Patients turn to their primary care physicians for answers, making them a key member of a treatment team.
There is a growing number of individuals seeking treatment for a host of symptoms aligned with attention-deficit/hyperactivity disorder (ADHD). These individuals typically see their primary care physician (PCP) first with complaints of poor sleep, heightened anxiety, restlessness, lack of ability to concentrate, forgetfulness, fatigue, inability to focus on tasks, and trouble with making decisions. They seem to lose things often, can’t keep on a schedule, misunderstand instructions, or forget that they had a deadline or appointment.
The loved ones of the patient will typically add to the list of complaints that this person is impulsive and doesn’t pay attention during conversations, doesn’t follow through with promises, doesn’t seem to care about the needs of anyone else and is easily frustrated or angry. These symptoms cause disruption in life and the individual turns to the physician for answers.
Often adults have not been diagnosed as children and have not sought treatment until their ability to function at work or in school or their social relationships have become compromised. The PCP provides a diagnosis and prescribes medication that can have benefits, but doesn’t treat all the symptoms. PCP offices that have affiliations with behavioral health specialists recommend or refer patients for cognitive behavioral therapy.
Undiagnosed and untreated ADHD often leads to other mental health issues that require additional treatment. Individuals who struggle in their daily life with consistently feeling overwhelmed and disorganized in their thoughts, will experience a sense of anxiety. The anxiety may be a result of feeling overwhelmed or it may be from the negative consequences experienced in the past from the inability to follow through with deadlines, appointments or directions. Anxiety or depression may be severe enough to warrant a separate diagnosis. Mood disorders are commonly diagnosed comorbidly with ADHD which intensifies the feelings of frustration, anxiety, hopelessness, worthlessness and despair.
The PCP may need to prescribe antidepressants, ADHD medications and sleep medications to stabilize the host of symptoms disrupting the person’s life. When an individual experiences the inability to make decisions or focus on tasks at hand, or is in conflict with loved ones, there is a feeling of inadequacy. The experience of being a poor performer at work or at school leads to feelings of low self-worth or being inept. Consistent negative consequences from a parent, spouse, friend, boss or teacher leads to feelings of self-doubt. These symptoms of depressiveness and anxiety decrease the ability to perform daily tasks. Poor processing of information that is presented, or being overwhelmed by expectations leads to feelings of being disconnected from peers or loved ones which adds to isolation and depressiveness.
Medications prescribed can help with mood stabilization or a reduction in intensity of depression or anxiety while cognitive behavioral therapy is needed to process the experiences, interpersonal conflicts, negative self-talk and negative self-worth. Patients benefit most from having a PCP who can manage the physical medicine component with a behavioral health specialist who can manage the mental health component. The combination is needed to treat the whole person.
Treatment for ADHD works best when there is a multi-modal approach. Medication can help to alleviate some of the symptoms and promote a healthier lifestyle. Other treatments help with the negative effects experienced due to the symptoms and allow the individual to regain a sense of control, self-worth, resilience, and self-sufficiency. Psychoeducation provides the necessary information on the brain’s inability to plan, organize, prioritize, problem-solve, manage emotions, and process information taken in through the five senses.
The PCP is also the first line provider for patients who are using alcohol or street drugs to self-medicate. These substances are used to increase focus or decrease anxiousness and depression. PCPs are able to provide the diagnosis and educate patients on the negative effects of alcohol and drugs on the body. It is important for the PCP to investigate if there is a co-morbid diagnosis of ADHD with the substance abuse. Individuals with ADHD have to understand that the brain is looking for a way to alleviate negative emotions and self-loathing, and substances can become a quick fix with a long-term detrimental effects. Psychoeducation by the PCP and a referral for continued behavioral health care is the most effective treatment. Either a PCP or a behavioral health specialist can provide the education on ADHD.
Patients respond to lifestyle changes and treatment options when it is understood that ADHD is a biological brain disorder and not simply poor behavior, laziness or a character flaw. Knowledge of the symptoms is essential to learn management of the disorder. When an individual knows what to expect when attempting to complete a task, study, follow directions, understand a conversation, make decisions, and sustain attention, then it is easier to set realistic goals.
Sleep is essential for the brain to work optimally, but sleep is also affected by ADHD. Recognizing and being intentional about sleep hygiene can help get the needed rest. Use sensory input such as aroma therapy, tactile seeking activities, calming sounds, and taste to refocus and calm. Complete a sleep ritual before bed to signal the brain that it is time for sleep. If sleep still is a struggle, the PCP may consider a prescription to help a patient get to sleep.
Counselors or behavioral health specialists work with patients to make necessary lifestyle changes that improve their ability to manage symptoms. PCPs will offer lifestyle change recommendations; however, patients often require additional coaching or counseling to implement lasting change. Discussions around nutritional choices that increase attention and brain stimulation and reduce the tendency toward bouts of hyperactivity and prevent hard energy crashes and brain fog can be done either in the PCP office or with a counselor or nutritionist. Coaching by a counselor is useful to implement routines such as physical movement throughout the day to allow the brain to activate and work more effectively.
Take in the sights, smells, sounds and feel of the outdoors to relax, refresh and to readjust focus. Taking a walk around the building or around a block as a break when completing an activity that requires sustained attention can help with task completion. Add 20 to 30 minutes of outdoor time in nature each day to help the brain calm and clear from being overstimulated and reduce the anxiety felt throughout the body.
A referral to a counselor or ADHD coach increases compliance with implementation of strategies to help with memory and organization. A counselor or coach can teach techniques such as deep breathing, or other relaxation techniques when feeling overwhelmed. This reduces the chances of a panic attack and increases task completion.
Primary care or family physicians who treat entire families may discuss the use of family support. Having family supports who understand and are empathetic to the disorder of ADHD is helpful. Those who know when to step in and how to help use a relaxation tool, take a break, or who can assist in decision making, problem solving, or organization can make a huge difference in the ability to succeed. This reduces the feelings of isolation and self-loathing and increases the feeling of connection and wellness.
ADHD can be managed with the help of medication, education, cognitive behavioral therapy, coaching, lifestyle choices and family support. PCPs, family physicians and behavioral health specialists work together to provide treatment for the whole person.
Sheila Babendir, EdD, LPC, is the college academic director of counseling for the College of Social and Behavioral Sciences at University of Phoenix.