Treatment Landscape for the Management of ADHD - Episode 3
Theresa Cerulli, MD: I’d really love to bring Andy into the discussion at this point, given your vast clinical and research experience. What effect does ADHD [attention deficit hyperactivity disorder] have on a patient’s quality of life? Because that’s really the bottom line about everything we’re talking about.
Andrew J. Cutler, MD: Oh, absolutely. It important that this ultra-neurobiology causes symptoms, but clinically the effect is significantly negative on the patient’s quality of life, for both children and adults. The condition can really have a negative impact on quality of life in virtually all settings, including school, work, a home setting, socially, and psychologically and internally as well.
In school, of course they can get a lot of negative feedback. They may be in trouble all the time. They’re not doing what they’re supposed to do. They can be disruptive. There can be detentions, suspensions, and even ultimately expulsion from school. They don’t do their homework. They don’t do assignments and things they are supposed to do.
At work we know it can be very difficult to meet timelines, to be organized, and to work independently. Judgment is sometimes an issue. Impulsivity.
We also know ADHD can have a significant impact on the quality of life at home. As far as relationships, we know about the stress level it can cause. The negative feedback. The child is always in trouble and needs to be disciplined. The parents are stressed out. “Were we disciplining properly or not?” ADHD can cause problems with sibling relationships and parental relationships, of course.
And then socially, there can be problems with peer interactions and peer relationships. I’ll never forget a mom telling me about her 6-year-old son. “You know, he never gets invited to birthday parties.” And you could tell it was really affecting him. He was starting to notice that he wasn’t getting invited to birthday parties. And so this is a very sad thing.
It can also affect the ability of the family to just go out. I’ll never forget a mom talking to me after successful treatment for her 10-year-old son. She came in, virtually in tears, and I thought, “Oh, gosh, something negative has happened here.” But she told me, “We went to the mall this week and nothing happened.” You’d think it was the most significant achievement in the world, because they just couldn’t take the kid out shopping or to the mall.
Psychologically, it can have a significant impact on the patient’s self-esteem, their sense of self-worth, their identity. They start internalizing very negative self-images. They think of themselves as failures, as dumb, as lazy. “What’s wrong with me?” Really, the impact on quality of life can be quite significant in all spheres of life, and it can affect all relationships that the patient has.
Theresa Cerulli, MD: Well said. I agree with you. Ultimately, we’re not talking about a checklist of symptoms. We’re ultimately talking about functioning, right? How is the person doing in their day-to-day life? And ultimately, to help our patients’ understanding in this diagnostic and treatment process, what we’re really trying to do is assist people to be happier and healthier in their day-to-day living.
David W. Goodman, MD: We should highlight that this is all evidence based and research based. Quality of life has been measured in children, adolescents, adults, and even older adults over age 60. So it’s not simply a clinical impression, as your stories clearly reflect, but this is very much research based and shouldn’t be discounted as a clinician’s advocacy.
Andrew J. Cutler, MD: Absolutely, David. I’ve worked with many adults. When you make the diagnosis, they look back on the negative problems they’ve had in their lives and there is a grieving process. They feel sad. “You mean this was something I’ve had my whole life, that was treatable, and no one recognized it or helped me with this?”
David W. Goodman, MD: There is a strong element to psychotherapy, which we’ll talk about later. But for adults, it’s not only the grief of the opportunities lost in the past but the resurrection of self-esteem and self-image and understanding the difference between who they are and what they have, which is ADHD.
Theresa Cerulli, MD: Tim, did you have any additional comments you wanted to make as we wrap up this segment?
Timothy E. Wilens, MD: I think what you just heard from everybody is something that’s very important. This is not a cosmetic disorder. For some reason, some people see this as a cosmetic disorder. As Andy and Dave said, this is a very serious disorder that really needs to be properly diagnosed and properly treated.
Transcript Edited for Clarity