APSARD Leads the Charge for Adult ADHD Guidelines

In an exclusive interview, Psychiatric Times spoke with David W. Goodman, MD, about the importance of the first US adult ADHD guidelines and APSARD’s role in this landmark endeavor. Goodman is hosting a town hall discussion of the adult ADHD guidelines at the upcoming APSARD 2024 Conference.

“I'm Dr David Goodman. I'm an adult psychiatrist, and assistant professor in the department of psychiatry and behavioral sciences at Johns Hopkins Hospital School of Medicine. I'm also a clinical associate professor at the State University of New York, in upstate at Syracuse.

“I'm here to talk to you today about a very exciting and first project ever done in the United States. And that has to do with the development and eventual publication of the first US guidelines for the diagnosis and treatment of adults with ADHD.

“Why is this so important? Well, we don't have guidelines for adults with ADHD, like we do for children and adolescents. Now there are international guidelines developed in Canada, Europe, South Africa, Australia, and the UK. We've been slow in the United States to address this because it is an arduous and scientific endeavor that requires a number of experts. APSARD, the American Professional Society for ADHD and Related Disorders, has undertaken this initiative. We've been in the process of development over the past year. In order to develop a taskforce, you need to vet everyone's conflict of interest, which is not an easy task given that you're looking at national and international experts, clinicians, and researchers who have been involved with adult ADHD for years, if not decades.

“We have undertaken this process, and we now have constituted a group on the task force that is looking at the process of developing these guidelines. Were actually quite advanced now, having gone through the vetting of the conflict of interest, and have developed the guidelines in which we are now in the process of voting. There's a method that is used for the development of guidelines, which is an iterative voting process in order to reach agreement.

“It's important to understand the difference between clinical practice guidelines and expert consensus. An expert consensus is a group of experts that come together and have conversations and reach agreement based on their clinical expertise, anecdotal information, and it's a consensus of experts.

“Medical practice guidelines, however, involve a much more rigorous process, because that involves not only a collection of experts who have been vetted for conflict of interest, it also involves extensive literature review of all of the scientific research available in the world on adult ADHD. We then sit down and list out clinical guidelines.

“Now what is the clinical guideline? The clinical guideline is a specific clinical behavior that clinicians will execute in undertaking the diagnosis and treatment of patients. For example, we would likely recommend that a blood pressure and pulse to be taken before ADHD medication is taken and then regulate thereafter. That's an example of the specific clinical practice guidelines. And so we have a long list which includes in the categories of diagnosis, assessment, nonpharmacologic treatment, and medical treatment.

“Who will this effect? Why undertake such an onerous and rigorous process here? Well, it affects a number of people. First, we're looking to standardize the care of patients with ADHD in adults in the United States. We want clinicians to come up to speed with the clinical practice guidelines and clinical practice of taking care of patients. It also affects patients and their family and the general public. It is giving a baseline guide of what is to be expected when you are diagnosed and treated.

“It will also affect policymakers. With these guidelines, we hope that people in policymaking position will reconsider the importance of adult ADHD and its impact not only on parents and families, but also society as well. There's an economic burden for adult ADHD that goes untreated.

“It will also have an impact on education. Heretofore, believe it or not, there are very little formal focuses in professional training programs—that is residencies, psychology programs, nurse practitioner, physician assistant, and nursing. We want to encourage the professional training programs to add to their curriculum adult ADHD. And with these guidelines, I believe that it will encourage these educational curriculum to add a focus here.

“And so this gives you a number of stakeholders. This is going to have a tremendous impact on the care of patients, insurance coverage, and policy decisions.

“I'm so excited that you have taken the time to listen to me. This is the most important endeavor that APSARD has taken on, we hope that this contributes to a tremendous shift in the focus of adult ADHD.”