How to CORRECTLY Diagnose Attention Deficit Hyperactivity Disorder (ADHD) in Adults? - Dr Sanil Rege

Summary

In this edition of Hub Bytes, psychiatrist Sunil Rege discusses the comprehensive evaluation of ADHD in adults. He emphasizes that ADHD is a diagnosis of exclusion and should be considered from a longitudinal perspective, taking into account various factors that could contribute to ADHD-like symptoms. Rege highlights the importance of ruling out organic causes, considering inflammation, hormonal aspects, and the impact of substances and trauma on cognition. He also stresses the significance of addressing sleep disturbances and dietary interventions in the management of ADHD, advocating for a thorough and individualized approach to diagnosis and treatment.

Takeaways

• 🔍 ADHD is a diagnosis of exclusion, meaning other potential causes for symptoms must be ruled out first.
• 🌉 The evaluation of ADHD should consider a longitudinal perspective, looking at the individual's history and various contributing factors.
• 💊 A thorough cognitive examination is crucial, as ADHD symptoms can overlap with other conditions like neurodegenerative disorders.
• 🌙 Sleep apnea and other sleep disturbances can significantly impact daytime cognition and should be considered in ADHD evaluations.
• 🩸 Checking for organic factors such as vascular health, vitamin deficiencies, and hormonal imbalances is important due to their impact on cognitive function.
• 🔥 Inflammation, both neural and systemic, can lead to cognitive disturbances and should be evaluated as part of the ADHD assessment.
• 🧠 A comprehensive psychiatric evaluation is necessary to rule out conditions like psychotic disorders, affective syndromes, and anxiety that can mimic ADHD symptoms.
• 🚫 Substance misuse and certain medications can affect cognitive function and must be considered in the diagnosis process.
• 🍽️ Diet and nutrition play a role in cognitive health, and dietary interventions may be beneficial for individuals with ADHD.
• 💤 Addressing sleep disturbances is essential, as they can affect the effectiveness of ADHD treatments and overall cognitive function.

Q & A

What is the primary focus of the video by Sunil Rege?

The primary focus of the video is the evaluation of ADHD (Attention Deficit Hyperactivity Disorder) and the importance of considering various factors that might contribute to symptoms similar to ADHD to avoid misdiagnosis.

Why is ADHD considered a diagnosis of exclusion according to the video?

ADHD is considered a diagnosis of exclusion because it's important to rule out other underlying conditions that might be causing symptoms similar to ADHD before concluding the diagnosis.

What is the significance of evaluating ADHD from a longitudinal perspective as mentioned in the video?

Evaluating ADHD from a longitudinal perspective is significant because it allows for a better understanding of the patient's history and development, which can help identify any vulnerabilities or other factors contributing to the symptoms.

How does sleep apnea, as discussed in the video, impact cognitive functions related to ADHD?

Sleep apnea can significantly impact cognitive functions such as attention and concentration during the day due to hypoxia during the night, leading to unrefreshing sleep and fatigue.

What role do vascular factors play in cognitive deficits as discussed in the video?

Vascular factors like diabetes and hypertension can lead to white matter hyperintensities in the brain, which are associated with cognitive deficits that might be mistaken for ADHD symptoms.

Why is it important to consider vitamin B12, folate, and vitamin D deficiencies in the evaluation of ADHD?

These deficiencies are important to consider because they are involved in the methylation pathway and are necessary for the production of noradrenaline and dopamine, key neurotransmitters in the neurobiology of ADHD.

What is the inflammatory hypothesis mentioned in the video in relation to ADHD?

The inflammatory hypothesis suggests that neuroinflammation or systemic inflammation can present with significant cognitive disturbances, which might be mistaken for ADHD symptoms.

How can thyroid function and iron deficiencies present with cognitive issues similar to ADHD?

Thyroid function abnormalities and iron deficiencies can lead to cognitive issues, including attention and concentration problems, which can mimic ADHD symptoms.

Why is it crucial to evaluate hormonal aspects, particularly in females, when considering ADHD?

Hormonal aspects, especially estrogen levels, are crucial to evaluate because estrogen plays a significant role in cognition, and abnormalities can lead to symptoms that might be diagnosed as ADHD, particularly in perimenopausal or postmenopausal women.

What is the significance of considering substance misuse and certain medications in the evaluation of ADHD?

Substance misuse and certain medications can impact the subcortical areas and frontal lobe connections, which are involved in ADHD, and thus their effects on cognition need to be considered to avoid misdiagnosis.

How does the video suggest addressing sleep disturbances in the context of ADHD evaluation?

The video suggests addressing sleep disturbances by considering good sleep hygiene and, in some cases, using medications like clonidine or guanfacine to treat hyperarousal and improve daytime functioning.

