According to the National Institute of Mental Health, an estimated 8.1% of adults will experience ADHD between the ages of 18 to 44 years. Adult ADHD impacts an individual's abilities to participate in their work, education, and personal lives. Additionally, adults with ADHD are more likely to experience depression, mood or conduct disorders, and substance use disorders. Due to the effects of ADHD across the lifespan, adults with this condition are at risk of experiencing limitations in functioning at work, school, in relationships, and in their home lives. The role of occupational therapy is evident in children with ADHD, but growing evidence shows that occupational therapists are well equipped to intervene with adults as well. Occupational therapists can provide intervention for adults in the areas of skill building, executive function, self-esteem, emotion regulation, and more, which are all of great value to adults of any age who have ADHD.
Attention-deficit/hyperactivity disorder, also known as ADHD, is a common behavioral health condition that causes individuals to experience continual inattention and/or impulsive, hyperactive behaviors. The most recent statistics show that 6.76% of adults across the world are living with ADHD and 2.58% of the global adult population is living with ADHD that began in childhood. These figures equate to over 366 million and 139 million adults, respectively. Between 2.5% and 4.4% of American adults are living with ADHD with numbers varying based on those who have official diagnoses and those who do not. Additional studies show that less than 20% of adults who have ADHD are aware that they have the condition. Moreover, about 25% of the adults who are aware of their ADHD diagnosis and limitations actually seek treatment for the condition.
More males (5.4%) are diagnosed with ADHD than females (3.2%) are. However, the prevalence rates are likely more even than data shows. Males often have a more obvious presentation of ADHD (with more impulsivity, especially during adolescence) that may lead them to get diagnosed more quickly and more frequently. Studies show that females demonstrate more ADHD-related impairments than men in the areas of stress management, emotion regulation, social functioning, and time perception. Conversely, males with ADHD usually experience more limitations in working memory and academic performance than females with the condition.
ADHD is not to be confused with Attention-Deficit Disorder (ADD), which is a diagnosis that is no longer in use. ADD was a condition that individuals would be diagnosed with if they experienced chronic inattention that disrupted their functioning. When ADD was removed from the Fifth Edition of the Diagnostic and Statistical Manual in 2013, the diagnostic criteria for ADHD was also revised. The main changes to the ADHD diagnosis included the distinction of two subtypes that cover the primary symptoms of both ADHD and ADD, which are hyperactivity and persistent inattention.
While symptoms of hyperactivity and inattention do not necessarily indicate a problem, such symptoms are characteristic of ADHD when they interfere with a person's ability to function. This condition can impact individuals of all ages and may even affect someone across their lifespan. However, it can be difficult to diagnose because it presents differently in various age groups.
Children who have ADHD may present with what is seen as hyperactivity, while this same symptom may manifest as restlessness in adults. In addition, this restlessness reported by adults with ADHD may not be outwardly shown and can present as internalized anxiety. This is yet another reason why ADHD is sometimes underdiagnosed in adults. Children with ADHD typically experience the most symptoms around the ages of 7 or 8, which means this may also be when they have the most difficulty in school. Studies show that childhood ADHD symptoms 3 often decline in severity and frequency after this age, but many children with ADHD continue to experience symptoms into adulthood - whether or not they receive treatment for the condition.
According to the DSM-5, there are two main diagnostic criteria for ADHD. There are many components within each of these two criteria, which is why a specific number of each must be met in order to diagnose someone with ADHD. Children who are 16 years old and under must meet at least six symptoms of both inattention and hyperactivity in order to receive a diagnosis of ADHD. Adolescents 17 years and older along with adults must meet at least five symptoms of both inattention and hyperactivity in order to be diagnosed. The diagnostic criteria for ADHD are as follows:
In order to qualify as symptoms of ADHD, any inattention and hyperactivity must be present for at least 6 months, be disruptive to a person's life, and be considered inappropriate according to the person's developmental level. In addition, a child or adult can only be diagnosed with ADHD if the symptoms cannot be attributed to a different mental health condition (such as depressive disorders or anxiety disorders) and if the symptoms are displayed in two or more settings such as work, school, home, community settings, and social settings. Adults who receive an ADHD diagnosis must also have demonstrated some 5 concerns related to inattention and/or hyperactivity before they were 12 years old.
