Adult ADHD, what is it and how can it be treated

Tens of millions of people around the world have Adult ADHD, which can reduce their lifestyle if not treated. However, with the right help people with ADHD can become a huge success which has been proven with the high number of celebrities and business leaders who have been diagnosed with Attention deficit hyperactivity disorder. So we decided to get together with a leading expert by the name of Dr. Behrens, who has opened an Adult ADHD clinic in Milwaukee, Wisconsin called Envision ADHD Clinic to find out more about Adult ADHD.

  1. Dr. Behrens, You run Innovative/Revolutionary Clinic in Milwaukee, can you tell me more about the clinic?

The overall model at Envision ADHD came out of years of working as a general outpatient psychiatrist at a larger institution here in Wisconsin where I came to identify with and greatly enjoy working with ADHD in adults.  I came to specialize in this often overlooked and misunderstood patient population and found how life changing treatment can be for such individuals and how rewarding it was to be part of these treatment relationships.

Instead of being simply negative diagnosis that we “had to fight/cure” I saw ADHD as more of gift that I was there to help hone.   

Despite greatly enjoying regular appointments with my patients, I couldn’t help but to think about how difficult and time consuming it was for even stable individuals to consistently have to take time out of their busy schedules to commute to my clinic to either see me in person or to pick up a paper prescription for their medications.  

I could see the overall trend of people looking to use online messaging over in person visits for the obvious convenience factor but this unfortunately does not fit into the general “fee for service” model of our general insurance based healthcare system.  Being involved in the healthcare technology fields and organized medicine, I was aware of policy changes and technological advances that could change how care is received and day after day I was in clinic envisioning how I could leverage such advances to better serve my patients through things such as electronic prescribing of controlled substances, telemedicine visits, remote outcome tracking, etc.  Overall I was thinking, what would make my relationship with healthcare easier and more convenient as a patient myself.  

 

After brainstorming, product testing, and many meetings with policy experts, I realized that my idea for specialized clinic for ADHD in adults was not ridiculous.  I could leverage the tools of other customer service industries to bring a different type of experience to my patients and create a lean model where I could quickly pivot and evolve with the feedback and new technologies that can not occur in other systems.   The premise of Envision ADHD is to provide optimized and convenient ADHD testing, evaluation, and treatment for working professionals.   I wanted to return to being directly connected with my patients which simply cannot be done in large institutions where psychiatrists often have patient panels of 1000+.    The general premise of the clinic model wanted to focus on:

 

  1. immediate access to full ADHD testing, evaluation without the 3-6 month wait list
  2. ability to schedule and manage appointments directly online without having to use the telephone
  3. have access to objective attentional and motion analysis testing that is not available in other settings to aid in a more comprehensive diagnosis
  4. Direct access to and communication with your doctor who specializes specifically in adhd in adults.  (expert medication management).
  5. Follow-up appointments without commuting.  Able to communicate through secure messaging, telephone, and online secure video conferencing.
  6. electronic prescribing of controlled substances so that patients no longer need to drive to pick up a prescription each month just to then deliver to their pharmacy
  7. ability to use advances in technology to better track treatment outcomes and engage individuals in treatment
  8. Transparent and all inclusive pricing regardless of insurance utilizing a monthly membership based model for full access to your doctor when you need it.  No surprises in the mail.  no surprise expenses or charges.  
  9. Access to the full myriad of potential treatment options including pharmacogenomic testing, attentional testing, online ADHD coaching/therapy platforms, etc.
  10. Create a model to serve those in the state without convenient access to psychiatry through one time evaluations and then remote follow-up.

 

  1. According to a report back in 2012, 237,000 children aged 2 to 5 years in the United States had an ADHD diagnosis, do you think this number has gone down or has it increased?

Statistics on ages 2-5 may be a bit misleading as making a diagnosis this young is not easy as children have yet to start first grade and are likely still in the process of brain development.  The more commonly looked at statistics are for children ages 4-17 and the most recent estimates in the U.S. is roughly 6.4 million.  This number is likely rising and may be for many reasons, but more likely that awareness of the diagnosis is increasing and more likely to be recognized whereas in the past only incredibly hyperactive children who were particularly troublesome to their parents and teachers would have been looked at.  As we learn more about the less outwardly obvious hyperactive systems and more about the innattentive symptoms that are more likely in girls/women, the more we are likely to identify individuals with the condition.

