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‘I Can’t Focus…What’s Wrong with Me?’

By Heather Horton, MD, Neurologist

ADHD – attention deficit hyperactivity disorder – is the official, medical term for what was once called ADD. The condition affects approximately 10 million adults. In this article, we’ll look at how the condition is diagnosed and the options for treatment.

I have difficulty focusing, but I am too old to have attention deficit hyperactivity disorder… that only affects children…PLUS, I am NOT hyper.’ This is a misconception of the past.

People with ADHD do not have to be outspoken, boisterous or physically active. They certainly do not all have to be children. ADHD affects approximately 10 million adults. Most of these adults suffer with the symptoms of this condition and are unidentified; therefore, they are untreated and are attributing their symptoms to another source leading to a diminished quality of life.

How do I know if my patient has ADHD?
There are screening tools to help hone in on these patients. The World Health Organization Adult Self-Report Scale (ASRS) screener can be completed in office. If a patient endorses 4 of the 6 symptoms significantly, then formal diagnosis should be sought from a physician, trained in ADHD, that can perform a thorough evaluation.

What are my treatment options?
Medication alone is not sufficient to help a person improve his or her problems with organization, time management, prioritizing and using cognitive aids, but it does improve attention and reduce impulsivity in adults who have been correctly diagnosed with the condition. Medication comes in the form of stimulant and non-stimulant. Both classes are used to enhance brain activity.

Stimulants/psychostimulants are the most widely used medication for the management of ADHD symptoms in adults and children. The two most commonly used are methylphenidate and amphetamines. ADHD medications approved for adults include: methylphenidate; Focalin, Focalin XR; Concerta; Daytrana; Metadate CT; and the amphetamines, Adderall XR and Vyvanse. Short acting formulations last approximately 4 hours, necessitating multiple doses throughout the day; whereas, long-
acting preparations last up to 10-12 hours and are associated with fewer ‘ups and downs,’ meaning you can take the medications one to two times daily. Your physician can tailor a regimen best suited for your needs depending upon your daily routine and schedule. The most common side effects are loss of appetite, weight loss, sleep problems, headaches and jitteriness. They are known to potentially worsen psychiatric conditions like depression, anxiety and psychosis.

Non-stimulant options also exist, but are considered second-line (people with incomplete or failed response to stimulant agents), except for atomoxetine (Strattera). Whereas the effects of the stimulant are almost immediate, atomoxetine takes a longer time to produce a response, on occasion up to 6 weeks. Side effects include, but are not limited to, increased heart rate, increased blood pressure, dry mouth, difficulty sleeping and decreased appetite. Other options, although not as widely used in adults, include Clonidine and guanfacine. Side effects of these medications include sedation and potential for rebound hypertension (elevated blood pressure).  Some physicians will also prescribe antidepressants to treat the symptoms if other psychiatric illnesses affect the patient (depression, anxiety).

Better equipped to treat adults with ADHD
The belief that ADHD/ADD only affects children is a thing of the past. Clinicians now know better and are better equipped with resources to treat their adult patients that present with complaints of difficulty with concentration, restlessness, poor memory, difficulty completing tasks, etc. Do not be ashamed to discuss these symptoms with your provider because we are here to help. It is important to find a provider that is trained and experienced with the diagnosis and management of adult onset ADHD to set yourself on the path to improvement.

Our neurologists here at KCA Neurology are trained in the diagnosis, treatment and management of not only attention deficit hyperactivity disorder, but adult attention deficit hyperactivity disorder. We can assist you and your primary care physician through the process and put you on a plan to improvement so that your life is yours again.

To learn more or to schedule an appointment in our Franklin or Clarksville office, please call 615-550-1800, or visit us online at www.kcaneurology.com.

 Heather D. Horton, MD, Neurologist
Dr. Horton joined KCA in September of 2016. Her areas of expertise include migraines, seizures, neuropathy, multiple sclerosis and carpal tunnel syndrome. Dr. Horton can be seen in the Clarksville and Franklin locations.

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