These criteria are an important part of diagnosing ADHD, but providers must also remember that a patient's presentation may vary over time. A child who is diagnosed with ADHD may need treatment for different ADHD-related concerns once they enter adulthood. Similarly, an adult who is diagnosed with ADHD after adolescence may not look the same or fall into the same categories as younger people with the same condition do. There are three main categories or presentations of ADHD:
Many clinicians and researchers note the most recent set of diagnostic criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is not sensitive enough for an adult population. These experts suggest that much of this criteria's verbiage refers too much to children and academic-related tasks and does not give much reference to adults and their contexts. Some clinicians feel that, based on their experience in working with adults who have ADHD, the diagnostic criteria should be modified and expanded to include other areas such as executive dysfunction and disinhibition. Many adults with ADHD experience executive dysfunction in the form of time blindness, which means they have difficulty recognizing the need to attend to and prepare for events in the future.
Other ways that executive dysfunction manifests in adults with ADHD is in their difficulty resisting distractions that do not pertain to their goals and the trouble they have independently reengaging or being redirected back to tasks after they first lose focus. In terms of disinhibition, this clinical presentation changes with age. Children with ADHD usually demonstrate motor disinhibition, which includes compulsive actions. This type of disinhibition usually becomes less prominent with age, which is why adults with ADHD often experience more verbal disinhibition. Verbal disinhibition can lead adults with ADHD to verbally express their feelings, rude thoughts, or other unfiltered communication impulsively and without concern for who is around.
Different forms of impulsivity are other standout characteristics of adult ADHD that should be included in the criteria. For instance, cognitive impulsivity may prevent adults with ADHD from engaging in the proper thought processes needed to make sound decisions. Motivational impulsivity can cause adults to have difficulty finding the drive to perform or complete certain tasks if the associated reward is far off. Emotional impulsivity often leads adults with ADHD to struggle with regulating strong feelings. Unlike emotional impulsivity in conditions like borderline personality disorder or disruptive mood dysregulation disorder, situations that magnify someone's weaknesses or impact their confidence and self-image are more likely to trigger this symptom in adults with ADHD. While these are not officially part of the diagnostic process for adults with ADHD, anyone involved in the care of adults with this condition should be aware of these symptoms along with how they impact a person's treatment progress and function.
Any number of these symptoms, especially motivational impulsivity and poor frustration tolerance, can cause adults with ADHD to discontinue therapy or avoid it altogether. For this reason, therapists should be aware of the adverse outcomes that adults with ADHD are at risk of if they do not get treatment:
Depending on the person and the exact symptoms they present with, there are many differential diagnoses for adult ADHD. Some examples include:
There is some overlap between the differential diagnoses for ADHD and other health conditions that individuals with ADHD commonly experience. The following conditions - many of which are cognitive, emotional, and sensory in nature - are known to exist in people who have ADHD:
While occupational therapists do not have diagnostic capabilities, they are a valued part of an interdisciplinary team and should communicate any concerns they have to other healthcare professionals. If a therapist suspects their patient may have ADHD but was incorrectly diagnosed with a condition that presents similarly, what steps should they take and who should they contact?
Differential diagnosis - A condition that may be mistaken for other health conditions with similar symptoms, signs, and presentations
Recidivism - When convicted criminals leave prison or jail, reoffend, and return to similar correctional facilities
According to the most recent edition of the Occupational Therapy Practice Framework, an occupational therapist's role is to address a person's client factors, strengths, routines, performance patterns, habits, and rituals all within their natural contexts. While therapists should focus on enhancing a patient's strengths regardless of their diagnosis and presenting problems, this type of approach is especially central to the work OTs do with adults who have ADHD. Strengths based treatment for ADHD involves placing a strong emphasis on a patient's assets and abilities rather than focusing on their weaknesses or deficits. While therapists must identify a patient's weaknesses and document measurable progress in those areas in order to receive insurance reimbursement for services, it is important that the treatment itself focuses on what a person is able to do as a way to help them function better.
