Addressing Common Clinical Challenges in ADHD Treatment

In this exclusive Q&A from on-site at Psych Congress 2023 in Nashville, Tennessee, Steering Committee Member Julie Carbray, PhD, APRN, clinical professor of psychiatry and nursing at the University of Illinois Chicago, sheds light on the clinical challenges faced by mental health care providers when treating attention-deficit/hyperactivity disorder (ADHD). From comprehensive diagnostic evaluations to personalized treatment plans encompassing both pharmacological and non-pharmacological interventions, Dr Carbray offers valuable insights into optimizing patient care. She highlights often overlooked factors in ADHD diagnosis and treatment, and shares resources to deepen knowledge on these topics.

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Psych Congress Network (PCN): What are some common clinical challenges that mental health care providers confront when treating ADHD?

Dr Carbray: The most important clinical challenge to begin with when managing ADHD is a very thorough diagnostic evaluation. Collateral information from family members or teachers is very important, so beginning with a good diagnostic evaluation would be the first challenge. The second challenge would be choosing a treatment that is personalized for your patient, including both psychotherapy components, wellness components, and psychopharmacology pharmacologic treatments.

PCN: What are some factors in ADHD diagnosis and treatment that are often overlooked?

Dr Carbray: Some of the factors in diagnosis and treatment that are overlooked include the patient's lifestyle, their wellness strategies, and their own personal challenges with how ADHD impacts their relationship. Although patients need to meet criteria for the diagnosis, one patient with ADHD may look very different from another as well as how symptoms impair their daily functioning. A treatment plan should really consider what that patient needs to best manage the repercussions of their illness in their day-to-day living, and treatment should be geared towards that.

PCN: How might clinicians balance pharmacological and non-pharmacological interventions when creating treatment plans for patients with ADHD?

Dr Carbray: Although we know pharmacologic treatments can be extremely beneficial for patients with ADHD, it's also important to consider non-pharmacologic interventions. A good balance of both provides the best treatment for your patients. And again, personalized approaches should include both pharmacologic and non-pharmacologic interventions like mindfulness interventions, good sleep schedules, and other wellness interventions along with coaching or therapy to support areas of life where the patient is looking to improve their mastery over their illness.

PCN: For clinicians seeking to deepen their knowledge on this topic, what are some initial steps they can take?

There's a wide array of options for clinicians to deepen their knowledge. On the topic of ADHD, starting with clinical journals, there are several podcasts available that focus on ADHD treatment. And professional organizations such as CHADD or online resources like Psych Congress Network and NP Institute that will give you tips and clinical pearls around best helping your patients.

Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, is a clinical professor of psychiatry and nursing at the University of Illinois at Chicago. Dr Carbray holds her PhD ('93) and Master of Science ('88) degrees from Rush University, Chicago, and her Bachelor of Science ('87) degree from Purdue University in West Lafayette, Indiana.