The Hidden Adult ADHD Crisis | Lenard Adler, MD

ADHD isn’t just a childhood condition—many adults go undiagnosed for years. Lenard Adler, MD, Director of the Adult ADHD Program at NYU Langone Health, breaks down the nuances of ADHD in adults, the challenges of proper diagnosis, and the latest treatments available. Learn about his research, the screening tools his team has developed, and what’s on the horizon for adult ADHD care.

🔍 Topics Covered:

00:00 Introduction
00:44 Dr. Adler’s Current Research Focus
01:47 Importance of Proper Assessment
03:44 Challenges in Diagnosing Adult ADHD
06:15 Gender Differences in ADHD Diagnosis
07:51 Impact of ADHD on Lifespan
10:10 Comorbidities and Treatment Approaches
14:54 Medication and Treatment Strategies
21:15 Medication Shortages and Solutions
28:42 Recent Developments in ADHD Research
35:01 Screening and Diagnostic Tools
37:33 Conclusion

📚 Related Resources:

• Lenard A. Adler, MD (official bio)
• Adult ADHD Program at NYU Langone Health
• Adult Self-Report Scale (ASRS) Screener
• Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study | The British Journal of Psychiatry
• American Professional Society of ADHD and Related Disorders (APSARD)
• CHADD: ADHD Resources and Support

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Executive Producer: Jon Earle

Transcript

DR. THEA GALLAGHER:   Welcome to the Insights on Psychiatry podcast. Today, I have the pleasure of discussing ADHD with Dr. Lenard Adler, who is a professor here at NYU Grossman School of Medicine in the Department of Psychiatry at NYU Langone Health, and also the director of the Adult ADHD Program here at NYU Langone. Dr. Adler, thanks so much for being with us today.

DR. LENARD ADLER:  Thanks, Thea. It's a pleasure to be here. 

DR. THEA GALLAGHER:   Well, we're going to jump right into it. Can you tell us a little bit about your current focus with ADHD research? 

DR. LENARD ADLER:  So we have a number of areas of interest in adult ADHD research. We spend a lot of time looking at how the diagnosis is made. Trying to refine our scales. NYU has a number of scales that we've developed for them in conjunction with Massachusetts General Hospital and the Harvard Medical School that are sort of the gold standard scales. And we spend time sort of refining them and trying to help clinicians use them so they make the diagnosis correctly and assess symptoms correctly. And we have a screener that's out there so we can help clinicians identify individuals who might be at risk for the condition.  So we spend time doing that but then also looking at newer treatments and trying to understand newer medicines or newer non-medication treatments for adult ADHD. 

DR. THEA GALLAGHER:   And why are proper assessments so important with ADHD? 

DR. LENARD ADLER:  So if the diagnosis isn't made correctly or symptoms aren't assessed correctly, you can't get the right medicine into the right people and you can't treat people. People aren't able to get the adequate treatment to be sure their symptoms and impairments are correctly and optimally treated. So it's got to be done right at the door. It sort of also highlights another area that we're working on, and that is that it's sort of an odd thing, but in the US we have treatment and diagnostic guidelines for children with ADHD, but we don't have US guidelines for the diagnosis and treatment for adults with ADHD. And the American Professional Society of ADHD and Related Disorders (APSARD) is in the process of developing those diagnostic and treatment guidelines and I'm on the steering committee and the subcommittee for medication treatment. Those guidelines will be out for stakeholder comment, we think, end of summer, early fall of this year.

So it's important. There are international guidelines for adults, be it from Canada, multiple European adult guidelines, and Australia guidelines but interestingly enough, we don't have them in the US yet. And those guidelines are important because they would form kind of a roadmap for clinicians to understand how the diag…give them some kind of guardrails as to how the diagnosis is made and some treatment parameters, not algorithmic, not so constraining so that it will dictate how treatment should be done, but really some thoughts about how good diagnosis and good treatment is made.

DR. THEA GALLAGHER:   You work with primarily adults and I'm wondering, are a lot of those adults not diagnosed till adulthood, or are they diagnosed in childhood but then not treated properly, or is it more that they need different kinds of treatments as they age into adulthood? What are the findings there? 