Since strengths-based treatment is holistic and multidisciplinary in nature, it includes a person's internal strengths along with their support networks. For children with ADHD, this often includes family training and education on community resources. However, adults with ADHD may have assistance available to them in the form of programs, physical tools, friends, mentors, social settings, support groups, and other types of alternative strengths outside of their existing personal abilities.
In order to use this type of approach on adults who have ADHD, occupational therapists must begin with an occupational profile, which does a great job of outlining a patient's strengths in preparation for treatment. Standardized assessments are another important part of the evaluation process for adults with ADHD. Some standardized assessments that are specific to ADHD and can be used to identify an adult patient's ADHD symptoms, weaknesses, level of engagement, areas of functioning, and more include:
The above assessments were all designed specifically for the evaluation of individuals who have an ADHD diagnosis or demonstrate signs/symptoms of ADHD. While such tests are of great help to adults with ADHD, there are a range of other standardized assessments that can benefit this population and help identify areas to be addressed in treatment. The most useful standardized assessments in this category include those that evaluate cognitive processes found to be of concern in individuals with ADHD, including executive function, impulsivity, attention, cognitive flexibility, memory, and more. In addition, some standardized assessments - such as the Driving Behavior Survey - focus on giving providers an idea of the impact such abilities have on a person's functional performance. Many of these assessments also serve the purpose of helping rule out other conditions that may present similarly to ADHD, such as anxiety disorders. Some examples of these related assessments include:
Many of these standardized assessments are well-known and cater to rehabilitation professionals by offering information that can be used to help patients therapeutically. However, providers may also wish to complete more indepth testing, specifically those focused on academic achievement and cognitive abilities. This additional testing can help providers rule out learning disabilities, which often have symptoms that mimic those of adult ADHD.
Though an occupational profile and standardized assessments are a large part of the evaluation process for adults with ADHD, there are several other components that are important in helping therapists gain better insight into a patient's needs and strengths. Aside from symptom checklists and behavior rating scales, therapists should also interview the patient to get a detailed history of their current functional abilities and past levels of functioning. Some patients will be able to provide this information themselves, yet, with consent, it's always helpful to speak with their friends, family members, spouses/ significant others, employers, and other relevant figures to get a more complete picture of their life. Self-awareness is often limited in adults with ADHD - especially as it pertains to the way their behaviors impact others around them. For this reason, it's doubly important that providers verify a patient's account of their life with others who know them well. While some of these interviews may be completed separately, therapists often find it important to sit down with the patient and their significant other together. This not only helps the significant other learn accurate information about the condition and how it impacts their loved one, but it also allows them to ask questions and hopefully take a more empathetic stance toward the person they live with. This can also be a good springboard for marriage or relationship counseling if the relationship is one of the chief challenges an adult with ADHD is experiencing. While the latter offshoot is more often addressed by licensed mental health professionals such as professional counselors or marriage and family therapists, a thorough occupational therapy evaluation process may play an important role in identifying the need for further counseling and making appropriate referrals.
Other aspects of the evaluation process for adults with ADHD include questions about drug and alcohol use (or misuse), work and/or academic experience, driving history, childhood development (including adverse childhood experiences, developmental delays, etc.), and general health history. Driving history is important since a history of accidents of any kind are common in individuals who have ADHD. While many such accidents may be minor and not medically treated or even disclosed by adults with ADHD, there is also a higher risk of major injuries taking place. Studies show that up to 6.18% of trauma surgery patients also have diagnoses of ADHD. Accident victims who have ADHD self-report more frequent distractibility, overconfidence, and stress in a general sense than accident victims who do not have ADHD. Each of these factors can lead to a greater risk of accidental injury. Many adults with ADHD also have a history of multiple accidents over the course of many years.
