Helen Dandurand (Host): Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand. And today, I'm going to be joined by Tracey Peachey, primary care provider at Riverside, to talk about ADHD in adults, right after this ad.

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Host: And we are back with Tracey Peachey. Thank you for joining me today. Can you start by telling us a little bit about yourself?

Tracey Peachey: Yeah, thanks for having me, Helen. I'm happy to be here. I am a wife and a mom. We have a busy household with three children and five dogs.

Host: Love the dogs.

Tracey Peachey: Yes, I do too.

Host: What kind of dogs?

Tracey Peachey: All different kinds of dogs.

Host: Okay, we don't have to get into it.

Tracey Peachey: They're all adopted.

Host: Yeah. That's amazing.

Tracey Peachey: Adopt, don't shop.

Host: Okay.

Tracey Peachey: Yes. I have been a nurse for 18 years. My background's in Internal Medicine, Geriatrics, and Home Healthcare. And I recently joined the wonderful team at Riverside Medical Group Internal Medicine as a nurse practitioner. And I am accepting new patients 18 years and older who are looking for a primary care provider.

Host: Awesome! So, our topic today, like I said before, is ADHD in adults, and that is something you can go to your primary care provider if you have any concerns about that. And so, my first question about that is, what are some common signs of ADHD in adults, and how might they differ from those seen in children?

Tracey Peachey: Yeah. So just starting off, ADHD stands for attention deficit hyperactivity disorder. It is a diagnosis, like you said, that's commonly associated with childhood. However, ADHD is characterized in adults by executive dysfunction, inattention, impulsiveness, restlessness, and emotional dysregulation.

And just to define a couple of those things, so emotional dysregulation in an adult might look like irritability, anger outbursts, low frustration tolerance, or a lack of motivation. And then, executive dysfunction, I just want to take a second to explain that a little bit better, but it's actually defined as self-directed actions needed to choose goals and to create and act and sustain actions toward those goals. So in daily life, that might look like trouble remaining focused on a task, organizing activities, time management, completing tasks. So collectively, these symptoms lead to significant issues in a patient's ability to function day to day. Typically, in adulthood, inattentiveness is more predominant than hyperactivity, which is often seen in children with ADHD.

Host: Got it. Got it. So, how often Is adult ADHD kind of misdiagnosed or overlooked and why would you say that happens?

Tracey Peachey: Yeah. So, the Attention Deficit Disorder Association kind of states that the research shows that less than 20% of adults with ADHD are appropriately diagnosed and treated, and that's not very many. There's always kind of this debate on whether ADHD in children is overdiagnosed. But in adults, it's more likely to be underdiagnosed or overlooked, especially in women. And there's really a lot of reasons that that might happen. The symptoms of adult ADHD overlap with many conditions. So, anxiety, depression, things like that, substance use disorders might mask the symptoms of ADHD, making it a little bit harder to diagnose. The other thing is that it is more common or thought of to be a childhood disorder, so it might not be on that healthcare professional's radar initially. In addition, adults might not seek treatment or assessment for their symptoms. Inattentiveness might not be as obvious or they develop strategies to compensate for their symptoms that they're experiencing every day.

Host: Definitely. What would you say are the primary ways that you assess and can diagnose ADHD in an adult patient then?

Tracey Peachey: Yeah. I'm going to use some bigger, longer words here at the beginning and then we'll break that down a little bit, but the American Psychiatric Association's Diagnostic and Statistic Manual of Mental Disorders Fifth Edition, which is better known and easier to refer to as the DSM-5, they've set diagnostic criteria for adult ADHD. So, obtaining a thorough history from the patient, gathering information regarding childhood, adolescence, adulthood is going to be imperative. That can be done during an office visit interview, just like when you go to see your doctor or your nurse practitioner. There are several screening tools available for healthcare professionals to use when assessing an adult for ADHD.

Part of the assessment is going to be ruling out other conditions that might cause similar symptoms. And then, the patient's symptoms really need to be persistent and severe enough to have contributed to significant psychosocial impairment, meaning ADHD is not going to be diagnosed in someone who reports they had trouble focusing last week at work because of a stressful home situation. For a diagnosis to be made, at least five of the symptoms from the DSM-5 criteria must be present for at least six months that negatively impact social, academic, or occupational outcomes.

Host: Gotcha. And is that something that your primary care provider can diagnose or do you just go to them with what you think the issue is and then they would kind of refer you?

Tracey Peachey: I think that's a very personal decision for the primary care provider. There are primary care providers that will do the assessment and the diagnosis. And if they feel like that is within their realm to treat, they will. And if not, they're going to refer out to a specialist.

Host: Got it. Cool. Can ADHD develop in adulthood or is it something that always starts in childhood?

Tracey Peachey: Yeah. The answer to this question isn't quite as simple as a yes or no. Hopefully, with a little explanation, it will make sense though. ADHD is one of the most common neurodevelopmental disorders of childhood and adolescents, and it often persists into adulthood. There has been some research that examines the possibility of a late onset or an adult onset type of ADHD. But the validity of that data just isn't as strong.