DR. LENARD ADLER:  Most adults have not been diagnosed until they present in adulthood. A percentage of adults have true adult onset ADHD, meaning they had no symptoms in childhood. But that's a very small percentage and actually in the diagnostic criteria they would not be included as having adult ADHD because the diagnostic criteria requires significant symptom onset in childhood. Several years ago, there was a lot of interest in the concept of pure adult onset ADHD. That happens. It's more rare than common.

So most adults who come into our program and elsewhere have not been formally diagnosed. Some have had a diagnosis in childhood, but many have not. Commonly, they may have had a child that has gone through a recent diagnosis. ADHD is a highly familial disorder. About 80% of the transmission, we think, is familial. So it runs a lot in families. If you have a first-degree relative that has ADHD, there's about a 20%, 25% chance that you may. So that's something that often brings someone in and that they've sat through an evaluation for their child and they've realized they've had similar symptoms or their significant other will sort of point out that they do. Or their life circumstances may have changed. Life has gotten more complex. They may have gotten a promotion and they've gone from managing themselves to say managing others, or they've gotten married, and they have greater responsibilities, or there are children now, or they've bought a home, or whatever it may be. They have a higher cognitive load. And that is one thing that happens in adulthood, that the cognitive load changes. And we know that ADHD doesn't occur in a vacuum. That the symptoms and impairments are context-based and that they occur in the kind of full landscape of the individual's life. 

DR. THEA GALLAGHER:   I know there's been a lot of talk about you know with younger boys being diagnosed, it's a little bit easier maybe because the hyperactivity is so obvious or so clear. Do you think for some of these adults that because they may not have presented with some of the same hyperactivity symptoms, that they may have not been diagnosed when they were younger?

DR. LENARD ADLER:  So that's true for women. For adults overall and especially true for women, the inattentive symptoms, meaning the trouble paying attention, easy distraction, forgetfulness, disorganization, not listening, those type of symptoms tend to be more prominent. Studies we've done in conjunction with Ron Kessler at the Harvard School of Medicine have shown that those symptoms are about 50% more common in adults than the frank hyperactive impulsive symptoms, meaning the restlessness, frank impulsivity, talking out of turn, interrupting others for adults overall. But for women overall, those symptoms are more common. And that's true for girls also as compared to boys. 

So the gender split in terms of diagnosis in childhood is about two to one, four to one, girls to boys. It's pretty even in adulthood. So that means more women relative to men are coming in to get their diagnosis for the first time in adulthood. And in fact, in our ADHD program, the gender split is really even. 

DR. THEA GALLAGHER:   That's so interesting. Switching gears a little bit, this recent paper in the British Journal of Psychiatry looked at, I think, over 30,000 participants. They mined some data from charts finding that people with ADHD had a significantly shorter lifespan, seven years for men and nine years for women. What are your thoughts on the findings of the study? 

DR. LENARD ADLER:  So it's an important study. One thing to keep in mind is when you look at a study that's longitudinal like that, is whether treatment was controlled for, because that's a major factor.  And we know that when we look at issues regarding affecting long-term outcomes, prior trials have shown that treatment can affect persistence, meaning is it likely for ADHD to continue into adulthood? We know that for ADHD children, young adults, aging at about the age of 26 is when their brains stop developing, one of the factors that will influence whether the condition will persist is the loading of symptoms and the degree of impairment. The more you have of symptoms, the more likely it is to continue, meaning that treatment is likely to mitigate against persistence. 

And similarly, we know from the substance use literature that it seems that treatment seems to be protective, actually, against future substance use as adolescents go through and become young adults. So this study did not seem to control for treatment, as the authors noted, and it sort of advocates that the findings they found about shorter lifespans, potentially higher suicide rates, and a variety of other negative outcomes might actually point towards the need for improved diagnosis and treatment. So it's always important when we have a study like this to actually delve into it, look at the data, and understand what it's telling us.  And I think it's fairly consistent with some of the Scandinavian registry studies that have come out over the years that, again, have shown untreated adults with ADHD have higher rates of accidents and other negative outcomes. 