In addition to accidents and other aspects of a patient's history, it's also important for providers to cover a patient's social history. This should include friendships, marital/romantic life, family relationships, and interactions with peers in school and/or work settings. Providers take a close look at this information to check if there are patterns developing in the life of an adult with ADHD. This also helps therapists identify any contributing factors in someone's life that may lead them to experience symptoms similar to ADHD that are not actually attributed to the condition.
Once therapists learn about a patient's health history through their questioning, they can also complete screening for co-occurring conditions. Research shows that ADHD rarely occurs alone, especially in adulthood. Data shows that more than 66% of all people with ADHD are living with one or more co-occurring health conditions. Some of the most common co-occurring conditions for individuals with ADHD include learning disabilities, anxiety disorders, depression, and substance use disorders. Studies suggest that up to 21% of individuals who are receiving treatment for substance use disorders are also living with ADHD. Other research shows that up to 15% of all adults receiving outpatient psychiatric care also have ADHD.
Ruling out medical concerns should also be a part of the assessment process for adults with ADHD, since certain medical conditions have symptoms that can mimic ADHD. While it is not within an occupational therapist's scope of practice to diagnose patients, it is their duty to gather information and make informed decisions pertaining to that data. In some cases, therapists may uncover certain patterns during their evaluation such as patients reporting that ADHD-like symptoms started around the time of an injury or other health concern. Therapists who notice this should communicate with other members of the patient's interdisciplinary team before beginning any treatment for ADHD. While occupational therapy treatment focuses on a patient's strengths and functional areas of need, it may still be ineffective if the patient has a medical diagnosis that has not been identified or addressed. Therapists can also suggest that patients get a recent physical to rule out any medical conditions that may be the cause of their symptoms.
What aspects of an OT evaluation may need to be modified for a patient who demonstrates inattention due to a TBI? How would this differ from evaluation modifications for a patient whose inattention is the result of ADHD?
Strengths-based treatment - An approach that can structure therapeutic treatment for a range of conditions; this type of care utilizes the patient's assets and current abilities to maximize treatment potential rather than strictly focusing on someone's deficits
There are several occupational therapy frameworks that can help guide OTs in treating adults with ADHD. Some examples include the Canadian Model of Occupational Performance and Engagement (CMOP-E), Person-Environment- Occupation-Performance Model (PEOP Model), Model of Human Occupation (MOHO), and Cognitive Behavioral Therapy (CBT) - both the traditional CBT and a modified version.
CMOP-E focuses on a person, their main occupations, and the environment to best treat adult ADHD. Addressing the person involves looking at their spirituality and surrounding aspects of their persona, including cognitive, affective, and physical skills. To address the person's occupation, therapists must look at productivity, self-care, and leisure, which are all important because they can be limited in adults who have ADHD. Lastly, the environment is impacted by cultural, social, physical, and institutional factors, all of which impact someone's daily performance. This type of CMOP extends beyond the standard format to include occupational engagement, which is at the core of the OT profession. By using this model, occupational therapists can better help their patients choose and participate in meaningful environments in their given environments. When OTs use CMOP-E to evaluate patients with ADHD, they should be sure to learn how difficult and/or satisfying patients find each task and occupation. Therapists will then take this information in combination with their observations of a patient's functional performance, and determine where improvements can be made.
While the PEOP Model has the same main components as CMOP-E, this framework goes into greater depth regarding the characteristics of a person's occupations, tasks, and roles. The PEOP Model also includes reciprocal consequences that are created when someone interacts with their environment. Therapists can use the PEOP Model to help adults with ADHD form a better fit between themselves and the environment in a way that encourages occupational success and overall well-being. This model also aligns with the strengths-based approach by allowing patients to set the goals they will work toward in collaboration with their provider.
