The presentation by Dr. Mahendra Perera discusses adult ADHD as both a clinical reality and the importance of accurate diagnosis and management. It highlights the prevalence of ADHD, its core symptoms, co-morbidities, and emphasizes a bio-behavioral approach to treatment, which includes illness education, behavioral modification, and medication options. The conclusion underscores ADHD as a lifetime condition requiring ongoing medical attention and a multimodal approach to support patients effectively.

1. ADHD
Myth or Cinical Reality?
presented by
Dr Mahendra Perera
Consultant Psychiatrist
MBBS, PhD, MD(Psych), MRCPsych, FRANZCP, MRACMA, FAChAM

2. Disclosure
• Sponsored by Eli Lilly
• Presented at drug company sponsored events
• Received Honoraria
• Includes this presentation

3. The past is our teacher,
the present our
opportunity and the
future our hope

5. Adult ADHD
Myth or Clinical
Reality

6. •Presenting Issues
•Diagnosis
•Management

7. Core Symptoms
Hyperactivity
Impulsivity
Inattention
ADHD

8. Health
HomeWork

9. •Anxiety
•Depression
•SUDs
• Relationships
• Issues at
work
• Achievement

11. NARRATIVE

12. Diagnosis
 History – presenting complaints
Adult Sx vary
 History – past performance (school
reports, psychological assessments
Problems start in Childhood
 History – corroboration by reliable,
independent person

13. Checklists
 DSM IV items
Basis for making the diagnosis
 WHO Checklist
Useful in follow up

14. Tests
 IQ
Subscale Variations
 Continuous Performance Tracking
 Neuropsychological Evaluation
Related reading writing problems
 Biological Tests- MRI, EEG,

15. Co-morbid Conditions
 Bipolar Disorder
 Depression
 Substance Use Disorders
 Personality Disorders – rare
 Psychosis – due to SUD or independently

16. Co-morbidities
ADHD
BPAD
Substance
use
disorders
Psychosis
Conduct
problems
Language
disorder
Depression
Patients do not read the text Book!

17. 2nd Opinion
 Talk with a colleague
 Write a letter
 Video conference/Skype/Face
Time
 Request a formal second opinion
 Follow up discussions

19. The Numbers
 Adults 3 – 6 % 1-2
 Children 5 – 10% 3
1. Fayyad, J. et al. (2007). Cross-national prevalence and correlates of adult attention-
deficit hyperactivity disorder. The British Journal of Psychiatry, 190(5), 402–409.
doi:10.1192/bjp.bp.106.034389
2. Das, D. et al (2012). A Population-Based Study of Attention Deficit/Hyperactivity
Disorder Symptoms and Associated Impairment in Middle-Aged Adults. (E. M. C.
Skoulakis, Ed.)PLoS ONE, 7(2), e31500. doi:10.1371/journal.pone.0031500.t006
3. Scahill, L & Schwab-Stone, M. (2000) Epidemiology of ADHD in school-age children.
Child and Adolescent Psychiatric Clinics of North America, Vol 9(3) 541-555

20. Management
is a
bio-behavioural
approach

21.  Illness education
demystify condition
 Deal with co-morbidities
 Behavioural modification
Psychosocial rehabilitation
 Family work
 Medication

23. Medications
 Stimulants
 Dexamphetamine
 Methylphenidate
 Non-Stimulant
 Atomoxetine
 Bupropion
 Anti-depressants
 Mood stabilisers
 Anxiolytics
 Hypnotics
 Melatonin

24. Precautions & Practice
 Keep copy of script
 Establish Pharmacy
 Rx at Pharmacy
 Note Rpt interval
 Calculate requirement
 Obtain PBS whenever
possible
 Inform GP, Rx Drs
 Psychiatrist Rx
 Permit
 Sch 8
 Follow Instructions
 GP’s can prescribe
 Renew permits
 Intersate
 Nightmare

25. Checklist

26. Conclusions
 ADHD is a lifetime illness
 Needs medical attention
 Psychiatrist are currently the major service
providers
 We need to Rx taking due precautions

27. A pain in the rear OR Someone
crying out for help

28. Conclusions
 ADHD is a lifetime illness
 These patients seek our help
 They need medical attention
 Psychiatrist are currently the major service
providers
 Multimodal approach is the key

29. Let us take the necessary risks
But remember we need to
keep
our eyes wide open