Outlines

00:00

🔍 Evaluating ADHD: Beyond the Symptoms

Dr. Sunil Rege, a consultant psychiatrist, introduces the video by discussing the importance of a comprehensive evaluation for ADHD in adults. He emphasizes that ADHD is a diagnosis of exclusion and should be considered from a longitudinal perspective. The video aims to highlight the need to rule out other underlying factors that might contribute to ADHD-like symptoms to avoid misdiagnosis. Dr. Rege uses the analogy of a bridge to explain how untreated vulnerabilities can lead to the 'breakdown' of a patient's condition, which might be mistakenly attributed to ADHD. He stresses the importance of considering the cumulative effect of all addressed factors for a beneficial outcome, linking this approach to psychiatric formulation and management.

05:00

🧠 Organic Factors in ADHD Evaluation

The second paragraph delves into the organic aspects of ADHD evaluation, focusing on medical conditions that can impact cognitive function. Dr. Rege discusses how sleep apnea, vascular factors like diabetes and hypertension, and cognitive examinations are crucial in the diagnostic process. He mentions the potential for neurodegenerative conditions to present ADHD-like symptoms and the importance of ruling these out. The paragraph also covers the role of vitamin deficiencies in ADHD, the inflammatory hypothesis, and the impact of thyroid function and iron levels on cognition. The discussion extends to hormonal aspects, particularly in females, and how conditions like polycystic ovarian syndrome can affect cognitive function.

10:01

🌐 Psychological and Lifestyle Factors in ADHD

In the third paragraph, Dr. Rege explores the psychological and lifestyle factors that can mimic ADHD symptoms. He discusses the impact of substance misuse on cognition and the importance of considering prescribed medications that might affect cognitive function. The paragraph also addresses the psychotic spectrum, emphasizing the need to rule out psychotic disorders before diagnosing ADHD. Affective syndromes, particularly depression, are highlighted for their co-morbidity with ADHD. The discussion includes the effects of trauma on neurodevelopment and cognition, the link between ADHD and anxiety, and the importance of evaluating for hyperarousal. Dr. Rege also touches on the role of sleep disturbances in ADHD, suggesting that addressing sleep issues might improve cognitive function without the need for stimulant medication.

15:03

🌙 Sleep and Diet: Crucial Aspects of ADHD Management

The final paragraph emphasizes the importance of sleep and diet in ADHD management. Dr. Rege discusses how sleep disturbances can affect cognitive function and how addressing these issues might improve ADHD symptoms. He mentions the role of circadian rhythm disturbances and the potential use of medications like clonidine to treat sleep-related issues in ADHD. The paragraph also highlights the importance of a healthy diet in managing ADHD symptoms. Dr. Rege concludes by reiterating the need for a thorough evaluation to rule out other vulnerabilities before diagnosing ADHD, advocating for a deductive reasoning approach to reach the most accurate diagnosis.

Keywords

💡ADHD

ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental disorder characterized by symptoms such as inattention, impulsivity, and hyperactivity. In the video, ADHD is the central focus as the speaker discusses the importance of thorough evaluation before diagnosing it. The video emphasizes that ADHD is a diagnosis of exclusion, meaning other potential causes for symptoms must be ruled out first.

💡Cognitive Deficits

Cognitive deficits refer to impairments in cognitive functions such as attention, memory, and problem-solving. The video discusses how various factors, including sleep apnea and vascular conditions, can lead to cognitive deficits that might be mistaken for ADHD symptoms. The speaker highlights the importance of considering these deficits in the diagnostic process.

💡Sleep Apnea

Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. The video mentions that sleep apnea, particularly obstructive sleep apnea, can significantly impact daytime cognition, leading to symptoms like fatigue and poor concentration, which may be confused with ADHD.

💡Vascular Factors

Vascular factors refer to conditions affecting the blood vessels, such as diabetes and hypertension. These conditions can lead to white matter hyperintensities in the brain, which are associated with cognitive deficits. The video underscores the significance of addressing vascular health in the evaluation of cognitive issues that could be attributed to ADHD.

💡Neuroinflammation

Neuroinflammation is the inflammation in the nervous system, which can result from systemic inflammation. The video discusses how neuroinflammation can cause cognitive disturbances and is linked to conditions like fibromyalgia and chronic fatigue syndrome, which can present with cognitive symptoms similar to ADHD.

💡Thyroid Function

Thyroid function refers to the proper operation of the thyroid gland, which is crucial for metabolism and overall health. The video mentions that thyroid dysfunction can lead to cognitive issues, emphasizing the need to evaluate thyroid health as part of the ADHD diagnostic process.

