Goals of ADHD Treatment

Theresa R. Cerulli, MD: Let’s move to discussing goals of ADHD treatment, focusing on patient impairments, both function and symptoms. What would you like to share, Birgit? Birgit and Dr Mattingly, let’s start with the 2 of you with regard to goals of ADHD [attention-deficit/hyperactivity disorder] treatment.

Birgit H. Amann, MD: I like to ask the patient what their goals are when I take that initial history. Sometimes I hear those classic ADHD symptoms, and other times I don’t. At the end of my intake—the first visit with them—I ask them, what are the top 2 or 3 things that you feel are most important for us to accomplish? That’s what we utilize. As we move along treatment, we revise them. If we’ve accomplished some but not others, we work to accomplish them all if we can. That helps me tremendously. Always reflect back at what we wanted to get done initially, and then revise if there are new things or different things we need to look at.

Greg Mattingly, MD: I agree. We learn from different things we do in life, obviously. Often I learned from my patients—the stories, the difficulties, the challenges they have with ADHD. Sometimes I learned from the research I do. One thing I learned from a research trial was 1 of the successful ADHD trials that was completed. We not only measured symptoms but asked every patient at the beginning, “Give me 3 areas of your life where ADHD affects you.” We’re going to track that, and we’re going to see how it improves as we get you on the right treatments. Give me something in the morning, give me something in the middle of the day, give something at home in the evening. Let’s track those areas where ADHD makes a difference in your life. Then I want you to come back and tell me how treatments made a difference as we go along.

Theresa R. Cerulli, MD: Dr Amann, how do you evaluate response to treatment?

Birgit H. Amann, MD: Aside from that, and I’ll just add a little more to what I said earlier and to what Greg just said. Let’s not forget collateral input. It’s not uncommon for the significant other to come in and say, “Get this treated or else.” But it’s also invaluable to know that baseline is that tenuous, to ask the patient and—if they’re willing—the collateral person, “How are things going?” As I said, I like to utilize other tools as well. I mentioned briefly the ASRS [Autism Spectrum Rating Scale]. I utilize that and other rating scales. It’s helpful for me. It’s my baseline. It’s like my blood draw. As I move along in treatment, not every visit, I like to repeat it. It’s visual. The patient benefits from seeing changes, progress that’s encouraging. I utilize that tool among others to help me assess their clinical response.

Greg Mattingly, MD: You said something fascinating, and I’d never thought of it in that context, although we do it all the time. In the same way that a patient likes to see that their blood pressure is getting better, my blood pressure used to be 160/100. Now it’s running at 40/70, and they’ll tell you that. It’s important for patients to see those numbers getting better as their ADHD is getting better. I like that approach. I can see it numerically. I can tell it’s getting better. I’m tracking it, and I’m following it getting better. That’s a really important message for our patients.

Birgit H. Amann, MD: It aids in adherence compliance. They’re more willing to stick with their treatment.

Transcript Edited for Clarity