How I Treat: Adult ADHD With Dr Napoleon Higgins Case Presentation

• Jenice is a 55-year-old Black female "uber-professional" accountant, a position she has held for many years.
• She fully engrosses herself in her work, but despite her doing well on the job, she notices some problem areas at home.
• Within the home, she feels she has not been as accountable as she expects herself to be. Jenice often misses things regarding her children (ie – homework, soccer practice timing, etc.), overlooks specific dates and times, forgets to pay bills, and avoids finalizing decisions that need to be made.
• She fully engrosses herself as a manager at work, but still struggles with timeliness and disorganization. She also struggles to start and stay focused on tasks that she isn't very interested in.
• A family therapist referred Jenice for anxiety, an issue that would often arise when talking to her husband, and a pattern that was noticed while they were going through marital therapy. When he would ask questions, she would feel anxious, like she needed to be able to come up with an answer but was also acutely aware that she had forgotten the previous discussion. Generally, they would work together to come up with a plan for things that needed to be done for the family, but Jenice’s husband would interpret her forgetfulness as aloofness, or a lack of care for the home. When evaluating this situation, I noticed that Jenice seemed to return to explanations such as, “' I forgot this,' or 'I'm trying to cover ground,' or 'I'm trying to make up for what I was thinking at the particular time.'"
• After the initial evaluation for anxiety, we started paying closer attention to the role that depression might play. Jenice was upset that she often fell short of both her own and others’ expectations, leaving her with the feeling that she is a failure, despite the characteristics of her life that would lead outside observers to she is functioning extremely well. She has a beautiful family, with her professional husband and wonderful kids, but as the kids get older and shoulder more responsibilities, Jenice struggles to keep track of it all.
• During the pandemic, we conducted our appointments via telehealth, and so I saw her office. She had a corner office with windows on each side, but throughout, there were stacks of papers standing at least a foot and a half high. She said that the piles of papers served as reminders to help her complete tasks because she would trip over them.

​​​​​​​Note: The patient's name and identifiers have been changed for anonymity. 

Dr Napoleon Higgins is a child, adolescent, and adult psychiatrist in Houston, Texas. He is the owner of Bay Pointe Behavioral Health Services and South East Houston Research Group. Dr Higgins received his MD from Meharry Medical College in Nashville, Tennessee, and he completed his residency in Adult Psychiatry and his fellowship in Child and Adolescent Psychiatry at the University of Texas Medical Branch at Galveston. He is the President of the Black Psychiatrists of Greater Houston, Past President of the Caucus of Black Psychiatrists of the American Psychiatric Association, and Past President of the Black Psychiatrists of America, Inc. Dr Higgins is co-authors of Bree's Journey to Joy: A Story About Childhood Grief and Depression, How Amari Learned to Love School Again: A Story about ADHD, Mind Matters: A Resource Guide to Psychiatry for Black Communities, and author of Transition 2 Practice: 21 Things Every Doctor Must Know In Contract Negotiations and the Job Search.