DR. THEA GALLAGHER:   I think it's interesting, you’ve been talking about the correlation potentially with depression and anxiety and my question here is that I think that some clinicians will feel overwhelmed by diagnosing ADHD, autism spectrum disorder, even addiction. It feels like, okay, that's for a specialist. But if they're presenting to psychiatrist, therapist, and they're presenting maybe with depression and anxiety, but there also might be ADHD in the mix, what should they do in terms of diagnosis and treatment? Because it seems like there are really evidence-based manualized treatments that could be utilized by these professionals and also maybe the diagnostics. Is there a way to make that kind of less overwhelming? 

DR. LENARD ADLER:  So I think the first step is getting the diagnosis correct. And ADHD more commonly occurs with other conditions than not. And there was also another paper, I think, that just came out. Steve Faraone is one of the authors that looked at another set of real-world data out of the Scandinavian Registry Set that looked at the types of patients that are in the real world and are they the same as the patients that we're including in some of our clinical trials? And actually, about 35% of them had other conditions that we wouldn't include in our clinical trials, like other significant mental health conditions like depressive disorders, anxiety disorders, substance use disorders. So it's important to understand, does the individual, if you're a clinician sitting in front of you, just have ADHD, or more than half the time, they'll have a significant mood disorder, an anxiety disorder, a substance use disorder.

And then the clinician has to decide, what am I going to treat first? What's the most impairing condition? And what am I comfortable treating? There's an education gap here that we're trying to work on in terms of trying to get everybody, be they a mental health provider or a primary care provider, comfortable treating ADHD and other disorders. If it's straightforward ADHD and let's say an anxiety disorder or potentially a less complicated form of ADHD, primary care providers are still concerned, but they may be more likely to treat. If it's a complicated case of comorbidity, they're very likely to refer out for treatment because the data is they haven't received the level of training necessary to feel comfortable to treat those kinds of individuals.

The other thing that we've been doing some research on are a set of co-traveling symptoms that come with ADHD. These aren't formal mental health disorders, but these are a set of symptoms that happen with ADHD. Other conditions too, like mood disorders and other conditions. But those are executive function deficits which are problems of higher-level cognitive thinking like trouble organizing, planning, trouble with working memory, keeping things in mind, procrastination.  That symptom set along with not a mood disorder but moodiness, changeability of mood, difficulty overreacting when something happens, a kind of irritability within the day, those two symptom sets are really quite important, and we're spending a lot of time identifying those symptoms, understanding how those symptoms should be treated. They tend to be less medication responsive, and that's where our psychotherapies can be quite helpful.

DR. THEA GALLAGHER:   And when you're talking about these cognitive elements and the moodiness, is there the idea that these symptoms are actually impacting the moodiness? Because I can imagine if you're not organized or you're procrastinating, falling behind, or maybe not able to keep things in working memory, that that would have an impact on self-worth, mood, your relationships. Do they think that there might be a correlation in that direction?

DR. LENARD ADLER:  So we know that when there's a lot of executive function problems and when there are problems with emotional regulation, there's a lot more impairment. So part of what we're trying to do is to not only have individuals assess the core ADHD symptoms of trouble paying attention, distraction, those inattentive symptoms, and the hyperactivity, impulsivity of restlessness, restlessness in your mind for adults, but impulsivity, but then also these executive function problems and emotional regulations, emotional over reactivity.

DR. THEA GALLAGHER:   So for someone treating someone with ADHD right now, the gold standard treatment is medication and behavioral treatments in combination with each other? 

