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Adult Attention Deficit Hyperactivity Disorder

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.

Dr. David W. Goodman on CHADD Webinar Ask the Expert April 18, 2019 at 2pm LIVE

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“What can I expect as an adult from my ADHD treatment in the first 6 months?”

I have been invited to speak online LIVE for the Children and Adults with ADHD Association Webinar Series “Ask the Expert”. I will discuss 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.

Register for the Webinar at CHADD.org and find out what you can expect from treatment. I’ll post the link as soon as CHADD sets it up.

Dr. David W. Goodman Interview by NPR Morning Edition May 29, 2017

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National Public Radio recently posted my interview (click on “Heard on Morning Editon”) from April 2017 about a research publication reviewing a revised adult ADHD screener developed in coordination with the World Health Organization. What the journalist didn’t know at the time that I will share with you is that I was a pre-publication peer reviewer on this study. That means I was very knowledgeable about the details of the study and had offered my critique to the publisher prior to publication. For additional background on this screener, see my previous blog.

 

Now, let’s address the audio quotes.

Dr. Lawrence Diller says “I don’t know what ADHD is anymore” referring to changes over the past 3 decades of changes in the Diagnostic and Statistic Manual used to establish diagnostic criteria for psychiatric disorders. I’m surprised by his comment given 20+ years of international research (tens of thousands of scientific publications from around the world) that has better defined the symptoms and impairments of ADHD. It is this research that has contributed to better defining ADHD in children and the progression of ADHD into adulthood  therefore accounting for the evolution of changes in the current DSM 5. The diagnosis of ADHD is not based on a cluster of symptoms at one point in time. The diagnosis is based on the cluster of symptoms as they impair the person over the course of their life. Everyone has some inattention and distractibility at some point but few have the symptoms since childhood that have never gone away and are observed by others as a problem.

How about Alan Schwarz’s comments who disqualifies published peer reviewed science by indicting the experts and researchers who have conducted research with and without pharmaceutical support. To indict the international ADHD research community would be to suggest an international conspicacy of hundreds, if not thousands, of physicians and psychologists across 7 continents. This is a basic journalistic method (shoot the messager) to distract readers from the merits of an issue. I have personal experience with Mr. Schwarz who took to indicting me in his New York Times article when he conveyed to readers that I was advocating teaching primary care physicians how to diagnosis ADHD based on a short video clip. What he deliberately chose not to include in his article was the fact that the video was a visual representation accompanying a 2500 word, 168 scientific references, and peer reviewed article. Focused only on his agenda to act as “educator” to save the “victims” of ADHD medications from the “villians” of doctors, he deliberately misrepresented information for his self-serving purposes.

So, I’ll leave you with my saying, “The credibility of information is dependent on intent of the provider”. A salesperson gives you only information he/she wants you to have to close the sale. An educator gives you information so that your interest is best served first. You need to carefully discern this for yourself.

I will continue to present science in the halls of opinions.

Thank you for your interest….and focused attention.

David W. Goodman, M.D., FAPA

Dr. David W. Goodman interviewed by Vox.com Misdiagnosis of ADHD

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Dr. David W. Goodman was video interviewed by Vox.com on misdiagnosis of ADHD as a counterpoint to Dr. Allen Francis, psychiatrist, who believes ADHD is overdiagnosed. The video is excellently edited and very engaging. While it is easy to say ADHD is overdiagnosed because of the extensive media coverage, it is not overdiagnosis. The basis for my opinion lies in the research facts: 4.5% of US adults ages 18-44 are believed to have ADHD, a diagnosis whose basis is the persistence of symptoms since childhood of which 75% were never diagnosed as children. Of the adults with ADHD in the U.S., only 25% have been treated in the last year. With the prevalence rate of ADHD internationally ranges from approximately 2-10%, appallingly few adults outside of the U.S. are identified and treated.

Setting aside those adults who are accurately diagnosed  with a comprehensive evaluation, there are patients who are given the diagnosis of ADHD and don’t have it. Inadequate clinician training, little time spent obtaining the history, and strong patient demand for ADHD can lead to misdiagnosis. These patients who do not have ADHD should not be placed on stimulant medication. More often, primary care clinicians are prescribing short-acting stimulants which can be abused, misused, and sold/given away to friends/customers.

