The Battles We Face: ADHD From A Patient Perspective, And What Providers Should Know

Even if you aren’t a long distance runner or walker, you can still appreciate someone who finishes a marathon; after all, 26.2 miles is no small feat! Now imagine that person crossing the same finish line, but this time, carrying an invisible backpack full of weights. It’s still impressive, but it would be even more awe inspiring had the onlooker understood the added burden that person was carrying the whole time. This silent and invisible struggle is a daily reality that someone with Attention Deficit Hyperactivity Disorder (ADHD) can relate to.

ADHD is inherently difficult to “spot,” especially for those who don’t present as hyperactive or lack obvious focus. I know this from personal experience. I got good grades in school. I wasn’t getting in trouble. Teachers didn’t find me disruptive. But internally, it was chaos. As young as 4th grade I can recall being terrified of rejection and experiencing severe battles with anxiety.

For well over a decade, I had to work every day to keep my life together. To get to places on time. To complete simple tasks like cleaning that needed to be done. I did this without medication that would have made living with ADHD much more manageable. ADHD didn’t even cross my mind until I was officially diagnosed at 25. Unfortunately, my story is far too common. But there are things providers can do to help patients like me.

The rise of ADHD in America

Over the last 30 years, there has been an increase in the number of people being diagnosed with ADHD. That number has surged since 2020. The CDC estimates that more than 7 million children aged 3-17 have been diagnosed with ADHD. Boys are nearly twice as likely to receive a diagnosis as girls, who can present with ADHD in different, and more subtle, ways.

Increased awareness and advancements in research have largely been behind the uptick in the diagnosis of children. However, when it comes to adults, a lot more work is needed. Despite six percent of adults in America living with ADHD, less than 20 percent will ever receive care and treatment.

Untreated ADHD can lead to problems completing school and keeping a job. It also increases the chances of substance use disorders and even suicide. As someone who suffered in silence for years, that has to change. It begins with the patient-provider relationship and experience.

How clinicians can better support patients with ADHD

For patients who suspect they have ADHD or have been diagnosed, simply reaching out to schedule an appointment can be a monumental task. Before a patient ever steps foot in the door or signs in for a telehealth visit, they’ve already overcome multiple hurdles. Simply picking up the phone, waiting on hold, or driving to and from appointments can be monumental tasks.

With that in mind, providers should keep the following in mind:

1. Treat the request as a potential crisis, not a routine appointment. Patients with ADHD generally seek care after years of suffering alone, and just making an appointment can exhaust any remaining executive function. To reduce cognitive overload, new appointments for ADHD patients should be prioritized and streamlined. Limit wait times and stagger staff scheduling to ensure patients aren’t waiting weeks or months for care.
2. Minimize friction points in the patient journey. Any new patient is welcomed with a mountain of paperwork, which can overwhelm those with ADHD. These patients are already struggling, their appointment shouldn’t add chaos to an already challenging time. When possible, simplify the intake process, offer digital paperwork options, and provide flexibility to see the patient via telehealth to remove unnecessary barriers, such as driving to and from an appointment.
3. Look for the underlying cause. Many patients with depression and anxiety may also have ADHD. This is particularly common in women who may have developed advanced coping mechanisms to deal with their ADHD. For years, I was treated for depression and anxiety, which were symptoms of my undiagnosed ADHD. Providers should seek to identify and treat the cause, not the symptoms.  

4. Show interest and listen. Most ADHD patients want providers who show genuine interest in their story rather than just prescribing medication. For this exact reason, new patient appointments for those with a possible ADHD diagnosis can’t, and shouldn’t, be a routine 10 or 15 minute exam. I recommend blocking 45-minutes for this initial appointment.
5. Create a clear and concrete plan. Patients with ADHD need a solid plan and next steps before the appointment ends. Schedule follow-ups, and complete authorization steps needed for the patient to access continuing treatment. Create a process to check-in between visits and understand how patients are responding to medication. If a patient with ADHD leaves an appointment with no clear next steps, they may not have the bandwidth or motivation to follow-up themselves.

Caring for patients with ADHD, or those who potentially have ADHD, extends far beyond diagnosis and prescribing. The invisible struggles these patients deal with, such as completing simple tasks, keeping a job, and meeting deadlines, necessitates a provider and care team that stays engaged.  

The future of ADHD in America

According to some estimates, the number of Americans diagnosed with ADHD is expected to increase by more than a million over the next six years. Providers must start adapting now to meet this growing demand. 

By better streamlining the patient journey and creating an encouraging path forward, many of these patients won’t have to suffer in silence. Remember, the moment a patient with ADHD reaches out for help is the moment they’ve decided they can’t do it alone anymore.

Photo: Thinglass, Getty Images

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