ADDA Newsletter  American Deficit Disorder Association 

ADHD in Adults
By Judy Brenis
  
         “ADHD in adults is REAL,” says Jonathan Marx, MBA, Senior Vice President of InQuill Medical Communications, an award winning medical education and communications company with expertise in adult learning and multi-media web technologies. “Most people don’t realize that adult ADHD is a serious disorder that, untreated, can wreak havoc on families, results in high rates of divorce, job loss, life-threatening accidents, alcohol and drug use disorders, and lower achievement levels and income.”
         Marx and his wife Johanna Lackner Marx, MPH MSW CCMEP, founder and president of InQuill, are currently part of a national education project funded by a generous grant from AHRQ (the Agency for Healthcare Quality and Research), a Division of Health and Human Services of the United States Government, which has identified ADHD in adults as a priority condition for funding in health education. The project is a partnership between InQuill, The American Professional Society for ADHD and Related Disorders (APSARD) and the National Association for Continuing Education (NACE).
         “There are approximately 10 million adults in the United States with ADHD,” according to Marx, “and of those 10 million, only 10 percent have been diagnosed and treated,” he points out. “It wasn’t until the 1980’s that ADHD in Adults was even recognized as a legitimate disorder that begins in childhood, and almost 70 percent of the time, continues into adulthood.”
         “But the word is getting out and that’s a good thing,” Marx says. “We have got the participation of the best ADHD clinicians and researchers in the country, who are taking part in this campaign, called the “Adult ADHD Research Dissemination Partnership Initiative”. They are helping us provide the latest information and updates to primary care physicians, physician assistants, nurses and other health care professionals. We’re also using the latest technologies in our accredited online education courses to help train these health care professionals on the realities, diagnosis and treatments for ADHD in Adults (www.adhdinadults.com).”
         Principal investigator for this project, Stephen V. Faraone, PhD, a psychologist, and Distinguished Professor of Psychiatry and Neuroscience and Physiology at SUNY Upstate Medical University, explains that while primary care physicians are the first line of diagnosis and treatment for most adult ADHD patients, they are poorly educated about the disorder, as well as the medications used to help offset some of the challenges of ADHD. Primary care physicians (PCP’s) are also concerned about the safety of prescribing stimulant medication, at times fearful patients are coming into their practice solely to obtain these drugs.
         As a result, in order to educate and address these concerns, Faraone, along with other researchers such as Lenard Adler of New York University and Anthony Rostain, a professor of psychiatry and pediatrics at the University of Pennsylvania and currently Director of Education for the Department of Psychiatry at the University of Pennsylvania MD, have identified five practice gaps in the treatment of adult ADHD in primary care. They are:
         Recognition: symptoms of inattention, disorganization, procrastination, poor impulse control, over activity, academic or occupational underachievement and problems in social functioning which are not recognized by many primary care physicians as signaling that the patient should be screened for ADHD.
Diagnosis: PCP’s are unaware of, and under-utilize well-validated ways to screen for ADHD. PCP’s need to learn about such tools to identify the presence of ADHD symptoms, their severity and frequency, and the degree to which such symptoms may be causing impairment in functioning.
         Choice of pharmacologic treatment regimens: Once the diagnosis of ADHD is made, PCP’s still requiring guidance in choosing the appropriate medication, which takes each individual’s symptoms and possible other disorders into account. It is important for PCP’s to know that many adults with ADHD also suffer from disorders such as depression, anxiety, etc.

         
       
           
Long-term management of ADHD and communication: ADHD is a chronic disorder that requires treatment adherence and long-term management. Adult patients are generally uninformed about their ADHD and this is an ideal setting in which to explain important information regarding what ADHD is, how it impacts the executive functioning skills such as time management, priority setting, organization, focus; and what can be done to manage it.Use of non-pharmacologic interventions: Among PCP’s, there is a lack of knowledge about what can be done to treat ADHD instead of, or in conjunction with medication such as cognitive behavioral therapy, nutrition, acupuncture etc.
         In fact, Faraone is co-editing a book to be released in the fall of 2014 that addresses the use of non-pharmacologic interventions for ADHD. In the book, experts in the field explore the use of nutritional treatments, cognitive behavioral therapy, Chinese medicine, and neuro-feedback just to name a few.
         “Education for PCP’s regarding the diagnosis of ADHD is a crucial first step toward improving the health of adult ADHD patients,” Faraone says.
         This is where Marx steps in, creating online materials such as the ADHDinAdults.com website, webinars, and long and short form videos for health care professionals to take advantage of while earning Continuing Education Credits (CMEs). Faraone shares his expertise in one video on how to treat ADHD with medication. He talks about patient safety when using stimulant medication. Adler presents another two seminars on how to diagnose and test for severity of ADHD, and one in which he discusses cognitive behavioral therapy, found to be very effective in treating ADHD, according to Faraone. Marx has also created five or six shorter webinars on screening, and diagnosing other disorders that often go along with ADHD.
         Faraone points out that it is important for PCP’s to understand that when treating a patient for depression or anxiety, for example, that the patient may also be dealing with ADHD and to look for that as well.
         After launching the Web site in January 2014, just last year, Marx says they have had over 250 sign-ups per month, which puts them right on target for their goal of training 5,000 professionals by the end of next year. Videos on You Tube have received more than 1,500 hits.
         “The magnitude of under-treatment is a serious public health problem,” Marx reiterates. Using Google’s keyword tool, we found that there are an average of 246,000 searches each month using the term “adult ADHD.”
         In the future, Marx says they are looking to build a leadership-base of physicians, nurses, nurse practitioners and physicians’ assistants, who want to take this research and information about ADHD and bring it to their patients for the benefit not only of the patients, but the millions of people who support them. “We have fertile ground now in the treatment of ADHD. We have the research that proves it exists. We have the medications and treatment modalities that are successful. All we need now is to get the information out there so that everyone can benefit.”

ADHDinAdults.com

ADHD in Adults is a partnership of four organizations expert in ADHD, physician education, and adult learning. They are The American Professional Society of ADHD and Related Disorders (APSARD), Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), The National Association for Continuing Education (NACE), and InQuill Medical Communications.

Judy Brenis is an ADHD coach based in Santa Cruz, California. ADHD has touched her life in the form of her 22-year-old daughter who was diagnosed with ADHD at age five, and Judy is passionate about helping those with ADHD create successful, happy, and healthy lives. Reach her at www.judyadhdcoaching.com.