Transcript

Lee Tetreault:

Welcome to Frequently Ask Questions from the session 'ADD and ADHD in children and adults, beyond stimulants'. We are joined by Dr. Press. Before we begin with these questions, doctor, would you be able to reiterate a few key pointers from today's session to our audience?

Dr. Press:  

Sure, I think ADHD can be a challenge as it's frequently diagnosed, and there's a number of people who believe they have the condition, who may not, but still when one weighs the possibilities of over-diagnosis and under-diagnosis, there's certainly a number of people out there who clearly have attention problems who can benefit from therapies. And that's what we focus on, is the therapies and how to best diagnose those patients.

Lee Tetreault:

Great, let's get into some questions. Is ADHD something that can be diagnosed by a primary care doctor?

Dr. Press:  

I think that in the cases where it's really quite clear that there's a primary attention problem that's been present since childhood, and that there's no other disorder that can explain it, I do think a primary care doctor can definitely diagnose it. Still there are other times where there are atypical features that can make it more challenging, and that's where I think a specialist can be beneficial.

Lee Tetreault:

Which medicine is best to start therapy with?

Dr. Press:  

There's two main classes of stimulant medications. Those are methylphenidate and dextroamphetamine. And then there are the non-stimulant medications. Unfortunately, the non-stimulant medications aren't quite as effective, so in the cases where symptoms are quite significant, we typically do start with one of the two stimulants, either methylphenidate or dextroamphetamine, and the main difference is in how long they last. Methylphenidate only last about three or four hours, whereas dextroamphetamine, the mixed salt, lasts about five or six hours, so it is typically given twice a day, rather than perhaps three times a day for the short-acting methylphenidate.

Lee Tetreault:

When is more detailed testing required?

Dr. Press:  

I think that more detailed cognitive testing or neuropsychological testing is particularly useful when the diagnosis is unclear, when there's perhaps more than one disability, for instance, ADHD plus some other learning disability, such as a reading disability. And finally, when accommodations are needed. If someone's gonna need extra time in testing, particularly in standardized tests, they typically would require neuropsychological testing to validate the diagnosis.

Lee Tetreault:

And lastly, do you recommend behavioural therapy or medication therapy as a first-line treatment?

Dr. Press:  

I think that when symptoms are quite significant, people usually do best with a combination of the two. It turns out behavioral therapy alone is not usually sufficient, if the significant symptoms are bad enough that they're causing day-to-day difficulties. Sometimes people have mild attention problems, they can get by with just behavioral therapy, but the ones who, the people who have more significant symptoms, usually require medications, and the medications then help them to engage in the behavioral therapies.

Lee Tetreault:

This is great information, doctor, thank you so much for your time.

Dr. Press:  

My pleasure.




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