The Model of Human Occupation is another fitting framework for occupational therapists to use with adult patients who have ADHD. Its person-centered nature aligns well with strengths-based therapy, as it also takes a top-down approach that involves breaking functional tasks down into smaller parts to address specific concerns. MOHO consists of three main components: volition (someone's internal motivation for occupation), performance capacity (cognitive and physical capabilities required for occupational performance), and habituation (the act of completing occupations in routines or patterns). Occupational therapists can use MOHO to understand how to motivate patients for certain tasks, what client factors are impacting their performance both positively and negatively, and the ways that scheduling and consistency can help their engagement. Each of these aspects can be largely helpful for adults with ADHD, which helps therapists get to the root of their occupation-based concerns.
Cognitive behavioral therapy, which is a blend between traditional cognitive therapy and behavior modification, is another helpful tool for adults with ADHD. CBT is intended to modify negative automatic thoughts a person experiences in response to certain stimuli (events, situations, etc.). By altering these negative thoughts and replacing them with more positive ones, CBT aims to also remediate nervousness, sadness, and other feelings someone may experience along with harmful behaviors they may have developed to cope with such emotions. Some examples of negative thoughts that may arise in adults with ADHD include:
Adults with ADHD can also use CBT to shift their attention from negative events to positive outcomes that are also likely present. Research shows that CBT is most effective for adults with ADHD when used in combination with medication. In particular, research shows that a combination of CBT and ADHD medication increases self-esteem, lowers symptoms of depression and anxiety, and improves the overall level of function in adults with ADHD when compared with medication alone. Other studies suggest that the same combination of CBT and ADHD medication led to both short-term and long-term improvements between 12 and 48 weeks after CBT programming ended. Specifically, significant gains were seen in the areas of emotion regulation, executive function, self-esteem, quality-of-life, brain function, and core symptoms of ADHD (inattention and hyperactivity).
There is also a range of research supporting the use of CBT alone for adults with ADHD. Either way, the general consensus is that ADHD medication tends to be more effective in managing symptoms of impulsivity, distractibility, and limited attention, whereas CBT helps adults with ADHD to create skills and routines for self-management, interpersonal relationships, and emotion regulation. There is another type of CBT that is also helpful for adults with ADHD, and that is mindfulness-based cognitive behavioral therapy (MBCT) or mindfulness-based cognitive therapy. This involves many of the same principles as traditional CBT, but they are paired with training on mindfulness practices, the idea of accepting one's flaws while trying to improve, and persistence to help someone better cope with their condition. One large-scale research study showed that MBCT helped adults with ADHD experience less symptoms along with partial improvements in emotion regulation and executive function. Participants in this particular study also reported improvements in quality of life, ability to be more mindful in their daily lives, cognitive function, and grade point average in adult education settings. Additional research suggested that, when compared to pharmacological ADHD treatment, MBCT improved self-compassion in adults with ADHD. These improvements led to an overall increase in mental health up to 6 months postimplementation. This study did not find a notable link between greater mindfulness/self-compassion and fewer ADHD symptoms. However, results showed that more inhibition was one of the biggest improvements in symptomatology.
An additional study that compared participants who received MBCT to participants on a waiting list noticed fewer ADHD symptoms in the treatment group along with improvements in mindfulness skills and executive functioning. This study did not show that the intervention had any impact on overall functioning or symptoms of depression and anxiety. Much of the research on ADHD treatment suggests that MBCT and mindfulness awareness practice (MAP) were more popular protocols for adults with the condition; MBCT and mindfulness based stress reduction (MBSR) were more commonly implemented with adolescents and children who have ADHD. MAP involves more targeted practice of mindfulness skills in isolation, whereas MBSR often involves a combination of mindfulness and yoga. The latter approach emphasizes physical practices that aim to improve someone's ability to be present in order to ease stress.
The treatment of adults with ADHD should be based on a therapist's assessment of occupational roles. This will help therapists determine the activities and skills that are most important to patients and allow them to target interventions effectively. Therapists should be aware that much of the guidance below is highly individualized and, while therapists make tailored recommendations for patients based on their assessments, there is a chance patients will not find success with certain strategies. Patients should be encouraged to report these outcomes to their therapist and collaborate to find new ways to improve their symptoms and function.
