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Research Updates
Adults with ADHD and Substance Abuse is Important
Timothy Wilens, of Massachusetts General Hospital, reported in a 2004 article in the Journal of Clinical Psychiatry on the importance and safety of treating adults with ADHD who have a history of substance abuse. Dr. Wilens notes that treatment should include both psychotherapy for the addiction and pharmacotherapy. Pharmacotherapy should start with medications with lower likelihood of misuse, such as atomoxetine or bupropion. Stimulants should be a second line treatment if necessary. A literature review done by Wilens indicated that there was nearly a two-fold reduction in substance abuse found in treated ADHD adolescents as opposed to those untreated. Methylphendiate, taken orally, has low abuse potential becaus of its slow uptake in the brain. Clinicians treating adults with ADHD and substance abuse should monitor the patient with frequent follow-ups and toxicology screens and should manage the intensity and diversity of substance abuse treatment as necessary.

Wilens, T.E. (2004). Impact of ADHD and its treatment on substance abuse in adults. Journal of Clinical Psychiatry, 65, 38-45.

Can adults with ADHD be diagnosed and treated by primary care physicians?
A recent article in the June 2005 issue of The ADHD Report summarizes the findings of B. Montano as published in the Journal of Clinical Psychiatry. Montano concludes that most adults with ADHD can be effectively diagnosed and treated in a primary care setting. He notes that a significant number of children with ADHD will continue to have symptoms through their adulthood. Adults suspected of having ADHD must be carefully evaluated by reviewing developmental history with corroboration from records or other reporters to establish a valid diagnosis. There must be current impairment across settings. Many adults with ADHD continue to show problems with disorganization and impulsive behavior although hyperactive symptoms may not be as obvious as they were in childhood. Problems with inattention and impulsivity and disorganization can have profound impact on functioning. Montano indicates that clinicians must pay careful attention to possible co-morbid conditions such as mood disorders. Rating scales can be useful for assessing symptoms. Medication treatment of adults with ADHD is generally safe and effective. If treatment with psychostimulants is aversive then use of atomoxetine or bupropion may be an alternative.

Montano, B. (2004). Diagnosis and treatment of ADHD in adults in primary care. Journal of Clinical Psychiatry, 65, 18-21.

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July's Featured myADHD.com's Tools
Parents of children with ADHD can benefit from using this month's treatment tools. Below are three job charts and a home token economy system that can help you reinforce your child's behavior this summer and keep your home running smooth.