Question of the week
Adult ADHD diagnosis and treatment are becoming a central topic in mental health care. With more adults seeking evaluations, clinicians face challenges in confirming diagnoses, navigating cultural influences on rising rates, and managing overlapping conditions like anxiety and depression.
In this case, a 31-year-old man comes in after getting an online ADHD diagnosis and a stimulant prescription. His practitioner is seeking to understand what’s really driving his symptoms, whether ADHD is the primary issue, and how to treat him safely without making things worse.
How would you suggest this practitioner verify the ADHD diagnosis? Log in or sign up to share your approach and see the consensus.
Post:
A 31-year-old man presents after seeing multiple social media posts about adult ADHD. He reports long-standing issues with procrastination, distractibility, and trouble finishing tasks, which have worsened since he began working remotely. He has no childhood documentation of an ADHD diagnosis or school accommodations, but recalls being “a daydreamer.”
He recently saw an online psychiatrist who diagnosed ADHD (inattentive type) after a 30-minute video visit and prescribed amphetamine-dextroamphetamine 10 mg BID. He reports improved focus but new anxiety and irritability. He’s now seeking a second opinion. He also screens positive for generalized anxiety disorder and mild depressive symptoms, and works in a demanding, high-distraction job environment.
Questions for consult
1. How do you approach adult patients presenting with possible ADHD but no verifiable childhood history?
2. Do you view the current surge in adult ADHD diagnoses as an overdue recognition of a real condition, or as an overextension of a broad diagnostic label influenced by social and cultural trends?
3. When ADHD symptoms overlap with anxiety, depression, or burnout, how do you determine which condition to treat first — or whether ADHD is primary at all?
Comments
Key takeaways about adult ADHD diagnosis and treatment:
- Diagnosis requires more than symptoms
When adults present with possible ADHD but no childhood history, clinicians rely on formal neuropsych testing and collateral reports to rule out anxiety, depression, or burnout as the true cause. - The surge reflects both awareness and influence
Some see rising adult ADHD diagnoses as overdue recognition of a real condition, while others point to social media trends and telehealth-driven access to medication as fueling overdiagnosis. - Mood disorders often take priority
When ADHD overlaps with anxiety or depression, most clinicians treat those first, as stimulants can worsen anxiety. Others combine therapy and medication, but coping strategies remain essential regardless of the approach.
Psychiatry
"1. There should be formal tests to determine ADHD in this individual.
2. I view the current surge in adult ADHD diagnoses as an overdue recognition of a real condition.
3. I would consider a multidisciplinary approach and incorporate meds for his anxiety, depression, or burnout, and support him with ways to deal with his ADHD symptoms. This can be accomplished concurrently."
Psychiatry
"1. I do an extensive history, including the administration of several scales for objective confirmation. I also try to get corroborative information from relatives.
2. Trends and the ease of getting meds as a result of telehealth COVID changes.
3. I treat the anxiety or depression first, then reevaluate. I also may start someone on medication that could treat more than one diagnosis."
Family Practice
"1. I normally send patients for neuropsych testing.
2. I think social media has really played a role in people wanting a label on themselves. I try to explain to patients that while medications can help, the coping mechanisms learned in therapy are ultimately the best. There may be a time when medications may be contraindicated for them, so we should also try to have our coping skills.
3. I try to treat the anxiety and depression first. Stimulants could worsen the anxiety."
Psychiatry
"1. I try to gather collateral data from a parent, if possible, who can describe the patient in childhood. Also rule out that the endorsed cognitive symptoms aren’t better explained by other mental disorder(s).
2. Overextension of a diagnostic label by social and cultural trends. It’s also inaccurate and leads people astray from what might actually be causing their impairment.
3. I treat the anxiety and depression first while promoting evidence-based interventions that support better cognitive functioning."
Family Practice
"1. I definitely get a thorough medical and mental health history. Sometimes ADHD could present as a sign of anxiety and MDD. Work burnout could also be a big factor.
2. I think both factors are contributing to overdiagnosis. In the fast-paced lifestyle, I think both the physicians and patients are getting exposed to the reality of people suffering from ADHD, which might have been undiagnosed in the past.
3. I personally always focus on treating underlying GAD and depression. I follow the patient closely. If they continue to have symptoms consistent with ADHD, we give a trial of a stimulant to see if that helps."
Wondering how other practitioners would manage the official diagnosis and treatment of ADHD for this patient? Read the full post on Healthcasts to see all comments and share your own opinion.
