Menu

adult ADHD treatment

“What can I expect as an adult from my ADHD treatment in the first 6 months?” David W. Goodman, M.D. CHADD Webinar

, , , , , , , , , , ,

If you were recently diagnosed with ADHD as an adult, I invite you to listen to this webinar. I was asked to speak online LIVE for the Children and Adults with ADHD Association (CHADD) Webinar Series “Ask the Expert”. I discussed the benefits of ADHD treatment as they unfold over the first 6 months of treatment. If effectively treated with the sequence of medication and psychotherapy, there is a predictable pattern of improvement that can be expected. Understanding this pattern will help you discover what gets better and when. Patients and families are often amazed that I can predict what will happen over the first 6 months and you may be too.

Because it is a long all inclusive video, you may choose to watch two months at a time depending on where you are in treatment. I would encourage the ADD adult to share this video with family members in the house. It will faciliate discussion and help others understand how to be helpful.

I owe my patients the insight I have gained from their journey of distress to satisfication. Hopefully this is helpful to you.

David W. Goodman, M.D.

Dr. David W. Goodman invited to speak at the Neuroscience Education Institute in Las Vegas, April 2020

, , , , ,

A faculty speaker for the Neuroscience Education Institute (NEI) for many years, I have been invited to present several talks on adult ADHD and the complexity of medications. There are currently 28 different ADHD stimulant preparations (my last count). While there are only 4 different chemical compounds (methylphenidate, d-methylphenidate, amphetamine, d-amphetamine), the technologies delivering medication have exploded. With so many options, individual selection for each patient is possible. Good news for patients. Confusion for prescribers.

One of my presentations will focus on how to think through the medication options. How do you decide on the chemical compound? How do you select the delivery system? What medications interactions are concerning and what are not? Will side effects change if the deliver system is changed, even though the medication compound is the same?

Patients can help prescribers understand their experience with the medication by describing:

  1. What positive cognitive effect do you notice with the medicine? What time do you take it and when do you notice it’s cognitive effect wearing off.
  2. What side effects do you notice and when do they occur relative to taking the medication? Do the side effects occur 1-2 hours after taking medicine or do the side effects occur when it is wearing off? What side effects are subsiding and which ones are persisting?
  3. Can you afford the medicine? There are large price difference between medications. Without understanding the range of options (remember: 28 different stimulant preparations), you may not know there is a more affordable option.
  4. Can you swallow the medicine? There are several different forms: tablet, liquid, chewable, patch. All these forms have long-acting delivery systems so once daily dose is still possible.

The biggest challenge for prescribers now is the obstacle of insurance prior authorization and approval. This is an increasing frustration for patients and prescribers who work hard to find the right medication only to have insurance companies “decide” what medication is “appropriate” for you, the patient. Work with you prescriber to negotiate this obstacle course. Every time a patient changes insurance policy, these issues raise their head. Even if you have been stable on medication, the new insurance policy may deny future coverage. Oh, boy. Now that’s scary.

Believe it or not, I intended to describe my upcoming talks in April but got distracted by what I believe are important issues for patients to understand. It is the doctor in me to come back to the patient treatment and benefit.

Thank you for your valuable time. David W. Goodman, M.D.

Addendum: Because of COVID-19, this Neuroscience Education Institute conference was postponed and has been scheduled for Colorado Springs, Colorado November 5-8, 2020.

A Randomized, 6-week, Placebo-Controlled Study of Treatment for Adult Attention-Deficit Disorder: Individualized Dosing of Osmotic-Release Oral System (OROS) Methylphenidate With a Goal of Symptom Remission

, , , , , , , , , , ,

Goodman DW, Starr LH, Yi-Wen M, Rostain AL, Ascher S. Armstron RB. J ClinPsychiatry 2017;78(1):105-114.

click to read abstract

The New York Times: Older Adults with ADHD

, , , , , , , , , , , , , , , , , ,

On September 30, 2015, The New York Times ran an article in the Tuesday Science section on ADHD in older adults. I was interviewed for the article and discussed a former patient age 73 who was first diagnosis with ADHD by me and successfully treated. The article is an introduction into an important clinical area for ADHD heretofore ignored. As we discovered, 60% of children will continue to have ADHD symptoms to an impairing degree into adulthood. The presumption is that ADHD in adults will simply continue throughout one’s life. However, the research is only just accumulating to support this assumption. The largest collection of research in this age group is published by my colleagues in Amsterdam and additional research from other research groups around the world.

