Diagnosing Complex ADHD
Diagnosing complex ADHD starts with confirming that a patient meets DSM-5 criteria for ADHD alone. Children with ADHD need to exhibit six or more symptoms of inattention and/or hyperactivity and impulsivity to merit a diagnosis. Adults need only exhibit five symptoms. Learn more about DSM-5 symptoms and full diagnostic criteria here: What is ADHD, and how is it diagnosed?
Even if a patient does exhibit symptoms of ADHD, clinicians should still rule out alternative explanations as part of the evaluation. Changes to the patient’s home environment and circumstances, for example, could influence symptom severity and presentation.
Regardless of whether an ADHD diagnosis is established, clinicians should assess for comorbid conditions. The diagnosing clinician, if experienced in doing so, can carry out assessments for other conditions. Otherwise, they should refer the patient to an appropriate subspecialist.
Assessing Complex ADHD
As with ADHD, clinicians may assess comorbidities by using diagnostic rating scales like the Patient Health Questionnaire, Mood Disorder Questionnaire, and Social Responsiveness Scale-2.
While complex ADHD is generally defined as ADHD with a co-occurring condition, the SDBP notes that complex ADHD is defined by any of the following:
The presence of suspicion of co-existing disorders and complicating factors; neurodevelopmental disorders; specific learning disorders; mental health disorders; medical conditions; genetic disorders; complicated psychosocial factors; and/or functional impairments
Diagnostic uncertainty on the part of the primary care clinician
Inadequate response to treatment
The patient is younger than 4 or older than 12 years of age at the time of initial presentation of symptoms
Complex ADHD: Treatment
The accepted approach to addressing complex ADHD is to treat the comorbidities first only if they are severe, and, in all other cases, to treat ADHD and the comorbidities simultaneously. This is what makes treating complex ADHD a delicate balancing act – one condition can’t be ignored for the other(s). Treating ADHD may resolve and improve co-existing conditions. However, comorbidities may also require separate treatment. It is also true that treating just one condition can worsen others.
This updated paradigm differs from the previously accepted approach of treating comorbidities first and then treating ADHD.
Treating ADHD symptoms in an individual with complex ADHD should follow a multimodal approach that may include:
- Neurofeedback Therapy
- Psychotherapy (individual, couples, and/or family) may also help manage co-existing conditions
- ADHD and executive function coaching
- Behavioral parent training (for children with ADHD)
- Academic and/or workplace accommodations
- Individual and family support
- Healthy habits – nutrition, sleep, and exercise
Pharmacotherapy options are available to help with certain ADHD symptoms but may only be recommended and prescribed by a doctor.
Clinicians should work with patients to determine unique areas of impairment and difficulty, and tailor treatments accordingly. At the start of treatment, patients should list goals and symptoms to target for improvement. Over time, the patient should note (perhaps using a scale model) how close (or far) they have moved with each symptom.
Here at Neurohealth Associates, we specialize in Neurofeedback treatments. Neurofeedback may be helpful for treating ADHD symptoms, especially if you are unsure about putting yourself or your child on medication. The easy, noninvasive treatments can painlessly improve your mental health condition and outlook on life. Schedule a consultation with NeuroHealth today and find out how we can help you.
Original article posted by ADDitude Mag.