In accordance with the above treatments and techniques, it's important that therapists discuss each patient's occupational roles. These roles offer clearly defined activities and patterns that can then materialize into occupational choices. This may allow adults with ADHD to continue in existing occupational roles or find and enter new ones that develop into habits.
Both children and adults with ADHD may also look to alternative treatments to manage ADHD symptoms. When individuals use treatments exclusively outside of the medical field to treat conditions, the modalities are referred to as alternative treatments or alternative medicine. When individuals use outside treatments in addition to traditional medical intervention, the modalities are referred to as complementary treatments or complementary medicine. Therefore, the same modality can be considered either alternative or complementary depending on whether or not it is supplemented by medical treatments.
While all individuals have the autonomy to make their own medical choices, many alternative ADHD treatments lack evidence supporting their efficacy for that purpose. Some examples of such therapies that lack include:
How might a therapist help an adult with ADHD who feels overwhelmed by the amount of scheduling that their management will likely entail?
Affirmation - A simple saying used to reframe situations and minimize negative self-talk, anxiety, and other negative emotions; an affirmation can focus on a range of topics and be used for a variety of purposes, and they also typically lead to more self-acceptance, goal fulfillment, and personal improvement
Alternative modalities/medicine - Treatments that are used in lieu of traditional medical treatment and supervision
Complementary modalities/medicine - Treatments that are used alongside traditional medical treatment and supervision
Emotional lability - Rapid mood changes that involve strong emotions and an exaggeration of both positive and negative feelings
Mantra - A simple saying used to set intentions for your life or certain days, tasks, and situations; a mantra can center on any topic you'd like and can serve a range of purposes; mantras may result in more self-acceptance, goal fulfillment, and personal improvement
A 23-year-old female who recently graduated from college just took her first job in New York City as a marketing associate. During her college years, she was actively involved in her sorority, several extracurricular activities, academic societies, and volunteer work. Overall, she did well academically and received average grades. For the past 3 months, she has been experiencing increased difficulty sleeping, trouble focusing for longer than 30 minutes on work-related tasks, an increase in restlessness, and a spike in generalized feelings of anxiety. Her performance reviews are consistently excellent, but she is finding it harder to meet deadlines and block out distractions as they come up. She has coworkers who like to have side conversations, which takes time away from her work. She has tried using standard headphones to block out some of the noise and kindly give off the impression that she is not able to talk, but this hasn't been very effective. Her cubicle is right at the end of a row, so it's also in a high traffic area that sees a lot of activity.
What is the first step she should take to ensure these concerns do not impact her work?
How can this patient adjust her environment to make it more conducive to work?
Is it possible that this patient has ADHD that was not apparent before?
This section will review the case studies that were previously presented. Responses will guide the clinician through a discussion of potential answers as well as encourage reflection.
What is the first step she should take to ensure these concerns do not impact her work? This patient would benefit from a combination of environmental modifications and organizational strategies. The first step would be to implement organizational strategies to help her function better, since those are some of the easier aspects to control. She should start with using (or revamping) her calendar with color-coding, blocks of time for each task she has, and - most importantly - breaking down projects of any size into smaller tasks that she can handle more easily. This will help with deadlines and overall task completion. She can also begin using the Pomodoro technique to help keep her on task. She is already able to work for 30 minutes at a time, so this technique may mainly serve as positive reinforcement that she can keep working at this interval as long as she adds in breaks to maintain her focus. Another helpful strategy for this patient is earmarking several specific times each day to answer emails and phone calls (and adding those times to her schedule), since these can often serve as a distraction. Outside of the scheduled times, the patient should silence her phone and use focus assist features to mute the sound of incoming emails. Since her current attempts to focus (by using standard headphones) did not help minimize distractions from nearby coworkers, this patient should also exercise some boundary setting. She can start off by telling her coworkers that she cannot talk at certain times because she needs to focus on work. If she wishes to maintain her relationship with these coworkers, she can pencil in some brief times each day to engage in conversations with her coworkers. She can also suggest getting lunch together or going for a happy hour after the work day ends. Otherwise, she can maintain a cordial working relationship by politely saying 'no' to these distractions when they arise.
