured of the accuracy of the diagnosis in order to initiate medication. Of course, the effective use of the medication will depend on the doctor’s experience with ADHD medications.

Unfortunately, there are some countries that have banned stimulant medications entirely. Luis Augusto Rohde, professor of child psychiatry at Brazil’s Federal University of Rio Grande do Sul, and former president of the World Federation of ADHD has noted Russia, Algeria, Egypt, Morocco, and Jordan are in this group. However, treatment options for ADHD include behavioral/organizational skills beyond medications.

Most importantly, it is the relief that comes from knowing your ADHD is what you have, not who you are.

If people around the world think they have ADHD, help is available. Before seeking an evaluation, go to credible websites (ADDadult.com; CHADD.org; CADDRA.org; ADHD Europe; and read/listen to information to see if it describes your experiences of your life. If so, we may be able to help.

Elected to the Board of Directors of American Professional Society of ADHD and Related Disorders

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The American Professional Society of ADHD and Related Disorders is an organization of national and international researchers and clinicians. I was honored to be invited to present “Adult ADHD and Medication Treatment Options” at the annual conference held in Washington, DC in September 2013. During the conference, I was nominated and elected to the Board of Directors consisting of 15 experts from around the world. This is an opportunity for me to directly participate with the international community of experts and assist in disseminating the state-of-the-art research and clinical treatments. In addition, I will provide assistance in the pre-publication peer review process for the Journal of Attention Disorders.

I look forward to making my contributions on behalf of all the people with ADHD and their families. Thank you for your interest.

David W. Goodman, M.D.

Faculty speaker, annual American Professional Society for ADHD and Related Disorders conference

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American Professional Society for ADHD and Related Disorders (APSARD) is an organization founded by a national and international group of experts in ADHD treatment and research. The annual meeting, “ADHD Advances: Challenges and Opportunities” being held September 27 – 28, 2013 at the Hyatt Regency Washington on Capitol Hill in Washington, DC  brings together these experts and other professionals interested in learning and advancing their skills. The presentations are the cutting edge research, treatment options, and technology developments to further our understanding of ADHD and the co-existing psychiatric and medical disorders.  Information and discussions extend beyond U.S. research to include Canadian, European and Middle East research and treatments.

I am honored to be invited to present a 60 minute workshop on the “Choice and Optimal Dosing of Medications for Adults with ADHD” with my co-presenter Dr. Janet Standard, a psychiatric Advanced Practice Nurse at the NYU Health Services. 

The conference is open to professionals in the health care field and registration is available now. . this link, you can browse the conference agenda, location, and hotel accommodations. This is a top-level, relatively small conference that allows all participants to engage and exchange thoughts and ideas. If you are in the field of ADHD, this is a conference not to miss. See you there.

David W. Goodman, M.D.

ADHD Treatment in New Zealand

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psychiatrists at the University Hospital, Auckland, New Zealand for the purpose of exchanging perspectives on diagnosis and treatment of ADHD across the life span. Many of the physicians had been to U.S. conferences that covered this topic so they were familiar with U.S. perspective.

Although we all agree on the validity of ADHD as a psychiatric disorder, there were some clear differences in approach. First, it is important to know that the only stimulant medications available in New Zealand are methylphenidate compounds (Ritalin, Ritalin LA, Concerta). They do not have any amphetamine preparations (Dexedrine, Adderall, Adderall XR, Vyvanse). Without clinical experience with amphetamines, there were a bias against them believing that they represented a “stronger and potentially more addictive”.

Although 50-60% of ADHD patients will respond to either stimulant compound (methylphenidate or amphetamine), about 25% of patients will respond better to one vs the other. Without amphetamine, there are a group of patients that won’t be optimally treated.

When physicians lack experience in using some medications, there is a bias that develops against the medication. This phenomenon develops beyond just ADHD into the rest of medical treatments.

Another issue in New Zealand is the rare physician who will treat ADHD in adults. Not only are adults unlikely to get newly diagnosed as adults, but children diagnosed with ADHD who grow to adulthood will find it difficult to obtain ongoing medication treatment. Apparently there is a special license needed to prescribe stimulant medications and very few adult physicians have such a license.  Physician pursuit of such a license is not high. The perception is that adults with ADHD are quite rare. This belief is in contrast to numerous studies showing world-wide prevalence rates between 2-6% in adults.

What will usually drive an increase in treatment of medical disorders is the increasing number of effective treatments. One can see this in the history of depression treatment. As more antidepressants came on the market after Prozac, the rate of depression treatment increased over time. Now most depression is treated, not by psychiatrists, but by primary care providers.  In fact, 80% of all psychotropic medications in the U.S. are prescribed by primary care providers

So, for my patients treated with amphetamine preparations that may be traveling in New Zealand for periods of time (eg student study abroad), we advise that a family member in the U.S. obtain an adequate supply of medication (usually 90 days though insurance plans) and ship the medication to the individual. If treatment is needed by a psychiatrist in New Zealand, there are several excellent and experienced doctors in Auckland and Christchurch.

When looking for expert physicians for adult ADHD, see my blog that offers instructions on locating such doctors around the world.

As always, thank you for your interest.

David W. Goodman, M.D. Read more…

Finding ADHD Experts Around the World

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Because my patients travel from the U.S. or come to consult me from other countries, the question of locating experts in ADHD, especially for adults, comes up often. Here is my suggestion to locate such an expert.

Go to www.pubmed.com.   This is the National Institute of Health website on medical publications.

In the search box, enter “ADHD” and the city and/or country in which you seek an expert.

Several publications will come up with authors in your designated location. Find one that is relevant, Open the link and you will see a summary of the publication.

The first author will often have an academic affiliation whose geography you can check. The first author often has his/her email address listed. You can email the author and ask if he/she sees patients or to whom he/she would refer someone for evaluation and treatment of ADHD.

You may have to go through emailing a few people to get to someone with the expertise you seek and is currently seeing patients.

Simple and effective. Hope this helps those who stumble across this blog.

David W. Goodman, M.D.