Early this year I  wrote an article for CHADD’s Attention Magazine on issues related to diagnosis and treatment of ADHD in older adults. The diagnostic issues and treatment considerations in older adults are more complex. In brief, diagnosis needs to consider medical illnesses, medications, history of head trauma, and other medical illness that worsen thinking ability. Treatment consideration are complicated by the presence of medications and medical illnesses that might limit the use of ADHD medications. Older patients and families considering an evaluation for possible ADHD should see a psychiatrist or mental health professional who has expertise and experience treating adults with ADHD.

Remember, while attentional changes occur in those of us over age 50, the cornerstone for the diagnosis of ADHD is the presence of symptoms since childhood that are relatively chronic and unchanged over one’s life and that these symptoms cause impairment in daily functioning. A comprehensive evaluation of all possible psychiatric and medical is critical for the accuracy of the diagnosis.

David W. Goodman, M.D., FAPA

Reliable ADHD information

, , , , , , , , , , , , , , , , , , , , , , , , , , ,

If you’re reading this blog, you are one of the millions of people who now use the Internet to gain information on medical issues. In a recent survey of consumers, this is where people are looking for medical information.
Most accessed online resources:
53% web M.D.
22% Wikipedia
19% health magazines and websites
16% advocacy group websites
12% YouTube
10% Facebook
10% blocks
9% Pharma company websites
(results from third annual national consumer survey by Makovsky Health and Kelton, 2014)

I would like to take this opportunity to direct your attention to the attitude magazine website that has a large number of webinars from noted academic and professional experts in ADHD. For many with ADHD it’s often easier to watch a video on a specific ADHD topic then to read a book. While many with ADHD can sit and read for extended periods of time, it always struck me as odd that clinicians referred patients to books knowing their ability to sustain attention would be limited, especially in the evening when it medication affect us dwindled.

Explore the webinars on this site as a can be extremely helpful. On this blog site, I will continue to direct my patients in readers to reliable sources of information and clinical insights from my practice not available elsewhere.

ADD stimulant substitution by insurance prohibited in Maryland

, , , , , , , , , ,

Step therapy is the requirement that a patient first try less costly medication before being prescribed medication a doctor thinks is best for the individual patient and specific symptoms/history. In the recent past, insurance companies had requested that adults with ADHD first be treated with a short-acting stimulant despite the fact that no short-acting stimulant is FDA approved for the treatment of adult ADHD. More recently, many insurance companies request “prior authorization”. This is a paperwork process to see if the patient can be directed to less costly medication despite the fact that the “recommended alternative” may not last long enough during the day. I’m relieved now with the passage of a new law in Maryland that will prohibit this practice. The following text appeared in the Maryland Psychiatric Society newsletter May 29, 2014. MedChi is the state of Maryland medical association.

MedChi applauds the enactment of SB 622/HB 1233, a bill that addresses a dangerous health insurance practice known as “step therapy.” Step therapy (or “fail first” policy) jeopardizes patient health by requiring them to try and fail on up to five older, less effective treatments before the insurer will cover the treatment originally prescribed. This law protects patients and keeps treatment decisions in the hands of doctors. The Maryland Health Care Commission recently studied step therapy, and Senator Middleton and Delegate Bromwell introduced this bill to codify some of its recommendations. The Middleton/Bromwell legislation, which takes effect on July 1, prevents insurers from forcing patients who are already being effectively treated on a medication to undergo the step therapy process, and also prohibits insurers from forcing patients to try medicine the FDA has not approved for treatment of a specific condition. Maryland is the first state in the country to enact the latter provision. Evidence suggests that step therapy may increase overall health care costs. Patients forced to manage multiple insurer “steps” often endure additional trips to the doctor or pharmacy, with additional time off from work or child care. When patient treatment is unnecessarily delayed, manageable conditions can devolve into more difficult to manage diseases. From May 5 MedChi News 

I encourage my patients, their family and all those for who this applies to actively pursue and receive the most effective treatment and medication that works for them. And then let your insurance company know that you are an informed patient who will advocate for your legal right to individualized treatment.

