ADHD: Tips on Diagnosis and Treatment

By Edward Hallowell, MD Harvard-trained child and adult psychiatrist Director of the Hallowell Centers in Manhattan and Sudbury, MA

Posted on | By Edward Hallowell, MD
  • Make sure you consult with a well-trained specialist. The doctors who have the most training in ADHD are child psychiatrists. If you are an adult, be aware that all child psychiatrists also are trained in adult psychiatry. Ask the person you see if he or she has extensive experience in working with patients in your age group. It is imperative that you consult with a professional who has extensive experience. If you can’t find such a person, start by calling the department of psychiatry at the medical school nearest to you.
  • The diagnosis rests upon a careful history taken from the identified patient as well as at least one other person, such as parent, spouse, sibling, or close friend, as well as, if possible, teacher comments.
  • You should develop a comfortably connected relationship with the person diagnosing and treating you so that you can turn to him or her with trust whenever the need arises.
  • The history may be supplemented by neuropsychological testing. This is paper-and-pencil testing that includes puzzles and games. It’s actually often fun to take these tests. They are not diagnostic of ADHD, but they add valuable information.
  • Treatment begins with education. The patient and concerned others need to learn what ADHD is, and what it is not. A diagnosis of the mind, like ADHD, must be fully understood if it is to be mastered and made good use of. At its best, ADHD can become an asset, rather than a liability, in a person’s life. But, for this to happen, the person has to develop a deep appreciation for how ADHD works within him or her. To understand ADHD, a person could begin with one of my books, like Delivered From Distraction, or with some other book on the topic. Just be sure you read a book by a highly qualified expert who writes clearly and well.
  • Treatment proceeds with a re-structuring of one’s life. Usually, disorganization is a leading problem in the life of the person who has ADHD. Often an organizational coach can help enormously in developing new habits of organization and time management.
  • Treatment should also include physical exercise, at least 4 times per week. Dr. John Ratey’s work and his book, Spark: The Revolutionary New Science of Exercise and the Brain, notes that physical exercise is one of the best treatments we have for ADHD.
  • Proper nutrition plays an important role in the treatment of ADHD in all ages. The key simply is to eat well, avoid junk food and sugar, eat whole foods, and don’t self-medicate with carbs, as many people with ADHD are tempted to do.
  • In addition, the work of Dr. Lidia Zylowska and her book The Mindfulness Prescription for Adult ADHD has shown that mindfulness training and meditation produces results comparable to medication in improving the problematic symptoms associated with ADHD.
  • Medication may also be helpful for people of all ages who have ADHD. The stimulants, like Adderall and Ritalin, are the most effective medications we have to treat ADHD.
  • In using stimulants, a person should be under the care of a highly experienced specialist, a doctor who has extensive experience in treating ADHD and prescribing stimulants. The standard I use with my patients is this: I want to see target symptom improvement while on the medication with no side effects other than appetite suppression without unwanted weight loss. If you abide by that standard, you can avoid all dangers that can accompany the use of stimulants and you can reap the considerable benefits. Stimulants will help people who have ADHD about 80% of the time. That means 20% of people who have ADHD will either get no benefit or will experience side effects that lead to discontinuation of the medication. All side effects of medication are reversible by lowering the dose, changing the medication, or discontinuing the medication altogether.
  • Benefits occur right away, usually within 20 minutes of taking the initial dose. Side effects also occur soon. Do not continue to take the medication in the face of side effects. Stop the medication and call your doctor immediately.
  • Make sure at least one other person is involved in your treatment, other than you and your doctor. People who have ADHD are poor self-observers. That’s why it is important to involve at least one other person whom you trust and who sees you regularly.
  • Check in with your doctor on a regular basis. You can determine with him or her how often this should be, but especially if medication is being prescribed, regular medical check-ins are important. Should a side effect unexpectedly arise, call your doctor right away.
  • Used properly, stimulant medications like Adderall are safe and very effective. Used improperly, however, they are dangerous, and as was seen on The Dr. Oz Show, potentially lethal.
  • A final word of advice: Never worry alone. If you have a concern or a question, seek out a reliable expert. When it comes to ADHD, sound advice can be difficult to find, because there are not enough highly trained experts. As was stated previously, a good place to start is the department of psychiatry at the medical school closest to you.

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