COMMENTARY

Diagnosing and Treating Adult ADHD: A Guide

Matthew A. Goldenberg, DO

Disclosures

February 01, 2016

In This Article

Compensatory Mechanisms

As mentioned previously, many patients (especially those who are high-functioning) will develop and depend on coping mechanisms to overcome or hide their ADHD symptoms.[3] In addition to the strategies I mentioned previously, some patients will unknowingly rely on coworkers or family to an inappropriate extent in order to complete tasks and meet their obligations.[3] This can muddy the diagnostic waters; however, as mentioned previously, speaking with someone close to the patient can help clarify the diagnosis.

In my experience, a well-conducted and thorough diagnostic interview will pick up the coping strategies that a patient had been using to overcome ADHD. The loss or failure of their coping mechanism to continue to control their symptoms is why the patient is presenting for help now. For example, does a recent move, promotion, divorce, or other life change explain why their ADHD symptoms are now unmanageable? If we do not account for coping mechanisms, it may make our patient's symptoms appear too acute to meet the criteria for ADHD. However, when the patient's coping mechanisms are taken into account, it can be easier to see the chronic nature of their symptoms.

This is why it is so important to obtain a history from the patient and also collect collateral information from someone close to the patient. I have seen many cases where the patient was unaware of the extent of their reliance on coping mechanisms or the duration of their dependence on others.

I have had several cases of patients who had been able to control their symptoms with behavioral modifications (such as removing distractions from their environment, allowing extra time to complete tasks, and making lists). Then, as the pressures and demands of their environments increased, they were no longer able to control their symptoms effectively, and the symptoms began to negatively affect their performance. However, unaware of their long history of struggle, patients may report only their recent difficulties and overlook years of borderline functioning. To assist you in clarifying and solidifying your diagnosis, screen for coping mechanisms and consider speaking to loved ones or colleagues (with the patient's permission).

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