ADHD in Adults: A Practical Guide to Evaluation and Management: 0 (Current Clinical Psychiatry)

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We have a wide variety of expertise and backgrounds that we bring to this unique group practice. We are currently accepting new clients into our practice. Georgia Ede Psychiatrist , MD.

Adult ADD - Mayo Clinic

Do you prefer all-natural strategies that minimize medications and maximize your control over your symptoms? Are you motivated to make healthy lifestyle changes, but don't know which changes are worth making? Have you already tried diet, exercise, or supplements without success? If any of these describe your situation, I can help you. With the right information, nutrition therapy becomes a powerful medical intervention that can address the root causes of brain dysfunction. One session is often all it takes to get you on your way. Nataliya later entered a field of drug discovery as a platelet biologist and immunologist and worked at Biogen IDEC and Merk.

We use a strength- based approach. We do not treat disabilities so much as help people unwrap their gifts. Hallowell has both ADHD and dyslexia and this helps us understand these conditions from a personal as well as professional standpoint. All the clinicians subscribe to my strength-based approach. Mark Strecker Psychiatrist , MD.

What makes it possible to change entrenched ways of coping that are not working? My focus in therapy is to help patients deepen their personal relationships and find their work more rewarding; medication can sometimes help alleviate symptoms that interfere with achieving these goals. By providing a safe and supportive environment for the patient's search for self-understanding, and listening closely to what is being said and not said, I collaborate with the patient in finding creative and pragmatic ways to overcome obstacles to change.

It is my passion to work with my patients and families to address their challenges in a comprehensive way which results in the best outcomes for my patients and their families. Medication evaluations, medication management, and supportive psychotherapy are my specialties. I also teach advanced practice nursing and psychopharmacology at Northeastern University. I've spent well over 10, hours meeting with clients who struggle with distraction, procrastination, and disorganization.

The amazing positive changes I have witnessed over the years continue to inspire me, and I feel very fortunate to have met with and learned from so many intelligent, creative, and interesting people. Craig Surman Psychiatrist , MD. I am a Harvard Medical School investigator, specializing in helping clients get around to, stick with, and finish what matters - through management of mood, anxiety, attention and organizational challenges.

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I am an expert on ADHD in adulthood, and investigate new supports for such self-regulation challenges in my research at Massachusetts General Hospital. With training in neuropsychiatry and experience working with a few thousand clients that have self-regulation challenges, I can offer unique suggestions regarding what is likely to be high yield to better adjust to life - from the latest research on medication, to effective coping strategies. I believe in collaborating with all aspects of healing and treatment in western and eastern medicine.

We are all on this journey of human experience together. I work with clients 18 and over. Think you may have ADHD? I combine cutting-edge medication management with psychotherapy, mindfulness, and cognitive behavioral techniques. I draw from different modalities in order to tailor treatment to the most important person--YOU. I don't believe in cookie-cutter approaches and I feel strongly that "medication only meets you half-way. Office is near:. Restoring mental health can be a tricky road to navigate, but with perseverance and treatment, change is possible.

I enjoy working with people, and from long years of experience, have a good sense of what it takes to help my patients return to productive, healthy lives. Sharon L. I have worked in a wide variety of settings including hospitals, outpatient practices and residential schools. I provide diagnostic assessment, medication, management, parent guidance and education.

I have a particular interest in working with individuals struggling with depression, anxiety or ADHD. Being professionally evaluated and treated with appropriate psychiatric medication will often alleviate the psychiatric symptoms quickly and effectively. With more than more than forty years of combined professional experience, Dr. Jeffrey Speller and Dr. Tanya Joanne Korkosz are Harvard-trained physicians and psychiatrists who specialize in the use of psychiatric medication for adolescents 12 to 19 and adults with Attention Deficit Disorder and associated disorders.

ADHD in Adults : Craig B.H. Surman :

I see patients across the lifespan with a variety of diagnoses including, but not limited to, depression, anxiety, attention deficit hyperactivity disorder, bipolar disorder, panic disorder and obsessive compulsive disorder. I provide diagnostic assessments and pharmacological management, while integrating cognitive behavioral therapy during my sessions.

I work to help my patients achieve maximum success in their lives through a well rounded treatment plan. Compared to clinical samples, cluster 2 even shows larger deficits than patients with major depressive and adjustment disorders, but similar deficits as patients with chronic recurrent depressive disorders. In contrast, cluster 1 reports better skills compared to other clinical groups. In cluster 1 the proportion of males is Cluster 2 is dominated by patients with the combined type After correcting for multiple testing, the only significant difference on single comorbid diagnoses between the two clusters could be observed in somatoform disorders with cluster 2 having a significantly higher proportion Empirically derived symptom profiles based on cluster analysis from adult patients with ADHD revealed two clusters.

