ADHD Websites
Treatment of ADHD
Pharmacological options for treatment of ADHD include stimulant and non-stimulant medications. Benefits, risks, dosing regimens and side-effects of medications are discussed before a prescription is written. Students suffering from ADHD may require a supportive letter of accommodation and the template below is a useful guide. The benefits of medication are often enhanced by cognitive behavioral psychotherapy (CBT) and two suitable CBT books are listed in the “Recommended Reading” section of this website.
Academic Accommodations
Students struggling with symptoms of ADHD often benefit from academic accommodation, i.e. arrangements that allow a student with a disability a fair opportunity to engage in academic activities and fulfill essential course and program requirements. Examples of such accommodations include: assignment extensions, extra time when writing exams, counselling support, learning strategist, permission to tape record lectures, noise cancelling headphones or ear-plugs, peer-provided lecture notes, reduced course load, reduced number of examinations per day and writing exams in a quiet location.
Attention Deficit Hyperactivity Disorder (ADHD)
No rating scale can make a diagnosis of ADHD. However, scales are used to prompt a full psychiatric assessment.
The Adult ADHD Self-Report Scale (ASRS) has 18 questions reflecting the 18 symptoms of ADHD according to DSM-V.
The first 6 questions of the ASRS can be used as a “screener” with 4 or more marks in the shaded areas being highly consistent with adult ADHD. Some clinicians use the ASRS to assess response to treatment.
Childhood Symptoms
To make a diagnosis of ADHD, several symptoms must be present prior to age 12 years. However, many adults forget that they were diagnosed with ADHD as children. The WURS scale helps adults to recall childhood symptoms of ADHD. A full psychiatric evaluation is always required as many symptoms occur in other psychiatric disorders. In addition to input from significant others, clinicians may provide a more thorough adult ADHD evaluation if they review more objective measures from childhood such as school report cards.
Functional Impairment
When making a diagnosis of a psychiatric disorder, including ADHD, there are 3 essential components. 1. A minimum number of symptoms. 2. Symptoms persisting for a minimum period of time. 3. Symptoms causing impairment of functioning in one or more life areas.
In ADHD, symptoms must be present in 2 or more settings (e.g. at home, school, or work; with friends or relatives; in other activities) and must clearly interfere with, or reduce the quality of, social, academic, or occupational functioning.
Comorbidity: The importance of a comprehensive psychiatric evaluation of adults presenting with ADHD symptoms
Comorbidity is said to occur when two, or more, medical disorders coexist at once. Patients with Adult ADHD often suffer from other (comorbid) conditions including depression, anxiety disorders, substance use disorders and personality disorders. One review (Sobanski 2006) reported that between 65-89% of all patients with ADHD suffered from one or more additional psychiatric disorders during their lifespan, complicating the clinical picture in terms of diagnostics, treatment and outcome issues. It is essential that patients are assessed by an expert with knowledge, not only of ADHD, but also of the wide range of disorders that mimic or complicate ADHD symptoms.
Medical Monitoring of Patients on ADHD Treatment
Before commencing stimulant or non-stimulant treatment, a personal and family cardiac history is taken. Baseline blood-pressure and heart-rate are measured and then monitored periodically during treatment. ECG screening and cardiologist referrals are only recommended if indicated (Hammerness et al 2011). Studies suggest that stimulants have a more profound effect on heart rate than on blood pressure. (Mick E et al. 2013). A persistent heart rate above 80 beats per minute may warrant a change in treatment. (Perret-Guillaume C et al. 2009).
Recommended Reading
“You mean I’m not Lazy, Stupid or Crazy?!, by Kelly & Ramundo, is a very readable and relatable book describing the struggles associated with adult ADHD.
“The Mini ADHD Coach” is a simple introduction to the world of the patient with ADHD. Instead of heavy text, the author, who herself suffers with ADHD, uses animation to engage the readers. Full of advice and tools, the book is available on Amazon.
Sleep Disturbance with ADHD Medications
Insomnia, a side-effect often observed with ADHD medications, may exist even before treatment with medication commences. It is important, therefore, to assess sleep pattern before medication is initiated. The Insomnia Severity Index (ISI), developed by Charles Morin, PhD., Professor of Psychology at Laval University in Quebec City, is available (with kind permission) at the link below. A score 0-7 suggests no clinically significant insomnia while 8-14 suggests mild to moderate severity. A score of 15-21 is usually significant enough to warrant further evaluation and treatment.