Primary Care Adult ADHD Evaluations

We commend Dr. Mullen and her colleagues for their innovative approach to assessing adults with ADHD concerns. This method empowers primary care providers with a clear workflow, reducing the need for external referrals that can cause delays and improving the diagnosis of comorbid conditions within primary care.
In our resident/faculty practice over the past two years, a dedicated family physician has been conducting adult ADHD assessments in primary care, alongside clinical psychology evaluations. This process was introduced in response to the significant increase in adult ADHD diagnostic requests in our clinic.
We are particularly interested in the approach Dr. Mullen and her team use to manage the 75% of patients with comorbid conditions, given that the DSM-5 precludes diagnosing ADHD if symptoms are better accounted for by another mental health condition (e.g., mood disorder, anxiety disorder). Specifically, do providers diagnose both Adult ADHD and comorbid conditions simultaneously, or address the comorbid conditions first and reassess for ADHD afterward? Additionally, when comorbid conditions are diagnosed, do providers treat sequentially (e.g., mood disorders first, then ADHD) or concurrently?