Around the Practice: Management of Adult with Attention Deficit/Hyperactivity Disorder (ADHD) - Episode 17

Case 3: 24-Year-Old Patient With ADHD

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Stephen Faraone, PhD, presents the case of a 24-year-old patient with ADHD.

Stephen Faraone, PhD: This is a 24-year-old female diagnosed with ADHD at the age of 14. Has presented to her psychiatrist after multiple treatment failures. Prior to this visit, her ADHD was handled by her pediatrician, and then by her primary care provider. When she was diagnosed at age 14, her pediatrician had tried multiple therapies. But she failed therapy, either due to lack of efficacy, lack of adherence, and lack of understanding of how to use the therapy.

Stephen Faraone, PhD: Between 14 and 16, this patient first tried some non-pharmacologic approaches. And these failed for lack of efficacy. During ages 16 to 17, she was tried on OROS methylphenidate, and that failed due to lack of GI absorption. Ages 17 to 18 tried a patch form of methylphenidate. That seemed to work, but she had reactions to the patch- adverse reactions to the patch, at the site of the patch. And she couldn’t use the patch. Ages 18 to 21, patient switched to an immediate-release form of mixed amphetamine salts. She could not tolerate mixed amphetamine salts. And they had also showed some lack of efficacy. The next attempt at age 21 was lisdexamfetamine, but that wasn’t covered by insurance. And then she was switched to atomoxetine, which was not effective. Now, at the age of 22, she was started on extended-release mixed amphetamine salts, 15 mg. She’s been on this medication since graduation and finds it to be very effective. Yet she complains that there is no off button when she is done working and cannot enjoy the rest of her evening. She has tried to skip days of not taking the medication. However, due to the nature of her work as an accountant, working 8 to 9 hours a day in her office at home, she found it to be a necessity. She has also admitted taking an antihistamine at night, to help her sleep. Upon reading notes from her PCP, it’s noted that she has had 2 previous encounters with abusing illicit substances in her teen years. However, there has not been any recurrences in the past few years. Her brother also had a history of substance abuse, but she no longer lives with him. The patient admits to smoking one pack of cigarettes every 4 days but is trying to stop smoking. She claims she only smokes when she is stressed.

Transcript edited for clarity