ADHD: Frequently Asked Questions

2. If my patient has ADHD what is the chance other family members have ADHD?

Evidence from family, twin and adoption studies shows strong genetic contribution to ADHD. It is very likely that close relatives of a patient with ADHD may also have ADHD. It is also likely that a parent with ADHD has an above 50% chance of having a child with ADHD. 

3. Do you have to have ADHD as a child to have it as an adult?

No. One does not have to have a diagnosis of ADHD as a child to have it as adult, but several inattentive or hyperactive-impulsive symptoms need to be present before age 12 for a formal diagnosis.

4. Does a diagnosis of adult ADHD always have to have childhood onset?

No. While in most cases ADHD often lasts into adulthood, ADHD can be diagnosed for the first time at any age. 

5. What symptoms are needed for Diagnosis in Adult ADHD?

For a formal diagnosis of ADHD, symptoms of hyperactivity-impulsivity and/or inattention should meet the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The symptoms and/or behaviors must have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church) and have to negatively impact academic, social, and/or occupational functioning. In patients aged < 17 years, ≥ 6 symptoms are necessary; in those aged ≥ 17 years, ≥ 5 symptoms are necessary. Access information about symptoms of ADHD.

6. If my patient is diagnosed with ADHD how often will there be co-morbid psychiatric diagnoses? How do I screen for these?

The most common psychiatric comorbidities that often co-occur with ADHD in adults are depression, anxiety disorders, bipolar disorder, Substance Use Disorders (SUDs) and personality disorders. Access information about screening for differential diagnosis.

7. When does normal behavior reach the level of ADHD?

Almost everyone experiences symptoms similar to ADHD at some point in their lives. ADHD is diagnosed only when symptoms are severe enough to affect daily functioning in at least two settings — for example, at work and at home. These persistent and disruptive symptoms can be traced back to early childhood.

8. Can a traumatic brain injury (TBI) look like ADHD and respond to stimulants?

Yes, it is possible that traumatic brain injury may have symptoms similar to ADHD. Current evidence shows that stimulants appear to improve attention after first-time administration and for short time periods in individuals with TBI. 

9. How frequently do I need to follow my patients?

It is suggested that all adults with a new ADHD diagnosis, uncontrolled symptoms or any change in medication should be seen within 30 days and monthly thereafter until the symptoms and functionality improve. When symptoms and function improve, visits every 3-6 months are recommended.

10. How do I explain to my ADHD patient how we think these medications work?

ADHD stimulants boost levels of two neurotransmitters, or chemical messengers in the brain, known as dopamine and norepinephrine. Dopamine is thought to play a role in memory formation and the onset of addictive behaviors, while norepinephrine has been linked with arousal and attentiveness. Stimulants also affect dopamine and norepinephrine reuptake in certain parts of the brain and, as a result, increase the amount of these neurotransmitters helping messages within the brain be more effectively transmitted and received.

11. My patient just came out of rehab for opiate dependence, should I avoid stimulants?

Stimulant medications need to be used with caution in patients with previous substance use. If treatment with stimulants is necessary, it is advisable to use longer-acting stimulant formulations.

12. Do people have withdrawal symptoms when stopping stimulant meds? What is best way to taper?

Yes. There is a documented withdrawal syndrome for stimulant medications. The initial phase (crash) of withdrawal syndrome occurs as the stimulant effects wear off and withdrawal symptoms can persist for days and weeks. It is generally not recommended to stop taking a stimulant medication “cold turkey,” or suddenly, which may cause uncomfortable withdrawal symptoms. Instead, a slow and controlled taper, or weaning-off period, under medical supervision is considered more desirable.

13. What are contraindications to stimulant use?

Stimulants are contraindicated if the patient has any of the following:

• Comorbid Tourette’s disorder
• Thyrotoxicosis
• Arrhythmias
• Uncontrolled moderate to severe hypertension
• Active angina
• Pheochromocytoma
• Glaucoma
• Alcohol use disorder
• Anorexia nervosa

14. Who needs an electrocardiography (ECG) prior to initiating stimulant treatment? What other tests might be needed?

Patients with a medical history of arrhythmia beyond occasional palpitations and patients with a family history of sudden death may need an ECG. A regular physical exam is recommended as a part of diagnostic evaluation and prior to treatment initiation. 

15. Must medication be used?

About 60% of adults experience improvements in quality of life and symptom reduction in response to medication treatment. 

16. My patient has a SUD and I am unsure if I should prescribe a stimulant. What are some considerations and are any preferred in this situation?

Patients with active IVDU or active nonmedical stimulant use (cocaine, amphetamines, or methylphenidates) should not be initiated on a stimulant for ADHD. Patients with a history of SUD and who are in remission may do well with a stimulant medication. Either methylphenidate OROS or lisdexamfetamine are preferred to reduce the risk of nonmedical use via formulation manipulation to induce a rapid peak level in the serum.  

17. Can the risk of ADHD in my child be increased by certain behaviors when pregnant/breastfeeding and postnatally?

While the exact causes of ADHD are still unclear, studies show that having a biological relative with ADHD, pre- and post-natal factors such as exposure to lead, tobacco, maternal stress during pregnancy, and low birth weight/prematurity have been most consistently found as risk factors, but none are yet known to be definitively causal. Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. While many factors, including these, might worsen the symptoms of ADHD there is no evidence to conclude that they cause ADHD.

18. Where are behavioral health approaches available for adult ADHD in my community?

One option for identifying resources available within your community is to use the Neighborhood Navigator. The Neighborhood Navigator is a resource offered by the AAFP and The EveryONE Project^®. The Neighborhood Navigator is an interactive tool that can be used at point of care to connect patients to resources and programs in their neighborhoods. Over 40,000 social services are listed by zip code, which includes various physical health and mental health options. Access the Neighborhood Navigator.