In this video, neuropsychiatrist Theresa Cerulli, MD, debunks the myth that most cases of attention-deficit/hyperactivity disorder (ADHD) are simple to treat. ADHD is in fact a complex and heterogenous disorder that is difficult to both diagnose and treat, she says.
Dr. Cerulli, who has specialized in ADHD for approximately 20 years, is on staff at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and works in private practice in North Andover, Massachusetts. She is a clinical instructor at Harvard Medical School in Boston and a clinical supervisor for the Harvard Longwood Residency Training Program.
This is Part 2 of a 4-part video series marking ADHD Awareness Month, which is held in October.
Part 1: The Importance of Using Multiple Approaches When Treating Pediatric ADHD
Read the transcript:
Hi. I’m Dr. Theresa Cerulli. October is ADHD Awareness Month. This seems the perfect time to address a longstanding clinical myth that “most cases of ADHD are simple to treat.”
This is not true. Fact is that ADHD is a very complex, heterogeneous condition, making it both difficult to properly diagnose and difficult to treat. As a neuropsychiatrist specializing in ADHD for 20 years or so, I’ve been on the front lines with families struggling with this disorder. In addition to my professional experience with ADHD, I also happen to be the mom of a 15‑year‑old daughter with ADHD. I’ve personally seen how complicated this condition is in our own household.
I remember when I first started as an ADHD specialist, friends and colleagues would say, “Theresa, don’t you get bored seeing the same patients with the same condition all day?” I’d laugh, “Au contraire. ADHD is never the same.”
ADHD is challenging. That’s why we as clinicians tend to both overdiagnose and underdiagnose this condition. For example, there’s a tendency in kids with behavioral problems to just rush to an ADHD diagnosis. In the quiet inattentive ADHD kids, especially the girls, we tend to miss the diagnosis altogether.
The three core symptoms of ADHD, which are inattention, hyperactivity, and impulsivity, unfortunately, don’t leave us with much help in nailing down this diagnosis. Now layer in the additional challenges that upwards of two‑thirds of our ADHD kids also have coexisting psychiatric conditions, and an astonishing 60 percent of those have 2 or more psychiatric comorbidities with their ADHD.
No, I’m not just treating ADHD kids in my ADHD practice. I’m seeing depression, anxiety, bipolar disorder, insomnia, tic disorders, the list goes on, in terms of what I’m treating along with ADHD.
I was pleased to see in the last year that—ready? breaking news—our diagnostic and treatment guidelines for ADHD have been updated.
The American Academy of Pediatrics and the Society of Developmental and Behavioral Pediatrics, their guidelines have appropriately evolved to recognizing the fact that ADHD is complex. The timeline for this was that last fall, it…