DR. LENARD ADLER:  So there is no one way to proceed for an adult who's starting treatment for ADHD. Optimal treatment may be a combination of medicine and cognitive behavioral therapy. For adults, the first-line treatment, the first option treatment, is a little different than for children because adults have lived with their symptoms for the entirety of their lives and also have developed coping strategies. So it sort of, I think, depends on how the individual is functioning, what coping strategies they have developed. If they have effective coping strategies and they just are unable to put them fully into play, referring them for cognitive behavioral therapy to refine the coping strategies they have may not be all that effective. So sometimes medicine first will be without cognitive behavioral therapy and then adding in the cognitive behavioral therapy if the individual isn't able to make change can be done. Sometimes it's putting them both together. It really depends on tailoring the treatment plan for the individual and what they need.

DR. THEA GALLAGHER:   I think one of the things I've found even with patients who are on medication, I think one of the things that they like is that they might have to take their medication during the week, but then on the weekends, it doesn't maybe have as long of a time to set in as say an SRI, something like that, and it's not something that people have to be on necessarily every day. Do you find that that is a non-limiting barrier then? 

DR. LENARD ADLER:  So it depends on whether they're on a stimulant or a non-stimulant medicine. There are two major classes of medicines, the stimulant medicines, which are the methylphenidate, Ritalin type medicines, and then the amphetamine class, which are the Adderall, Vyvanse type medicines. And then the non-stimulants, two of which are approved for adults, which are atomoxetine, Strattera, and then viloxazine Qelbree. The non-stimulants are not as strong. They tend to take several weeks to ramp up and they are taken every day and they last all day long.

The stimulants are scheduled compounds. You need to actually have contact with your doctor every time the prescription is written. They will last a prescribed amount of time, even in their sustained-release versions. And we tend not to actually recommend, unlike for kids, we don't really recommend drug holidays for the entirety of the weekend. Most individuals, many individuals, will find they may sleep late on one day on the weekend and may not want to take their long-acting stimulant on that day. But drug holidays for adults are a little different because we're not so worried about the potential growth effects of stimulants for adults. And then Monday can be a bit of a jolt when they start back up because they're starting back on the dose you've titrated them to. So there can be a little jitteriness when they start back up on their full dose if they've taken two, three days off. So I think there's a difference between taking a day or so off and taking like two or three. So a little complicated answer there. 

DR. THEA GALLAGHER:   I think that's helpful to understand that for some adults, it actually might be too much of a transition between the week and the week date. If you're thinking like a normal work week, there's the need for all of those organizational skills. But like you said, if you have the cognitive load of being an adult, being in a parent, being in a relationship, there's also a lot of demands on the weekends. 

DR. LENARD ADLER:  Yeah, and I think that's important because the diagnosis of ADHD requires impairment in two out of three domains of an individual's life. So that means not only at work or at school, but that means home and social. So that means it's throughout the day, and we look to treat the individual throughout the day. And so there's often a discussion that occurs, like if someone wants to take their medicine as needed, we know the medicines don't work as well that way. And there's a fallacy to think kind of that you'll know when you have to pay attention. The medicine doesn't work as well. If you're going to take it and expect it to ramp up immediately, doesn't quite work that way. Life is unpredictable. You really don't know when you have to pay attention. You may have to drive unexpectedly. There's a whole literature on about half of the individuals or so or maybe more with ADHD have driving impairments. And if they're not taking their medicines, that can be significant. Many don't have, but some do. And something may happen in your day. Work assignment may come in, and you haven't taken your medicines, and they don't ramp up that quickly. If you're taking something later in the day and it's a long-acting medicine, that's going to be problematic. So we really try not to take the stimulant medicines on an as-needed basis. 

DR. THEA GALLAGHER:   That makes a lot of sense when you're thinking again about adults and kids because when you think about kids, you know they might have school throughout the week, but then on the weekends, they might have very few responsibilities outside of maybe sports or certain activities depending on their age, where, like you said, with adults, likely you're going to have to pay attention or do something that's going to require those skills. So that makes a lot of sense. 

DR. LENARD ADLER:  No, I think that's true and you know adults aren't just grown up children. But on the other hand, you have to work…everybody's working together for the same treatment plan, and there'll be days when an individual really won't have anything going on, and they'll be sleeping late, and they're not doing anything. And you really have to have a little bit of flexibility there in terms of establishing a treatment plan.

