L05 – Adult ADHD in Primary Care: A Team-Based Clinical Pathway to Assessment and Treatment

Summary

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral disorder that is most seen in children and adolescents. However, recent follow up studies of children with ADHD show that ADHD persists from childhood into adulthood in 35-65% of cases. Furthermore, there is evidence that many adults meet criteria for adult ADHD despite not having met criteria during childhood. The task of assessing adult ADHD can be a challenging one, particularly because symptoms of ADHD can be present in other mental health disorders and non-psychiatric conditions and because ADHD is often comorbid. In a primary care setting, these assessment challenges are amplified by the fast-paced nature, highly complex patient population, and primary care providers (PCPs) who may lack experience and/or confidence in thoroughly assessing for the disorder. Unfortunately, this can lead to misdiagnosed or undiagnosed/untreated adult ADHD and significant occupational, academic, and social functional impairment. Clinical pathways can be effective in identifying streamlined approaches to addressing the behavioral health needs of a target population, thus ensuring identification and treatment, as well as improving treatment outcomes. The purpose of the presentation is to provide those working in integrated primary care clinics with a team-based clinical pathway to assessing and treating adult ADHD. This presentation will review signs and symptoms of adult ADHD, comorbidities and differential diagnoses, risks of misdiagnosed or undiagnosed and untreated adult ADHD, validated screening measures recommended for use in primary care, previously proposed evaluation approaches, and present the team-based clinical pathway the authors developed for a family medicine residency clinic. Qualitative data from team-members who have utilized this pathway will be discussed as well as recommendations using behavioral health to support primary care physicians in the assessment and treatment of adult ADHD.