Compared to healthy samples 48 , 49 , 50 both of them were less skilled in ER, but compared to cluster 1, patients from cluster 2 reported more severe lack of skills: adult patients with ADHD from cluster 2 had highest ratings of emotional lability and reported the lowest ER skills, thus representing a subgroup of ADHD with severe ERD.

Even compared to other clinical groups 48 cluster 2 reported more impaired ER skills than comparison samples of patients with major depressive and adjustment disorders. In contrast, the total ER skill competence in cluster 1 was significantly higher than in samples of depressive, recurrently depressive and adjustment disordered patients.

In cluster 1 we found more heterogeneous presentations of ADHD with substantial proportions of the inattentive and the combined subtype. Replicating results of international studies 22 , 51 , 52 patients with severe ERD in cluster 2 were found to have higher levels of emotional symptoms as indicated by their reduced positive affect, elevated BDI score and negative affect ratings. In line with previous findings, we found the severe ERD in cluster 2 to be associated with higher impairments in most clinical areas as indicated by elevated SCL GSI scores and heightened prevalence of somatoform disorders, substance abuse disorders and affective disorders Furthermore, the severe ERD cluster showed more comorbidities.

As our external validators are rather limited, we cannot shed light on the question whether our clusters differentially represent emotionally ill patients, patients with different levels of ER capacities or both. Although a pathway from ADHD through ERD to affective and temperamental liabilities and comorbidities seems plausible, there is a gap in the literature and our data cannot fill this gap. We are missing longitudinal data showing that severe ERD as in cluster 2 compared to normal, impulsive ADHD as in cluster 1 attracts further emotional symptoms and adverse outcomes like a magnet.

This corresponds to our findings showing that neuropsychological variables did not contribute significantly to cluster formation. Most ADHD studies do not routinely assess emotional dysregulation. Recent data suggests that a substantial proportion of patients presenting with non-psychotic long-term mental health issues e. Our cross-sectional data only represent the static view on ER and ERD and miss the dynamics central to emotion regulation As outlined in the introduction, emotion regulation processes include more than global self-reports of valence of emotional experience and intensity of emotions 3.

Thus, our analysis is just an attempt to organize ADHD subgroups based on self-reports regarding neurocognitive and emotional dimensions, but it is only one, static piece of the puzzle. Dialectical behavior therapy DBT , an intervention that specifically targets emotional dysregulation, with modifications according to the special needs of patients with ADHD, has shown moderate to large effect sizes in treatments of adult ADHD, and might in light of our findings be worthy to be considered for further research 54 , 55 , This clinic is specialized on diagnostics of adult ADHD and has a large catchment area.

Our sample consisted of individuals newly diagnosed with adult ADHD who were all medication-naive. They were examined by experienced licensed clinical psychologists on the basis of a detailed clinical history, the structured diagnostic interview for ADHD in adults DIVA 2. The diagnosis was based on the DIVA 2. Our sample consisted of males Twelve subjects 3. Comorbidity was high in our sample, with 59 patients Summing up the number of comorbidities, patients Confirmatory factor analyses of the German version in healthy adults and ADHD patients supported this factor analytic solution 60 , The four subscales are significantly influenced by age, gender, and the number of years of education.

Symptom severity decreases with age, males score higher than females on hyperactivity and sensation-seeking behavior, and females score higher than males on problems with self-concept. Overall symptom ratings are higher for individuals with less education. Test-retest reliability ranges between 0. The same holds true for the CAARS-L: O, the observer version, which comprises ratings on the same items by a person who has a close relationship to the subject under examination The hypothesized factor structure was supported and the observer version also possesses satisfactory psychometric properties.

It encompasses the ten items for positive and the ten items for negative affect, from the PANAS, adding additional items to cover emotions of stress, fear, anger, sadness, depression, and shame with 3 items each; guilt and disgust are measured with 1 item each. Furthermore, eleven items address the extent of coping emotions optimism, courage, pride, etc.

In our study, we only used the two extended subscales for positive and negative affect with 25 items each. The second part is the Emotion Regulation Skills Questionnaire ERSQ 50 that assesses self-reports of adaptive responses to challenging feelings; it is based on the adaptive coping with emotions model 49 , The total sum score was used for cluster analysis in the present study. When comparing our data to previously published data, we used the average score for ERSQ.

As the ERSQ assesses ER skills as positive capacities, higher values indicate better skills, lower scores indicate deficient regulatory capacities. Internal consistencies are around 0.