So for the purpose of keeping things simple today, most agree that adults who are diagnosed with ADHD most likely had symptoms as a child or an adolescent. And one of the DSM-5 criteria is that several inattentive or hyperactive-impulsive type symptoms were present prior to age 12. I mean, there are several reasons why someone might not receive a diagnosis of ADHD until adulthood. One example is that the parents or the teachers didn't recognize a problem. They thought, "Oh, that's just a really rowdy little boy or girl," you know, and they didn't seek out an assessment. A child might have more of a mild form of ADHD, or they were able to manage this sufficiently until they were met with the higher demands that adulthood brings.

Host: Definitely. That makes sense. And I've heard, you even mentioned it a little before, but that it presents different in women, and I'm assuming that means that in female children as well, that it presents differently?

Tracey Peachey: And not so much that they say that it always presents differently in female children or women, but women tend to mask it and compensate for the symptoms they're experiencing.

Host: Interesting. Interesting. Okay. We're going to take a quick break to talk about finding a primary care provider.

Riverside knows that health is your greatest asset and that your primary care provider is your partner in health. Find a primary care provider that fits your needs at riversidehealthcare.org/primarycare.

Okay. So, we're back. Can you tell us a little bit about how ADHD affects everyday life, including work, relationships, that kind of thing, for adults?

Tracey Peachey: Yeah. So, adults with ADHD may feel like it's impossible to get organized. Stick to a job, remember to keep appointments, daily tasks like getting up in the morning, preparing to leave the house for work, showing up to work on time, and being productive might be especially challenging. These adults usually have a history of problems with school, work, relationships. Adults with ADHD may seem restless. They may try to do several things at a time, but usually they're not successful with any of them. Often adults with ADHD prefer quick fixes. They do not want to take the steps that they need to do to, work through problems to achieve better outcomes. Also, adults with ADHD can have higher rates of criminal activity, substance use disorder, motor vehicle accidents, traffic citations. So, managing ADHD in adulthood can make everyday life really challenging.

Host: Yeah. What kind of treatment options are available for ADHD and how do you determine the best approach for that?

Tracey Peachey: Yeah. So, the most recommended initial treatment is a combination of medication therapy and psychotherapy, specifically cognitive behavioral therapy. Again, another big word, but what cognitive behavioral therapy is, It's a focused type of therapy that helps individuals change their thinking and coping strategies. So, it helps you to focus on coping strategies and ways to overcome your symptoms. For an example, an adult with ADHD who's required to take on a big project at work may need to break this down into several smaller steps to make it more manageable.

And then, there are, like I said, pharmacological treatments. The first line for ADHD in adults is typically stimulants, which is very similar to children as well. There's many different types. There's many different forms. The decision regarding that really is individualized for the patient, should be based between the patient and the provider, and consider goals, lifestyle, and any comorbidities.

Medication, education, and close monitoring for adverse side effects is always imperative regardless of what medication is used. And I also think it's important for patients to understand that there's no perfect solution. It may take some time to find the best regimen that works for them. But there is hope for them. There's many different options and there's things that can be adjusted to help them, you know, have the best function that they can every day.

Host: Yeah. And you kind of mentioned at the start, maybe breaking down tasks for big projects, that kind of thing. Are there any kind of lifestyle changes or habits that you find can help adults manage their ADHD symptoms?

Tracey Peachey: Yeah. A lot of the recommendations for lifestyle changes and habits for adults with ADHD are going to be like what we recommend for everyone. So, focus on performing regular exercise, eating a healthy diet, and getting plenty of sleep. That regular exercise helps to work out some of that hyperactivity or impulsivity. Limiting screen time and external stimulation, noise, lights, smells, crowds, whatever that trigger is for that person might also be helpful.

Attention to time management and organization is really going to be key for these individuals. Make a list. Prioritize tasks and keep a routine schedule. Personal support systems are also really imperative These individuals need to connect with those who understand the diagnosis, the challenges and the needs, and just having a safe space, and giving yourself time to breathe and decompress. Sticking to the regimen that's prescribed, so going to your therapy appointments and taking your medications as directed, avoiding alcohol, tobacco, drugs, all of those things are going to help adults with ADHD, You know, have the best outcomes that they can.

Host: Awesome. Can you again share what role the primary care provider plays in the ongoing management of ADHD and treatment?

Tracey Peachey: Yeah, the primary care provider will continue to assess symptoms, adjust treatment, and offer support and education for the adult patient with ADHD. That's kind of in addition to promoting overall health for these patients. Primary care providers often act as care coordinators, which means they can offer referrals and facilitate communication between specialties to promote the best outcomes for their patients. I think a lot of times they can also act as advocates for their patients to ensure access to necessary resources for treatments and getting them connected with the correct treatments and providers and resources in our community.

Host: Got it. So for adults who suspect they're listening to this and they're like, "That might be me," they think they might have ADHD, what would you recommend as just the first step in seeking help?

Tracey Peachey: Yeah. Talk to your primary care provider about your concerns. Many PCPs routinely diagnose and treat ADHD. If that provider feels that you need a more specialized assessment or evaluation, they are going to refer you to the appropriate mental health professionals like a psychologist or a psychiatrist.

Host: Got it. Is there anything else you wanted to add today?

Tracey Peachey: I don't think so. I appreciate you having me, though.

Host: Of course.

Tracey Peachey: It's been good to be here.

Host: Of course. Thank you for being here. And thank you listeners for tuning into the Well Within Reach podcast brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org.