How can this patient adjust her environment to make it more conducive to work? The location of her desk (and what it exposes her to) may be another factor that contributes to her difficulty working. She should start by using noisecanceling headphones to more effectively cut out the auditory distractions. If this does not work or she finds a need to also cut down on visual distractions, she can use a room divider or something similar to block her workspace off from the hall where people frequently walk through. If these are not effective, she can ask her supervisor to move her workspace to a quieter area or simply ask for additional flexibility in terms of her working area. For example, if there is an atrium or small conference room she could use during off-hours, that would help her focus more.
Is it possible that this patient has ADHD that was not apparent before? Due to the busy undergraduate experience this patient had, it's very likely that she has had at least some of these symptoms for a few years. It's possible that the high level of involvement she had in college gave her enough mental and physical stimulation and variation that she could focus on everything when needed and got good sleep at night. Any feelings of anxiety or restlessness that arose during her college years were likely naturally kept under control by her full schedule because she was doing so much that there wasn't much of an opportunity for those emotions to arise. While we don't know much about her childhood, it's possible that something similar was happening then and that prevented her symptoms from being more apparent.
A single 35-year-old male diagnosed with ADHD was recently laid off from his job as an operations manager. This job departure was simply due to the company downsizing and was not the result of his performance. Due to this job loss and a depressive episode at the start of his unemployment, this patient's health insurance lapsed. As a result, he has not had access to his ADHD medication for 8 weeks now. He was diagnosed with ADHD when he was a sophomore in college because his symptoms began impacting his grades and attendance. It was at this time he was prescribed stimulants, which have been effective and taken consistently without concern for the past 13 years. He has begun self-medicating with alcohol and cocaine to manage his depressive symptoms along with feelings of being a failure and a sense of hopelessness due to difficulty in the job hunt. He lives alone and his home has become very disorganized in the past few months, which is preventing him from finding the paperwork he needs to regain his insurance and contact any of his healthcare providers.
What is the first priority for this patient? 2. In the event the patient does enter a program to detox from alcohol and cocaine use, what factors must be taken into consideration?
Once the patient has stabilized on ADHD medication again, what is the next step a therapist can help him with?
This section will review the case studies that were previously presented. Responses will guide the clinician through a discussion of potential answers as well as encourage reflection.
What is the first priority for this patient? This patient must prioritize getting in touch with his prescribing provider so he can get back on his medications. This is a safety concern, so it's prioritized above most other areas. For simplicity's sake and the essence of time, he can look his doctor's information up online and then save the contact in his phone for future reference. However, another priority is to declutter his home in a way that makes it more accessible. When he does contact his provider, he should ask about grant programs or other funding sources to assist with paying for his medications until he is able to get health insurance again. A therapist can then begin coaching this patient through the insurance process to renew their old plan or obtain another plan. Simultaneously, the therapist should instruct the patient in the use of coping strategies to replace alcohol and recreational drug use, which will not be an effective, long-term way to manage his symptoms.
In the event the patient does enter a program to detox from alcohol and cocaine use, what factors must be taken into consideration? If the patient needs help with the medical detoxification process from these substances, he can bring that up when he visits his provider to get more medication. If and when the patient enters a residential rehab program, he should be sure to find a dual diagnosis program that can effectively treat his substance misuse while taking his ADHD into account. These new providers should also be aware of the circumstances that led up to this hospitalization, since a comprehensive treatment plan with ongoing case management is likely the key to preventing relapse and further concerns. After his time in residential rehab, the patient should also look into outpatient psychotherapy to address the underlying feelings that led to this depressive episode and self-medication.
Once the patient has stabilized on ADHD medication again, what is the next step a therapist can help him with? A therapist can then help this patient with the job search by teaching him organizational strategies and reinforcing the use of positive coping strategies to handle any negative feelings that arise during the process.