SOME FACTS:

65% of all stimulants prescribed in the U.S. are prescribed primary care clinicians; 55% of all stimulants prescribed are short-acting; four international guidelines for the diagnosis and treatment of ADHD recommend long-acting stimulants as first line medication, not short-acting.

Well, that’s enough science for today. I provide this information so that if you are in a conversation about this topic, you are armed with meaningful data, beyond opinion.

As I have said before in my blogs, let science be the designated driver on the highway of opinions.

Dr. David W. Goodman interviewed by NPR April 4, 2017

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National Public Radio  interviewed me this week to comment on a research publication about a revised adult ADHD screener developed in coordination with the World Health Organization. What the journalist didn’t know at the time, that I will share with you, is that I was a pre-publication peer reviewer on this study. That means I was very knowledgeable about the details of the study and had offered my critique prior to publication.

As background, my colleagues just published a research paper revising the adult ADHD screener developed in coordination with the World Health Organization. Because of the diagnostic changes from DSM-IV to DSM-5, the previous adult ADHD screener needed to be revised accordingly.  While the six question screener looks rather basic, the article details the rigorous methodology and statistical factors that contributed to the selection of each of the six ADHD questions.

It should be enphatically stated that the screener simply allows clinicians to identify adults who may have ADHD, but it in no way makes a diagnosis. Because primary care clinicians are increasingly requested to provide mental health diagnoses and treatment. Because their time spent with patients is limited, the screener simply highlights someone who has some symptoms.  This encourages a further evaluation by someone with adult ADHD expertise.

Given that ADHD is a world wide disorder, the World Health Organization has been very interested in developing a preliminary screener to be performed in the offices of clinicians around the world. The previous screener has been translated into many languages to be used internationally.

To those who follow my blog, I apologize for the delinquency in posting any recent material.  My time has been consumed taking care of patients, developing slide decks to educate clinicians, serving on the national boards of directors for APSARD ( American Professional Society for ADHD and Related Disorders Association) and CHADD (Children and Adults with ADHD Association),  and working with journalists in order to present the latest science of ADHD.

Thank you to those who continue to read my blogs.

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

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

click to read abstract

Dr. David W. Goodman ADHD in older adults U.S. News and World Report March 2016

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Since the recent publication of our literature of published research on ADHD in adults over age 50, several news outlets have been interested in bring this subject to the public eye. ADHD in adults persists throughout one’s life. It does not go away because you got your AARP card or Medicare benefits.

Because I believe in the importance of accurate diagnosis and effective treatment for ADHD regardless of age, I wrote an editorial piece that U.S. News and World Report published online on March 7, 2016. This article was picked up by several news (Yahoo News) and professional organizations (American Professional Society for ADHD and Related Disorders – an organization of international clinicians and researchers, and the National Resource Center-a CDC funded organization affiliated with Children and Adults with ADHD Association CHADD).

For most people with ADHD, it is a lifelong condition to be understood, appreciated, respected, and treated effectively. Quality of function and life are greatly effected regardless of your age. I always encourage people with lifelong symptoms of ADHD to get a competent evaluation and learn more about managing these symptoms to improve daily functioning.

 

Dr. David W. Goodman interviewed by WOSU (NPR) on Adult ADHD January 26, 2016

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It appears that the topic of ADHD in older adults is catching some attention. I was invited by Ann Fisher of WOSU Radio (NPR affiliate) in Columbia, Ohio to discuss adult ADHD especially in older adults. The host, Ann, asked insightful questions about identification and diagnosis in older adult and how that’s different from younger adults and children. We also covered treatment options including medication and cognitive behavioral therapy.

I am very excited that some media outlets have decided that ADHD in older adults is an opportunity to increase public awareness that “ADHD is not just for kids.”

I invite you the listen to the 20 minute interview. You can find it here. On the time scroll bar, move it to 14:40 minute mark to listen.

David W. Goodman, M.D.

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