ADHD in Adults: Diagnosis, Treatment, and Alternatives

Q: ADHD in Adults: Diagnosis, Treatment, and Alternatives

Hello, A-Tian： If an adult continues to experience attention difficulties that significantly impact daily functioning, they may still be diagnosed with Adult Attention Deficit Hyperactivity Disorder (ADHD). <br>Health insurance regulations require that several long-acting ADHD me

Attention Deficit

Hello Dr.
Liang,
I am currently 20 years old.
Since childhood, my mother has mentioned that I might have mild symptoms of ADHD, but I have never been formally diagnosed.
Generally, I experience significant mood swings, and I sometimes hit walls or lose control of my impulses when I am happy.
As I have grown older, the impulsivity seems to have gradually diminished (though I still easily succumb to peer pressure and act impulsively).
However, inattention has become a major issue that troubles me.
I often sit at my desk for 1-2 hours without studying, getting up to walk around more than ten times during that period (if I sit for too long, I feel a very uncomfortable tingling sensation in my body that I cannot suppress without moving).
I can focus on things I am interested in for a long time.
In high school, I tried to eliminate all external factors that might affect my concentration, but the results were very poor.
Now that I am in college, I hope to manage this with medication, but I have heard that diagnosing adult ADD or ADHD can be more challenging.
Recently, I visited a large hospital and mentioned to the doctor that I would like to use a central nervous system stimulant to help me, but the doctor only prescribed Sertraline to help increase my serotonin levels and improve my focus, stating that adults over 20 in Taiwan are prohibited from using Adderall.
I have several questions:
1.
Is it possible to diagnose ADD or ADHD in adults who did not seek medical attention as children?
2.
The doctor mentioned that I appear to be doing well, but can ADD be visually assessed?
3.
Is Adderall really prohibited for those over 20, or is it that without a diagnosis during adolescence, it cannot be used after that period?
4.
Are there any alternative medications or central nervous system stimulants that can replace Adderall? (Sertraline has no effect on me.)
5.
How should I explain to the doctor that I would like to undergo an evaluation to confirm these issues and receive appropriate medication treatment? (I am concerned that the doctor may dismiss me because I seem to be doing well on the surface.)
6.
Should I see a general psychiatrist, or should I specifically seek out a child and adolescent psychiatrist? (I have heard that some doctors are willing to see adults.)
Thank you for your assistance!

A Tian, 20~29 year old female. Ask Date: 2019/04/20

Dr. Liang Sunyuan reply Psychiatry

Hello, A-Tian: If an adult continues to experience attention difficulties that significantly impact daily functioning, they may still be diagnosed with Adult Attention Deficit Hyperactivity Disorder (ADHD).
Health insurance regulations require that several long-acting ADHD medications (such as Concerta, Ritalin LA, and Strattera) must be diagnosed before the age of 18, and only adults who have been on medication for more than six months and are assessed by a physician as needing it can be prescribed.
Some children's mental health departments in hospitals also accept adult patients, so it is recommended to consult a child and adolescent mental health specialist for further discussion and evaluation.
Best wishes to you.

Reply Date: 2019/04/20

More Info

Understanding ADHD in adults is a complex process that involves recognizing symptoms, obtaining a proper diagnosis, and exploring treatment options. As you navigate your concerns about ADHD, it’s essential to consider several key factors regarding diagnosis, treatment, and the alternatives available to you.

1. Diagnosis of ADHD in Adults: Yes, adults can be diagnosed with ADHD even if they did not receive a formal diagnosis in childhood. ADHD symptoms often persist into adulthood, and many individuals may not have been diagnosed earlier due to a lack of awareness or understanding of the disorder. The diagnostic process typically involves a comprehensive evaluation, including self-reported questionnaires, clinical interviews, and possibly input from family members or partners. It is crucial to provide your healthcare provider with a detailed history of your symptoms, including those from childhood, to aid in the diagnosis.

2. Visual Assessment of ADHD: ADHD cannot be diagnosed solely based on appearance or casual observation. While some behaviors associated with ADHD, such as impulsivity or restlessness, may be observable, a formal diagnosis requires a thorough assessment by a qualified professional. This assessment will consider various factors, including your history, symptom severity, and the impact of symptoms on your daily life.

3. Use of Medications like Ritalin (利他能): In many regions, including the U.S., medications such as Ritalin are indeed available for adults diagnosed with ADHD. However, specific regulations may vary by country. In some cases, if you were not diagnosed before a certain age, it may complicate your ability to access certain medications. It’s essential to discuss these regulations with your healthcare provider to understand your options fully.

4. Alternatives to Ritalin: If Ritalin or similar stimulants are not an option for you, there are alternative medications available for treating ADHD. Non-stimulant medications, such as atomoxetine (Strattera), can be effective for some individuals. Additionally, behavioral therapies, cognitive-behavioral therapy (CBT), and lifestyle changes can also play a significant role in managing ADHD symptoms. These alternatives can help improve focus and reduce impulsivity without the side effects associated with stimulant medications.

5. Communicating with Your Doctor: When discussing your concerns with your healthcare provider, it’s essential to be open and honest about your symptoms and how they affect your daily life. You might say something like, "I’ve been struggling with attention and impulsivity, and I believe these issues may be related to ADHD. I would like to undergo a comprehensive evaluation to explore this possibility and discuss potential treatment options." This approach shows that you are proactive about your health and encourages your doctor to take your concerns seriously.

6. Choosing the Right Specialist: It may be beneficial to seek care from a psychiatrist who specializes in adult ADHD or a mental health professional experienced in diagnosing and treating ADHD in adults. While some child and adolescent psychiatrists may see adults, finding a provider who focuses on adult ADHD can ensure you receive the most relevant care and treatment options.

In summary, navigating ADHD as an adult can be challenging, but with the right support and resources, it is possible to manage symptoms effectively. Seeking a thorough evaluation, discussing treatment options openly with your healthcare provider, and exploring both medication and behavioral therapies can lead to improved focus and overall well-being. Remember, you are not alone in this journey, and many resources are available to help you understand and manage ADHD.

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