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Response to E-Letter "Primary Care Adult ADHD Evaluations"
We concur with the author that if a comorbid disorder is identified that could cause symptoms similar to ADHD, the diagnostic assessment should be postponed until further evaluation and treatment of the identified disorder are completed. Given that the adult ADHD diagnostic process was only offered to empaneled patients within our Family Medicine residency clinic, patients were understanding of potential delays and additional steps needed to complete the assessment.
Response to E-Letter "RE: Heltemes et al., Adult ADHD Diagnosis Innovations in a Family Medicine Clinic"
We acknowledge that the character/word limitation of the innovation article may have led to additional questions regarding the diagnostic assessment. Initially, the evaluation of the patient and the decision to offer screening instruments take thirty minutes. If the resident and faculty determine it is appropriate to offer the DIVA form, the standard process is to schedule a 60-minute follow-up visit. Patients are instructed during the initial visit to complete the DIVA form to the best of their ability with the help of a significant other, parent, or other close contact. Patients are also encouraged to bring this supporting party to the follow-up visit for additional questioning.
We agree with the author regarding the complexities of adult ADHD diagnosis. Residents and faculty participated in three hour-long didactic sessions on the assessment, diagnosis, and treatment of adult ADHD, delivered by our integrated behavioral health social worker and psychiatrist. Our quality improvement protocol was reviewed and approved by the department chair of psychiatry within our organization. Finally, the diagnostic assessment was not offered to patients outside of our clinic. We agree with the author that the primary care longitudinal relationship is essential for making this diagnosis within primary care. We believe primary care physicians are well-suited for this role, given their relationship with the patient and their understanding of the patient's medical, family, and social history.