 

  1. Obviously children grow up to be adults, but many people around the world are not aware of ADHD in adults, why do you think this is?

It used to be thought that ADHD simply disappeared at age 18.   (which does not exist for any other diagnosis but still was some how thought to be true here).   it may be true that many of the more outwardly evident hyperactive symptoms reduced with age as our overall energy levels naturally decrease.   ADHD was thought just to be something of hyper school children but is now not the case and the Diagnostic and Statistical Manual (DSM) continues to evolve to better recognize and adapt to the increasing amount of research and developments emerging now that we are able to study this diagnosis that previously could never be studied.   so often ADHD is something that is thought of as not being serious or severe and that people just need “more discipline” and to “focus and calm down”     while structure and routine can be imperative, it is not this simple and this stigma leads to people afraid to seek help and for those not affected to pass judgement on those seeking help.   I believe that much of the stigma stemming from other adults thinking  “well I’ve managed to get through without help,  why should this person get extra help”

 

  1. Do you think there should be more awareness about ADHD in adults?

I am likely biased on this, but I certainly think there should be more awareness of ADHD in adults.  it is estimated that ~60% of children with ADHD continue to have ADHD into adulthood and the overall estimate is 4% of adults in the U.S. have ADHD.

There is often a narrative of “ADHD overdiagnosis and over treatment” but what is so often missed is the real data on the consequences of “under diagnosis and under treatment”

untreated ADHD in adults:   

  1. 8 additional lost work days per year
  2. 22 additional lost days of productivity per year
  3. $105-194 Billion economic cost per year in U.S.
  4. earn $5,000-$10,000 less per year
  5. 18 x more likely to be disciplined for behavior problems at work
  6. 60% more likely to lose jobs
  7. higher rates of substance abuse
  8. higher rates of obesity
  9. higher risk of accidental death
  10. increased risk of being in a motor vehicle accident
  11. higher likelihood of committing a crime

 

Even if myself or loved ones do not have concerns for ADHD, I would still prefer for those concerned to have access to care and treatment as this may ultimately save myself or loved ones from things such as car accidents, crime, and the healthcare costs associated with so many of the other issues above.

 

  1. Many people are aware of how ADHD affects a child, but how does it affect an adult?

ADHD will affect all aspects of life.   it is not just about concentration or studying.   it can affect home, relationships, work, school, etc.  for more specific information, please see:

https://www.helpguide.org/articles/add-adhd/adhd-attention-deficit-disorder-in-adults.htm

 

  1. How do you and your clinic help adults with ADHD?

Easy to schedule appointments,  comprehensive testing and evaluation,  expert medication management and non-med recommendations for coaching, diet, exercise, mindfullness, supplements.  convenient and secure online video conference appointments.   Outcome tracking tools and most importantly direct communication and connection with your doctor to help guide through the full process.

 

  1. Is it possible for an adult with ADHD to have as a successful career as someone without ADHD?

Most certainly.  ADHD is a potential gift and present in all professions.  It is not something that we want to “cure” or eradicate but to hone.  may top CEOs, designers, entreneurs, artists, etc are open about their diagnosis and it does not have anything to do with intelligence or success but untreated, it may have significant consequences.

 

  1. You have gained a reputation as being one of the most pro-active in helping to change adults lives with ADHD, why do you feel you have gained this reputation?

Simply by being vocal and an open advocate of this condition.   Outside of work, those around me know just how vocal and passionate I am about such issues and work to be a resource to those in various healthcare systems and workplaces to help advocate and educate in this space.   Actively engaged in organized medicine at the state and national level with the american medical assocaition and american psychiatric assocation as well as educating medical students and psychiatric residents in this area.   Far from a shy individual in this space.

 

  1. If people do not live in the area where your clinic is based, can they still get help?

certainly.   we will need to meet in person for the initial evaluation  (needed for evaluation and testing and to establish care in order to proceed with treatment as dictated by the federal controlled substance act).   I work with many people who drive from long distances because they can be seen quickly and then managed more conveniently through online follow-up appointments.   Now also licensed in Illinois so able to see and continue to treat citizens from Illiniois as well.

 

  1. How important is it for adults with ADHD to get help?

Incredibly.  can be utterly life changing and so many examples of individuals asking  “why didn’t I look into this sooner”  “where would I be if I had looked into ADHD sooner”     Please see the risks of undertreating above for potential  risk reduction on many fronts.