DR. THEA GALLAGHER:   It seems like there is some flexibility with some of those kind of medicines, medication that you take each day that don't need that same ramping up. So you know I think one of the things that's really important is talking about this medication shortage. I know it's been very frustrating and challenging for so many patients. What are your thoughts on what's happening there and what needs to happen? 

DR. LENARD ADLER:  So the medication shortage has been ongoing. It's multifactorial in terms of things that have caused it. We know from data from the CDC and others that prescriptions for ADHD and prescriptions for other mental health disorders have gone up. But actually, the data show that it's not just the stimulants, it's for non-stimulants too. And there are some shortages for the non-stimulants, but it's not as pressing because they're refillable and you can get them. But for the stimulants, because they're not refillable, it's much more pressing. And when I write an order to a pharmacy for a patient to get a medicine, I don't know whether the pharmacy has it or not. There's no way for me to know. And then if the pharmacy doesn't have it, it's not transferable. We have to cancel the order and then try to find another pharmacy that may have it. So more patients got diagnosed during the pandemic for a variety of reasons, telepsychiatry being part of it, but the CDC data shows that's not the full answer. More patients coming into the system, some supply shortage issues during the pandemic contributing and one of the telepsychiatry providers and you know we want to be…probably didn't make the diagnoses correctly and they got in a lot of trouble for it. So you want the right people getting the right medicines and that had to be done. Although, in general, telepsychiatry, if you do it correctly, you can do this. Although the DEA has now come out with guidelines proposed, finally, after suspending kind of like, what do you do if you're going to give a stimulant for an individual? Do you have to see them in person? And everyone should read the proposed guidelines that they just put forward, but it's going to be pretty important to see an individual in person once, if you can, before writing a stimulant prescription. Otherwise, there are very strict guidelines that the DA has proposed about what will need to be done. 

That all being said, there are shortages of both methylphenidate and amphetamine-based products, both in the generic and in the branded forms and there's no way to know until the prescription is written if it's going to happen. There's some overall sense about which medicines may be in shortage, but it's not a hard thing. So it's really a partnership between the doctor and the patient, the clinician and the patient, to really try to get the prescription written. You know I tell my patients, "We'll write it as many times as I need to write it." And it's not a burden for us to cancel it, rewrite it. We'll do it as often as we need to. 

DR. THEA GALLAGHER:   My question to follow up with that is, do you think that's a bit overkill because you know I think the consensus is that typically people do not abuse these medications. Do you think there is some stigma around it? 

DR. LENARD ADLER:  So it's a complicated answer as to whether there's stigma around this. I think that these are controlled substances. These are not generally abused by individuals with ADHD. The concern is about individuals who don't have ADHD, who may be trying to get these medicines. For the clinicians who are hearing this podcast, you know when you have young adults coming in who are demanding immediate-release mixed amphetamines salts, which is the most commonly prescribed stimulant for adult ADHD, and won't take anything else, bells and whistles, alarms have to go off because short-acting mixed amphetamine salts, Adderall, is the one medication that is most commonly misused and diverted. So it's kind of hard to understand why an individual and why an adult wouldn't consider trying a sustained-release medicine to treat their symptoms for eight to 14 hours. We have those medicines available. And they want to take something that might last four to six hours and take it multiple times throughout the day and wear off. So there is some stigma associated with this, and that's something that CHADD and APSARD is working on. But it's a tough nut to crack. 

DR. THEA GALLAGHER:   It's an interesting point there and it sounds like almost there could be a delineation between the instant release or the extended release because it sounds like those would be harder to abuse. 

DR. LENARD ADLER:  We most exclusively start with an extended-release medication first. I think there's a lot of justification for that because you do want to treat the individual throughout the day. And we have lots of different preparations that are generic now that allow that type of treatment. 

DR. THEA GALLAGHER:   Do you hope this medication shortage will be resolved in the foreseeable future? 

DR. LENARD ADLER:  I'm hoping it'll be resolved. It seems a little bit lighter in the last couple of months, but you know it is, again, multifactorial and hard to know. It is something that both the DEA and the CDC are well aware of. 

