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I’m ecstatic that U.S. guidelines for diagnosing and treating adults with attention-deficit/hyperactivity disorder (ADHD) are underway, and everyone working in the field, or impacted by ADHD, should be as well.

With an estimated 10 million adults with ADHD today, it is long overdue. For years, clinicians have relied on European and Canadian guidelines for adults, but it’s time to standardize care in the U.S.

The outcomes for untreated or improperly treated ADHD are frightening. These include increased risk of accidents, emergency room visits, substance abuse, unemployment, divorce, depression, anxiety, and, worst case, death. While the statistics are difficult, it’s crucial to know that ADHD is persistent but also 100 percent treatable.

As providers, we must do everything possible at the front end, not just to diagnose but to treat and maintain treatment for long-term success.

ADHD is complicated by enormous overlap with coexisting conditions. The good news is we can address the outcomes and triggers leading to other conditions if we adequately identify and treat the underlying condition.

Effective treatment begins with an accurate diagnosis. It isn’t just about the ability to make a difference in treating ADHD symptoms, but rather to improve the trajectory of a patient's life.

Improving the Quality of Care for ADHD and Beyond

Given the mental health crisis we face as a country, it's irrefutable that we need to elevate the quality of care for ADHD and, frankly, healthcare in general. The steps to do so are the same for ADHD as for all other mental health conditions.

We know that ADHD rarely exists alone since 75 percent of patients with ADHD have at least one comorbidity, and 60 percent have two or more comorbid conditions. In fact, for adults, the comorbidity typically leads them to seek a diagnosis. Enhancing care for ADHD has a significant impact on mental health overall.

One change that will greatly impact the field is if we stop functioning in silos and collaborate to ensure all stakeholders are in-line and working in the same direction. Clinicians, patients, payers, pharmaceutical companies, and policy leaders must come together to collectively present what they know to determine how to achieve the best outcomes. Silos in mental health care are leading to suffering.

Critical Elements for Effective Standardization of Care

Subjective assessments have always been, and should always be, a critical part of the standard of care for ADHD. Historically, we relied on subjective data in mental health care because we had no objective options.

However, as technology has advanced and FDA-cleared testing solutions become available in any field, objective measurement must be written in the guidelines as part of the standard care process. Standard of care becomes standard of practice, becomes standard of coverage (insurance). They are all linked, but they must start with the guidelines.

Across the medical field, objective and subjective measures work in tandem to diagnose and treat a patient. From x-rays and MRIs to basic thermometers and blood pressure readers, physicians supplement observational data with objective evidence to ensure they capture a complete picture for their patients.

Psychiatry is one field that has opted not to follow this process, instead solely relying on subjective rating scales that are vulnerable to errors, which can lead to overdiagnosis by providers and patients. Without the support of guidelines, the lack of payer coverage forces prescribers to rely solely on subjective information that is all too easily manipulated and fabricated by patients. This needs to change, and I hope to see the opportunity seized with the new guidelines.

Objective Measures

Using objective measurements when diagnosing ADHD aids the process efficiently and cost-effectively. Every person with ADHD is unique and presents symptoms differently, regardless of age, gender, race, or socioeconomic status. Subjective measures don’t capture the whole picture; they are only part of the picture.

For adults with ADHD, the most common issues are having trouble paying attention and feeling overwhelmed, but several factors can contribute to this, completely unrelated to ADHD. With objective testing, we can measure core ADHD symptoms—inattention, activity, and impulsivity—to identify what a person is truly experiencing. This information allows us to determine the best treatment options to uniquely aid the patient in the areas they need it the most.

Previous objective tools, such as full neuropsychological testing, have proven inadequate for ADHD due to their lack of sensitivity. While better suited to detect learning differences in children and dementia in adults, neuropsychological tests are costly, inaccessible, and not scalable for everyday use in psychiatry.

Addressing Present Needs While Preparing for the Future

As the American Professional Society of ADHD and Related Disorders (APSARD) prepares its guidelines for diagnosing and treating adults, it’s important that we prepare not just for the present but well into the future, looking at all tools available to clinicians to get the diagnosis right. ADHD is the only neurodevelopmental disorder with reliable and scalable testing options, and it would be a great disservice to patients not to use it routinely.

Patients seek a diagnosis to alleviate their struggles. Providers work to improve patient lives. Together we all recognize the only way to treat someone properly and improve outcomes is to get the diagnosis right.

So why are we not using cost-effective, safe, available, FDA-cleared objective measures to do so? The question ought not to be why should we consider adding objectivity in psychiatry, but rather why shouldn’t we? An objective measure to contribute to our subjective process is essential. Without it, we’re failing to provide the highest standard of care.