Patient Case #2: Importance of an Integrative Approach in Adult ADHD


ADHD experts discuss the importance of an integrative approach in the treatment of adults with ADHD.

Stephen Faraone, PhD: Andy, what is the role of integrative treatment approach in adult ADHD using psychoeducation, behavioral, and psychosocial interventions, and medications?

Andrew J. Cutler, MD: The obvious answer is it's critical, it's desirable, it's certainly the goal. The idea of a collaborative approach, or an integrative approach, is different in kids and adults. In kids, there's a lot more people involved, often there's teachers and coaches, and all kinds of other people involved. After school care, relatives, who knows? With adults, there aren't as many people involved, but there certainly are providers involved, and then there are different modalities as we were talking about. I always like to say you don't throw pills at people and fix problems. I know we heard earlier pills don't create skills, and I'm a strong believer in that. It's just like diabetes, I wouldn't just give you insulin and let you eat all the chocolate cake you want, or let you sit around smoking and getting fat. As I already mentioned, I'm a big proponent of all kinds of complimentary things, exercise, various lifestyle interventions including healthy diet, smoking cessation, moderating alcohol and drugs, sleep hygiene. Also, healthy social relationships, healthy recreational activities. Sometimes I find adults with ADHD get into this rut because they're just like the hamster on the wheel and they're always going, going, going, and they just don't know how to relax or unwind, or how to have healthy relationships like that. I also take advantage of in my area, and I have an outstanding ADHD coach, a guy named Jeff Copper. He’s up in Tampa [Florida]. I utilize that. I utilize online resources. I try to direct people to reliable places, rather than all the strange craziness that’s out on the internet. The quackery, I like to say. And I also talk to people all the time about supplements. That’s something that comes up all the time. I do believe in some supplements, and certainly ones that are not likely to harm. I’m a believer in fish oil, for instance. And antioxidants are reasonable. Certainly, again, getting that from a healthy diet is very important. Another thing I preach is the importance of hydration. I live in Florida, where it’s very hot. And if you think about it, the brain needs oxygen and glucose to function. That’s the fuel. And how does it get there? What’s blood mostly made of? Water. People with ADHD, if they get dehydrated or hypoglycemic, their brain fails.

Stephen Faraone, PhD: Well, Andy, that’s great. And you mention the importance of going to resources that have accurate information. So I’m going to give a shout-out to my new Web site, ADHDevidence dot org.

Andrew J. Cutler, MD: Wow.

Stephen Faraone, PhD: Where I’ve been curating what I consider to be some of the best evidence we have about ADHD, its diagnosis, its treatment, its neurobiology. It’s extremely important, when we talk about integrated treatment- there are so many quackery treatments out there for ADHD, that one needs to get good information before you start working through a list of treatments that don’t work, because you’re afraid to take medication. That’s what patients do. And any prescriber needs to understand which of these treatments are evidence-based and which ones aren’t.

Andrew J. Cutler, MD: I’m going to bookmark that page right after we get done today.

Theresa Cerulli, MD: And I’m going to say, Steve, I’m your number-one fan, here, who went on and looked at your website, just before we started. Really incredible work. It’s a big shout-out and thank you for doing that. Steve has even put slides on there that practitioners can use for teaching purposes and getting the word out about ADHD meeting and treatment, and the existing data. Thank you.

Stephen Faraone, PhD: That’s right. It’s over 300 slides that describe the international consensus statement on ADHD. And they’re free for anybody to use for whatever purpose.

Andrew J. Cutler, MD: Oh, my goodness. Thank you.

Theresa Cerulli, MD: It’s wonderful.

Transcript edited for clarity

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