ADHD in Adults

These data were confirmed in other studies 10 , Depressive symptom severity was assessed with the revised Beck Depression Inventory 68 , 69 which is a item self-report measure assessing somatic, behavioral, emotional, and cognitive symptoms of depression on a 4-point scale ranging from 0 to 3. The total score ranges from 0—63, with scores higher than 14 points indicate clinically relevant levels of depressive symptoms. In addition, three global summary scores can be calculated. As the factorial validity for the subscales is debated, the present study only used the Global Global Severity Index which has proven as a valid indicator of psychological distress Second, all personality disorders for which respondents endorsed sufficient criteria for a specific diagnosis are carfully evaluated by an interviewer in order to assign a formal diagnosis We only used the questionnaire data in the present study which does not allow formal diagnoses.

A Practical Guide to Evaluation and Management

The self-defeating personality disorder is represented by 7 items, the dependent personality disorder by 8 items, the obsessive-compulsive personality disorder by 9 items, the negativistic personality disorder by 8 items, the depressive personality disorder by 8 items, the paranoid personality disorder by 9 items, the schizotypal personality disorder by 9 items, the schizoid personality disorder by 9 items, the histrionic personality disorder by 7 items, the narcissistic personality disorder by 16 items, the borderline personality disorder by 14 items, and the antisocial personality disorder by 15 items.

The ASTM measures negative response bias and insufficient motivation in psychological examinations It is presented as a test of short-term memory and attention. They should be read aloud and remembered. Then, a simple arithmetic problem is given. Afterward, another five words are presented, and the subject is required to identify the three words that were previously shown.

The score for the 30 tasks totals a maximum of 90 points. The reliability of the test is satisfactory. The internal consistency in different samples is around 0.

In a sample of mixed neurological patients, test—retest correlation was 0. The test also demonstrates good validity. Healthy controls from age 9 on master this test almost perfectly. Patients with neurological disorders, such as concussions, brain tumors, multiple sclerosis, or difficult-to-treat epilepsy, rarely have difficulties in handling this test, provided they do not have serious cognitive deficits. The test has been shown to identify ADHD patients with severe attention impairments Presented stimuli are a blue circle, a blue square, a red circle, and a red square.

A response key is to be pressed when two identical stimuli are shown in succession. The task requires stimulus information to be maintained in working memory until the next stimulus is presented and a matching process can be done The ratio of target to nontarget stimuli is During performance of the CPT, the movements of the participant are recorded with an infrared camera tracking a reflective marker attached to a headband worn by the participant. Participants are seated on a chair with back support but no armrest, to assure that they sit comfortably during testing, but do not adopt a reclining posture.

Q scores are derived for hyperactivity, inattention, and impulsivity.

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They are interpreted similar to Z scores with a mean of 0 and a standard deviation of 1. Cluster analysis is an iterative process. We therefore first performed k-means cluster analyses generalized to all scales of measurement with squared Euclidean distances The k-means procedure as a person-centered approach identifies relatively homogeneous subgroups while maximizing the variability between clusters. Variables were first examined regarding their importance for cluster formation as -to the best of our knowledge- this is not available in any R package.

We applied R packages clValid 82 and NbClust 83 to determine the best clustering algorithm and the optimal number of clusters Variables not used for classification further characterized the two clusters on a descriptive level. In case of multiple testing, p values were adjusted by Bonferroni correction Priority should be given to the analysis of effect sizes as there is a critical debate over Null Hypothesis Significance Testing NHST and its resulting p values 86 , Stemmler, G. Schmidt-Atzert, L. Ein Lehrbuch [ Psychology of Emotions. A Textbook. Kohlhammer Verlag, s.

Gross, J. Emotion, Emotion Regulation, and Psychopathology. Clinical Psychological Science 2 , — Psychological Inquiry 26 , — Fernandez, K. Emotion Regulation. Cognitive Therapy and Research 40 , — Beauchaine, T. Heart rate variability as a transdiagnostic biomarker of psychopathology. Werner, K. In Emotion regulation and psychopathology , edited by Kring, A. Jazaieri, H. Journal of Experimental Psychopathology 4 , jep. National Institute of Mental Health. Aldao, A. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review 30 , — Radkovsky, A.

Successful emotion regulation skills application predicts subsequent reduction of symptom severity during treatment of major depressive disorder.

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Journal of Consulting and Clinical Psychology 82 , — When are adaptive strategies most predictive of psychopathology? Journal of Abnormal Psychology , — Skirrow, C. Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. Journal of Affective Disorders , 80—86 Everyday emotional experience of adults with attention deficit hyperactivity disorder: evidence for reactive and endogenous emotional lability.

Psychological Medicine 44 , — Richard-Lepouriel, H. Similarities between emotional dysregulation in adults suffering from ADHD and bipolar patients. Journal of Affective Disorders , — Shaw, P. More info here. Ebook can be read and downloaded up to 6 devices. Ignore and show page. Edited by Craig B. Format: pages, 21 Tables, black and white; XIV, p. ISBN Other books in subject : Psychiatry.