DR. THEA GALLAGHER:   And so in this case, say there's a patient who is frustrated because they've gone to multiple pharmacies, it becomes difficult, would you say then it's appropriate to try a non-stimulant medication, which might be more easily accessible? 

DR. LENARD ADLER:  So I've had a number of patients that when we've been unable to fill their current stimulant prescription, switch to a different stimulant preparation. And switching to a non-stimulant is a little bit different, and I'll get to that in a second, because there is some literature on what happens when you take individuals and it's small, but there's some literature that once you've had a stimulant, the response to a non-stimulant may not be quite as great. It's not a reason not to do it. 

I've had a number of individuals that we've switched within class, meaning within the amphetamine class, or switched between classes to let's say they were on an amphetamine and switched to a methylphenidate product. And that needs to be done thoughtfully based upon what they're tolerating, what their symptom profile is like. But many of them have actually found that the second agent was…they like it better. So if it's done thoughtfully, sometimes there's a benefit to it. 

DR. THEA GALLAGHER:   And if the cost is that you're stressed because you don't have access to your medication, the benefit might outweigh that?

DR. LENARD ADLER:  I think that's true. And I understand there's a lot of fear in changing away from a medicine that you've had a response to. But at some point, if the medicine just isn't available, we have to look at an alternative. And that's usually when we do it, when they've gone a month and they've been off their medicine, and they just can't get it.

DR. THEA GALLAGHER:   Absolutely. Any major developments kind of in the diagnosis and treatment of adult ADHD over the last year or two years that's worth noting? 

DR. LENARD ADLER:  So there are a number of major developments that are kind of notable. There was a recent large meta-analysis done by Dr. Samuele Cortese that just came out.  Sort of a more definitive meta-analysis really showed kind of the benefits of medication therapy, both of all the stimulants and the non-stimulants being highly effective, and also cognitive behavioral therapy playing a role. So that just came out and it was an interesting meta-analysis because it allowed comparing across treatments. So I think that was a fairly definitive analysis so I think that was important. We've had a couple of smaller pilot things come forward that have been interesting. We had a pilot study here of neurofeedback based on targeting emotional regulation through amygdala that we had some interesting findings on. The use of neurofeedback has been kind of controversial in adult ADHD because when you add in a placebo control, the meta-analyses have shown that it hasn't been all that effective. Here, there was a pilot study. There wasn't a placebo here. There wasn't a sham control. But the results were promising, so more to come on that. We'll have to see. And targeting emotional regulation is important for the reasons we sort of talked about earlier. But we did get overall effects too. So that's sort of interesting, and that's an important finding. 

And then I think the role of non-stimulants has been something that everyone's trying to understand a little bit more. At the APSARD meeting that just occurred, the professional society meeting, there was an interim data cut on one of the non-stimulants, Viloxazine, in a real-world study that was presented. It was a study of patients self-referring for treatment. They had ADHD and not mood disorders, not depression and anxiety, but depression and anxiety symptoms. And they received structured ratings from trained clinicians, but they were done remotely. So it was kind of a little bit of a hybrid in that they weren't done in a clinic, but they were treated in the real world and then treated openly with Viloxazine. And then interestingly, not surprisingly, their ADHD got better, but there was a 50% reduction in their MADRAS, in their depression scores, and in their HAM-A scores and their anxiety scores. So that's kind of interesting and something to be followed up on. 

DR. THEA GALLAGHER:   Yeah, it really speaks to that relationship between the ADHD and the potential, like you said, moodiness, depression, and anxiety symptoms as well. And with the meta-analysis, is there an understanding about who benefits maybe from medication or cognitive behavioral therapy or the combination? 

DR. LENARD ADLER:  So that hasn't been fully addressed yet. That's an interesting question. The whole issue of predictors and tending to look at in the individualization of treatment is kind of, I think, the next level and kind of where we're hoping to go. I know that's where Dr. Cortese is going. And he's going to have more information on that as we go forward. He just gave us grand rounds. And I know that's the next level of analysis for him, is to try to…you've really got to get individual patient data to be able to delve in on that. I get lots of emails from him asking for our data. We give him what we can, but you've really got to delve into the data on the individual patient level to be able to make that kind of cut. 

