Adult-onset ADHD: Treatment in Primary Care via thecurbsiders
. Today we're going to be talking about attention-deficit/hyperactivity disorder . We had a great guest, Dr Kevin Simon, who taught us all about this. Paul, is it possible for adults to develop ADHD de novo?I'm glad you asked, Matt, because I love absolutes and I'm happy to answer any question yes or no. This question came up during our podcast, and the safest answer is probably"not commonly." It can happen, but by and large, ADHD is probably present in childhood.
The question is whether ADHD is recognized. It may declare itself in adulthood rather than coming into existence in childhood. The individual might have been able to compensate, or their ADHD might manifest only under certain stressors until they get to advanced or graduate studies, and their inattention is uncovered all of a sudden. Their ADHD has probably always been there. But there is still some argument about whether ADHD can actually occur de novo in adulthood.
What if a patient has a history of substance use disorder? Would that be a total contraindication to treating ADHD?The short answer is no. It might impact the agent you prescribe. If the patient has a history of stimulant use disorder and doesn't have a lot of initial success with a nonstimulant drug, then I might have that patient see a specialist rather than trying to manage it myself.
But if it's opioid use disorder or some other substance use, you would be cautious and mindful, but you can keep patients more engaged in care by treating their ADHD than by withholding the medications out of concerns for diversion, especially if you're prescribing the long-acting drugs. They are rarely diverted because they're designed to prevent misuse by being extended-release agents.
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