-There are no US guidelines for the diagnosis and treatment for adult ADHD?
-It takes many years for medical guidelines of any medical diagnosis to be published?
-Only Australia, Canada, Europe, Germany and the United Kingdom presently have published guidelines for adult ADHD?
Why, you ask, does this matter? Imagine that you as an adult realize that you may have ADHD. You were not diagnosed as a child, but you are suffering from life long symptoms: underachievement, hyperactivity, impulsivity, inability to focus, difficulties with executive functioning, etc. You speak to your doctor and tell them that you think you might have ADHD. They look at you blankly. They say to you, “Well were you diagnosed as a child? Why are you bringing this up now? I don’t know anything about ADHD. You seem to have done fine, you’re an accomplished adult.” Or the worst statement of all, “Oh, you don’t have ADHD, that’s a childhood disease.” (Yes, I know of more than one person whose doctor said this to them.) Many doctors simply don’t know much about ADHD, especially those who aren’t pediatricians. They don’t know what to say, let alone what to do with someone who presents themself with ADHD issues. Don’t you think these responses are ineffective, placating and dismissive? What is even more bothersome, is that doctors simply do not know much if anything about ADHD. Please understand, I am not throwing every physician under the bus here. But it is widely known that the medical community simply does not have the knowledge to address adult ADHD. Many well meaning physicians will then pass you along to a psychiatrist. But even finding psychiatrists who have experience and knowledge in adult ADHD are very difficult to find. And if you do find a psychiatrist who is well versed in ADHD, it can either take months to get in to see them or they don’t take insurance of any kind.
On another side of the coin, was the probable overdiagnosis of ADHD during the pandemic, and the plethora of online testing, diagnosis and again, probable over and inappropriately prescribing of stimulants. There seemed to be hundreds of online mental health sites offering diagnosis and prescriptions for all kinds of mental health issues. Many of those sites ended up being shut down over time. And there was true risk of people becoming addicted to those wrongfully prescribed stimulants.
The Diagnostic and Statistical Manual of Mental Disorders V (DSM) is the handbook used by healthcare professionals in the United States and much of the world as the authoritative guide on the diagnosis of mental disorders. DSM contains descriptions, symptoms and other criteria for diagnosing mental disorders. The DSM 5 (5th edition) in its description of ADHD does not address ADHD in adults. Yes, typically ADHD is diagnosed most often in children, but many children aren’t diagnosed and when they mature into adults, they suddenly find themselves unable to cope with work or school or life. It is then very difficult to get diagnosed and treated. There are many adults suffering from a plethora of ADHD symptoms that their physicians just simply don’t know what to do.
There is good news though on the horizon for the U.S. I attended a session at the International Conference on ADHD about the progress taking place right now in the development of Adult ADHD guidelines. The impetus for developing these guidelines were in response to the telehealth diagnosis and prescribing of ADHD medications during the pandemic. The American Professional Society of ADHD and Related Disorders (APSARD) were concerned about the overprescribing of stimulants and the possibility of creating another opioid-like epidemic. The two leading physicians from APSARD described the process of developing the guidelines. As you can imagine, it takes years for any kind of government medical guidelines to get accepted and published. Those of us attending were informed about the process and the timeline. It looks like if all goes to plan and there are no more delays, there should be US ADHD adult guidelines in 2025. This will help thousands of adults with ADHD, get diagnosed and treated with consistent and well documented care. For Ryan, this also means that his physicians and therapist will have guidelines to help treat him as an adult and not have to rely on just their own experience or articles written in medical journals. What a wonderful hope for the future. Physicians and psychotherapists will be able to easily access this information and help their patients. I look forward to the day when these guidelines are finally published.
If you want to read more about the process and information about the guidelines please click on the APSARD link below:
US Guidelines for Adults with ADHD
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