DR. THEA GALLAGHER:   Absolutely. And so last year, the FDA authorized this video game-based digital therapeutic as an over-the-counter treatment for adults with ADHD. What are your thoughts on this? 

DR. LENARD ADLER:  I think that there have been a couple of video games approved for kids and then now adults and it's unclear whether it's having sustained improvement on symptoms and whether it carries over to real-world effects. I'm not seeing a lot of potential traction in the community. So it's hard for me to know. 

DR. THEA GALLAGHER:   I think for clinicians, sometimes it's nice to be able to give your patients like a workbook or even an app that might help them to kind of build on the skills that they're learning in therapy and there's the Inflow app. Any thoughts on these apps that are being developed or what you think should be a part of the potential app or homework that is given?

DR. LENARD ADLER:  So I think good information, good educational information about ADHD is important. Mindfulness always can be quite helpful in terms of learning. There are apps for…you know the breathing app, even Simply on the iPhone can be quite helpful. In terms of just improving self-awareness and trying to clear things out, that's an easy one, and most people have that. It's a little easier to do that than to actually learn how to meditate, I think, for people with ADHD. It's kind of hard to get in the zone for them to be able to actually meditate. But to do the relaxed breathing, I think is another thing they can learn to do. Regular exercise is important. Good healthy diet. The actual data on dietary treatments for ADHD hasn't really panned out on much, except that a good healthy diet is important. Limiting your caffeine, being sure you hydrate, especially when you're on medication. Those sorts of things are critical. 

DR. THEA GALLAGHER:   And any kind of emerging research or technologies that you're excited about or that you think can push the diagnosis and treatment for patients, especially, again, on the heels of this finding that there might be impacts on life expectancy if untreated?

DR. LENARD ADLER:  So I think we have an effective screener for adults with ADHD. It's a six item screener. Easy to use. For the DSM-4, comes in pen and paper. The DSM-5 version is electronic, but the DSM-4 version actually works for DSM-5. You know I think we'd like to see that used as commonly for individuals when they come in. You know when you go into your primary care doc, you get a depression screener. We'd like to see this commonly used so that individuals with ADHD are identified who are at risk for ADHD. It doesn't give you a diagnosis. It only says you want to put resources in making this diagnosis for individuals who need it because there's no shortcut in making the diagnosis. You can't ask six questions to get a diagnosis. It takes time to get the diagnosis correct. But if you can use a screener to see who's at risk for it, then you're putting the time and energy into people who need to get at higher risk for getting the diagnosis. 

DR. THEA GALLAGHER:   And it's more of that titrated stepwise approach that the screener alerts that this should be further looked at, it's going to keep more people from being undiagnosed, which is really important. 

DR. LENARD ADLER:  That's right. That's the idea. And we can't be afraid of diagnosing more people. The condition is there if it is or if it isn't. And I think we just have to understand that the literature shows that we actually go into primary care doctor's offices, and we did this in validating the screener. We actually went into a large primary care group and actually gave out the screener and found screen positives and screen negatives and then validated them with structured interviews. These patients are there in primary care office. They often tend to be coming in with other complaints, be it depression and anxiety or vague medical complaints. But they're there, whether you screen them or not. 

DR. THEA GALLAGHER:  And can you tell our listeners the title of your screener? 

DR. LENARD ADLER:  So it's the ASRS. It's the adult self-report ADHD self-report scale. So it's available on the NYU website. And it's also available in the DSM-5 version on the APSARD affiliated www.adhdinadults.com. 

DR. THEA GALLAGHER:   Well, thank you so much for this conversation. 

DR. LENARD ADLER:  It's been my pleasure as always, Thea. 

DR. THEA GALLAGHER:   All right. And thank you to everybody who has watched or listened to this episode of Insights on Psychiatry podcast. I'm Dr. Thea Gallagher, and thank you from all of us here at NYU Langone Health.