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Adult ADHD Management

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Hi could you people please give suggestions on Adult ADHD management, I would be interested not only just medication.........

Any ideas on other country's guideline for eg: I heard Canadian guidelines are good?????????

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Mgt of ADHD in adults remains somewhat controversial with evidence for effective treatment mainly based of trials involving children.

There's suggestion of trial of medication together with supportive/psychologicl (not specific) therapy by Weiss & Weiss in Journal of Clinical Psychiatry 2004.

I've also read about behaviour modification, life management skills etc but have no data to back it up.

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nice guidelines came out before the end of last year...

have a look...

not very widely available services but recommendation to have more set up

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Summary of Nice guideline

1.7.1.1 For adults with ADHD, drug treatment should be the first-line treatment unless the person would prefer a psychological approach.

1.7.1.4 &nbsp:lol:rug treatment for adults with ADHD should always form part of a comprehensive treatment programme that addresses psychological, behavioural and educational or occupational needs.

1.7.1.8 For adults with ADHD stabilised on medication but with persisting functional impairment associated with the disorder, or where there has been no response to drug treatment, a course of either group or individual CBT to address the person’s functional impairment should be considered. Group therapy is recommended as the first-line psychological treatment because it is the most cost effective.

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Thanks kreely and godzilla.

You guys have any idea about how to taper off medication in Adults?

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Well it's going to depend on the medication you are using. Methylphenidate has a half life of 8 hours, osmotic release methylphenidate lasts 12 hours, and atomoxetine lasts considerably longer. If it is just methylphenidate, then they shouldn't really need tapering off as it comes out of their system overnight each day anyway. I would look at the literature for kids and see what they do there.

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Thanks for your response Chris. I think I have not made myself clear.

I would like to know when it can decided to take someone off any stimulant medication. For eg: if someone(ADULT PATIENT) been on the medication for 6-8 years and say pt has completed education, doing reasonably ok in a job. Then I guess may be time for considering taking off medication. I would like to hear people's views and experiences on this issue. :)

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Sounds reasonable. What you could do is do a baseline ADHD scale just now while on meds, take them off and then repeat the scale in 2-4 weeks time. If they get lots of symptoms back then they should presumably go back on the medication for another years or two and repeat the process. If they are functioning fine off the medication then it is safe to assume they can stay off it in future.

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That's is sensible. I have used Connors short scale before. I am not sure of any recent recommendations or developments in these scales. The Place where I am working now do not provide Connors scale. Any suggestions!!!!

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You can use the ASRS (adult self report scale , WHO) , mind you this is a screening tool and also the Wender UTAH both of which are free to download from the net and use.They are easy to use, just follow the instructions for a very simple interpretation.

The decision to come off medication actually rests with the patient. although like some would say sometimes it is a bit of trial and error as to when to come off it altogether.!!

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Sorry forgot to mention there are British Association of Psychopharmacology BAP guidelines on the management of Adult ADHD.Hope this is useful

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a baseline ADHD scale

Which is the scale that is recommended for this ?

Sounds like there ar a few scales around-Connors ( isn't that more for a diagnosis in kids ? have they validated that for adults as well ?)ASRS,Wender-UTAH etc.

Thanks

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I've used the ASRS for people I've seen. Seems a reasonable one. I don't know how well validated they are, but they come from WHO so presumably OK to use. There are different forms of Connors but I'm not sure if thee is a specific one for adults. Definitely for adolescents, but adults? I don't know. Plus the Connors are copyrighted and you have to pay them for each one used.

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Thanks for your suggestion people!

I have used Connors for Adults,there short and long versions, for patient and family to fill in. They sound reasonably good. Yes negative side is copy righted and have to pay for them. They come in a set of 3 carbon copies. Please feel free to make further suggestions!

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Well it's going to depend on the medication you are using. Methylphenidate has a half life of 8 hours, osmotic release methylphenidate lasts 12 hours, and atomoxetine lasts considerably longer. If it is just methylphenidate, then they shouldn't really need tapering off as it comes out of their system overnight each day anyway. I would look at the literature for kids and see what they do there.

If I remember correctly (was a long time ago that I did a child post!) but if someone was on long acting medication, changing to shorter acting forms and then slowly withdrawing over weeks used to be frequently used? The original Q of course has been answered.

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