Adult ADHD

Assessment and Management

 Adult ADHD Assessment
Checklist
ü  Poor attention and concentration
ü  Organisational difficulties
ü  Difficulties with time management
ü  Fidgetiness and squirminess
ü  Anger and frustration
ü  Forgetfulness
ü  Impact on relationships and vocation
ü  Drug and Alcohol history
ü  Childhood history of ADHD
ü  Family history of ADHD
ü R/o Depression and Bipolar Disorder
 Questions on Adult ADHD Self Report Scale
(Part A)

ü  How often do you have trouble wrapping up the final

details of a project once the challenging parts have been
done?

ü  How often do you have difficulty getting things in order

when you have to do a task that requires organization?
ü  How often do you have problems remembering
appointments or obligations?
ü  When you have a task that requires a lot of thought, how
often do you avoid or delay getting started?
ü  How often do you fidget or squirm with your hands or
feet when you have to sit down for a long time?
ü  How often do you feel overly active and compelled to do
things, like you were driven by a motor?
 Questions on Adult ADHD Self Report Scale
(Part B)

ü  How often do you make careless mistakes when you have
to work on a boring or difficult project?
ü  How often do you have difficulty keeping your attention
when you are doing boring or repetitive work?
ü  How often do you have difficulty concentrating on what
people say to you, even when they are speaking to you
directly?
ü  How often do you misplace or have difficulty finding
things at home or at work?
ü  How often are you distracted by activity or noise around
you?
ü  How often do you leave your seat in meetings or other
situations in which you are expected to remain seated?
 Questions on Adult ADHD Self Report Scale
(Part B)

ü  How often do you feel restless or fidgety?

ü  How often do you have difficulty unwinding and
relaxing when you have time to yourself?
ü  How often do you find yourself talking too much
when you are in social situations?
ü  When you’re in a conversation, how often do you
find yourself finishing the sentences of the people
you are talking to, before they can finish them
themselves?
ü  How often do you have difficulty waiting your turn in
situations when turn taking is required?
ü  How often do you interrupt others when they are
 Adult ADHD
Treatment Checklist

ü  Multimodal Treatment involving medication and psychosocial

interventions
ü  Provide psycho-education to the patient about core symptoms
of ADHD with the relevant sub-types
ü  Before treatment is administered a full psychiatric and medical
assessment should be completed
ü  Second opinion if there is uncertainty about diagnosis
ü  Rule out or identify co-morbidities
ü  Behavioural interventions and Goal setting
ü  Social interventions
ü  Assistive and organisational technologies
ü  Psychotherapy
ü  Medications (see next slide)
 Medication for Adult ADHD

•  Major Mood disorders and Substance use disorders should be

identified and treated prior to the treatment of ADHD.
•  Methylphenidate (stimulant) is considered first line drug in adults
•  Initial treatment 5mg three times daily for immediate release
preparations. Dose should be altered depending on symptoms and
side effects for 4-6 weeks
•  Maximum = 1 mg/kg. Canadian ADHD Resource alliance guidelines
recommends a maximum of 100 mg/day for Methylphenidate.
•  In some states in Australia, second opinion is required for doses above
60mg/day.
•  Modified-release preparations are usually given once daily (no more
than twice daily)
•  Modified-release preparations may be preferred in instances where
concerns are about adherence or substance misuse
•  Monitor weight and blood pressure.
 What if Methylphenidate is
Unacceptable or Ineffective?
Dexamphetamine (stimulant)
•  Initial treatment 5mg twice daily
•  Dose should be altered depending on symptoms and side
effects for 4-6 weeks
•  Treatment should be given in divided doses (usually between
two and four time daily)
•  Maximum = 60mg per day (NICE). Some states in Australia
require a second opinion if doses above 30 mg/day are
prescribed.

Atomoxetine (non-stimulant)

•  People >70kg initial daily dose should be approx. 0.5mg/kg,

increase the dose to 1.2mg/kg/day after 7 days
•  People <70kg initial total dose should be 40mg, increase the
dose up to a maintenance dose of 100mg/day after 7 days
 References

•  Spencer TJ. Pharmacology of adult ADHD with

stimulants. CNS Spectrums. 12:8-11, 2007

•  Sachdev P, Trollor J. How high a dose of stimulant

medication in adult attention deficit hyperactivity
disorder? Australian and New Zealand Journal of
Psychiatry. 34:645–650, 2000

•  NICE Guidelines (U.K)

•  CADDRA Guidelines (Canada)