Treatment for ADHD: The Present and Future Directions

Adult with ADHD

As a psychiatrist and mental health expert, with a private practice in Santa Monica, CA, I treat diagnose and treatment many patients with ADHD and ADD. Some patients come to my office with a previous diagnosis of ADHD and want to start or continue treatment. Other patients come to my office with a suspicion that their attention, concentration or ability to perform at work or home has been suffering. In either case, we first start with a comprehensive psychiatric evaluation to establish an accurate diagnosis and then discuss both non-medication and medication treatment options.


It may surprise you to learn that around 50% of childhood ADHD cases persist into adulthood. I often see cases that went undiagnosed in childhood but by the time my patients are in college, graduate school or entering the workforce, their techniques for overcoming the ADHD (called compensatory mechanisms) are failing them. In most cases, the more boring, repetitive, demanding and/or detail oriented the work/task, the more difficult it becomes to overcome the symptoms of ADHD.


There are non-medication and medication treatment options and often the best results are found from combining the two. Among the medication treatment options, there are non-stimulants and stimulants. The key is getting an accurate diagnosis and then a customized treatment plan for your individual needs and goals.


While the treatment for ADHD has not changed much over the past decade or so, I came across an article “Discoveries on the Genetics of ADHD in the 21st Century: New Findings and Their Implications,” in the October edition of the American Journal of Psychiatry.


The article discusses who twin studies led to the discovery of the genetic predisposition for ADHD. However, subsequent research has shown it is a combination of genetic and environmental factors that lead to ADHD. It is currently thought that the genetic heritability of ADHD is between 60 and 90%.


Genetic studies have shown some overlap with other diagnoses such as conduct disorder, Autism and Intellectual Disability. This does not mean you will develop these other disorders, but rather that the genes that lead to and contribute to each disorder are similar and likely overlap. Recent studies have shown that ADHD does not come from a single gene but is rather multi-factorial and polygenetic.


The current consensus is that routine genetic testing for ADHD is not indicated. For most patients, without other conditions (i.e. autism or intellectual disability) it would not change the diagnosis or management of ADHD. There are tests commercially available but their utility is suspect at this point, as evidenced by research from the article I reviewed. Although the authors acknowledge that may well change in the future.


If you or a loved one is suffering from ADHD, or suspect you have the symptoms of ADHD, please reach out for help. A psychiatric evaluation is the first step to get the help that you need.  


Stay Tuned! 


Dr. Goldenberg
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*Matthew Goldenberg D.O. is an addiction psychiatrist, board certified in General and Addiction Psychiatry and is a mental health and addiction expert. He maintains a private psychiatry practice in Santa Monica, California.

The conditions Dr. Goldenberg treats include depression, (major depressive disorder, MDD), bipolar disorder (mania and hypomania, aka bipolar depression), anxiety disorders (such as panic disorder and panic attacks; obsessive compulsive disorder, OCD; Posttraumatic Stress Disorder, PTSD); Attention Deficit Hyperactivity Disorder, ADHD; insomnia and sleep problems; addiction (alcoholism, drug addiction aka substance abuse and substance dependence); behavioral addictions aka process addiction (food addiction, gambling addiction sex addiction etc). 

Matthew Goldenberg, D.O. Matthew Goldenberg D.O. is double Board Certified in Psychiatry and Addiction Psychiatry and is a certified Medical Review Officer (MRO). He is an expert in the evaluation and treatment of mental health disorders and is an addiction specialist for adults in his private practice in Santa Monica, California. Dr. Goldenberg also provides addiction psychiatry consultations to some of the nation’s top residential and outpatient treatment programs in the Los Angeles area and is experienced in the evaluation and treatment of professionals working in safety-sensitive positions. In addition to his clinical work, Dr. Goldenberg is an active author, researcher and invited speaker at local and national conferences. He also volunteers his time as a Clinical Instructor in the Department of Psychiatry at UCLA and is an Assistant Professor of Psychiatry at Cedars Sinai Medical Center.

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