Hope this is useful to you.

 

WYPR interview on ADHD with Dr. David W. Goodman

, , , , , , , , , , , , , , , ,

My discussion with Dale Archer, M.D. (psychiatrist, best-selling author) on WYPR September 27, 2014 about ADHD, over- diagnosis, and over-prescribed medications was lively. While Dr. Archer advocates “medication as a last resort” and “the goal of treatment is to get off medication” after learning new skills, I offered the research on medication benefit and a quality of life measure to evaluate medication utility. Certainly, treatment of ADHD at all ages incorporates behavioral therapy, organization skills, couple/family/individual therapies, and academic/occupational accommodations, in addition to medication, when indicated.

For those of you interested, the radio broadcast is available and runs 35 minutes. I invite you to listen and decide for yourself the merits of each position. Ultimately, this information best serves those who have ADHD and their families.

Dr. David W. Goodman quoted in The New York Times Today (December 15, 2013)

, , , , , , , , , , , ,

Today the New York Times published an article “The Selling of  Attention Deficit Disorder” by Alan Schwarz. This is a lengthy article highlighting the increased identification of people with ADHD and  the concomitant increase in the prescriptions of effective medications.  The article is a feature story on the New York Times website today.

Toward the end of this article I am  quoted for the authorship of a continuing medical education article I wrote for Medscape.com in August 2012. In the Times article, he references a six-minute video clip of an interview between physician and patient I had included in my Medscape article.  He uses my quote “That was not an acceptable way to evaluate and conclude that the patient has A.D.H.D.” to  indict me for using  the short video as an example of how to evaluate adult ADHD. He sat with me for 30 minutes in Washington DC and recorded our interview.  However, what he failed to mention in his New York Times article was that the video clip he referenced accompanied a 2000 word continuing medical education article with 86 scientific references that was estimated to take physicians 2.5 hours to complete.  It would appear that Mr. Swartz had an a priori agenda in presenting his information. His remarks in the article malign and misrepresents physicians’ and researchers’ commitment to exploring causes and effective treatments for ADHD.  Unfortunately this is not my first experience with journalists dispensing with facts that don’t support their biased premise.

This evening I composed my  Letter to the editor and have forwarded it to them.   Let’s wait and see what develops. And now you have the back story to my quote.  Thank you for your interest.

David W. Goodman M.D.

High school students and stimulant use in Baltimore

, , , , , , , , , , , , ,

Style magazine in Baltimore has  published an article in September 2012 edition on stimulant misuse in high school students in Baltimore. The article distinguishes between the use of stimulants for performance enhancement by students vs the use of stimulants to treat legitimately diagnosed ADHD in young adults. I, along with Dr. Alain Joffe, director of Johns Hopkins University’s Student Health Center, were interviewed for our thoughts on this important issue.  Students interviewed offer their perspective as well.

The take-home point for me as a psychiatrist treating late adolescents and young adults is to obtain a complete history of ADHD since childhood confirmed with input from a parent. Other co-existing psychiatric and medical condition are also considered. Only after I am confident of the presence of ADHD do I write a prescription and recommend behavioral/organizational therapy.

As it is important to treat those who need medication, it is equally important to not prescribe to those students who don’t have ADHD.

ADHD over age 50 – WebMD

, , , , , , , , , , , , , ,

For those with ADHD as an adult, it doesn’t go away.  According to the National Comorbidity Survey Replication study published 2006, of those with adult ADHD, 75% were not diagnosed as children.

In my practice it is not uncommon for patients over age 50 to be newly diagnosed. I provided my expertise in this area to the author of an article for WebMD published live this week. The “moral of the story” is it is never too late to get evaluated and seek treatment. Daily functioning can improve at any age.

Load More