💡Polycystic Ovarian Syndrome (PCOS)

PCOS is a hormonal disorder common among women of reproductive age. The video highlights the importance of considering PCOS in women presenting with ADHD-like symptoms, as hormonal imbalances, particularly estrogen deficiency, can impact cognition.

💡Substance Misuse

Substance misuse refers to the improper or excessive use of substances like alcohol or drugs. The video discusses how substance misuse can affect cognitive function and potentially mimic ADHD symptoms, making it a crucial factor to consider in the diagnostic process.

💡Psychotic Spectrum

The psychotic spectrum refers to a range of conditions that include psychosis, characterized by symptoms like delusions and hallucinations. The video emphasizes the importance of ruling out psychotic disorders in the evaluation of ADHD, as some individuals with prodromal psychosis may exhibit neurodevelopmental abnormalities that could be misdiagnosed as ADHD.

💡Affective Syndrome

Affective syndrome refers to mood disorders, particularly depression. The video discusses the need to rule out severe forms of depression, like melancholic depression, which can present with cognitive symptoms similar to ADHD. It also mentions the potential for co-morbidity between ADHD and depression.

💡Trauma

Trauma, particularly childhood trauma, can impact neurodevelopment and lead to cognitive, impulse regulation, and emotional dysregulation issues. The video stresses the importance of considering past trauma in the evaluation of ADHD symptoms, as it can result in a complex interplay of conditions affecting cognition.

Highlights

Introduction to the evaluation of ADHD in adults, emphasizing the importance of considering other underlying factors that might contribute to ADHD symptoms.

ADHD is a diagnosis of exclusion, meaning other potential causes for symptoms must be ruled out first.

The importance of a longitudinal perspective in evaluating ADHD, considering the patient's history and development over time.

The analogy of a bridge to illustrate how underlying vulnerabilities can weaken a person's cognitive functioning, leading to ADHD-like symptoms.

The role of sleep apnea in impacting cognition and its relevance to ADHD symptoms.

The impact of vascular factors like diabetes and hypertension on cognitive deficits and their connection to ADHD.

The necessity of a thorough cognitive examination in individuals with ADHD, beyond just self-report scales.

The significance of vitamin B12, folate, and vitamin D deficiencies in the neurobiology of ADHD.

The inflammatory hypothesis and its link to cognitive disturbances, potentially mimicking ADHD symptoms.

The overlap between fibromyalgia, chronic fatigue syndrome, and cognitive deficits, and their relevance to ADHD evaluation.

The importance of evaluating thyroid function and iron levels in females for cognitive issues related to ADHD.

The consideration of polycystic ovarian syndrome in females due to its impact on estrogen levels and cognition.

The impact of substance misuse on cognitive functioning and its potential to mimic ADHD symptoms.

The evaluation of psychotic spectrum disorders and their potential to present with ADHD-like symptoms.

The importance of ruling out severe forms of depression, especially those with cognitive symptoms, before diagnosing ADHD.

The role of past trauma in neurodevelopment and its potential to result in ADHD-like cognitive and impulse regulation issues.

The significance of current stresses in exacerbating cognitive status and their role in ADHD evaluation.

The potential comorbidity of OCD with ADHD and the implications for treatment with stimulants.

The importance of evaluating anxiety in ADHD, especially the internal agitation that can present as anxiety in adults.

The consideration of sleep disturbances in ADHD, including obstructive sleep apnea and circadian rhythm disorders.

The impact of diet on ADHD symptoms and the importance of a healthy diet in management.

The conclusion emphasizing the thorough evaluation process for ADHD to ensure proper treatment of underlying vulnerabilities.

Transcripts

[Music]

hi welcome to

another edition of hub bytes i'm sunil

rege consultant psychiatrist from

psycsene

today i'll be taking you through the

evaluation of

adhd attention deficit hyperactivity

disorder

to set the scene i received a referral

from a physician

approximately three days ago it was a 42

year old female

it was for an evaluation for adhd

now one of the things we've got to think

about is if i went ahead

and basically carried out an adhd

adult self-report scale or cadre

questionnaire or

diva 2.0 and i identified attention

concentration deficits hyperactivity and

impulsivity

i could basically say this is a this is

adhd

but the question is what if there are

several

other underlying things that might be

contributing to these symptoms it's

possible

that could result in a misdiagnosis so

that's really the aim

of this video is to outline that the

evaluation of adhd

one adhd is a diagnosis of exclusion

two we should think about adhd from a

longitudinal perspective

and to look at several other factors

that might be contributing

to these deficits

and the reason why i think about it that

way is because

let's imagine this was a bridge

and you as an individual crossing the

bridge on a daily

basis and if the individual has adhd

they're doing that they've been

prescribed a stimulant and they're going

okay

but what if there are several underlying

factors that are making this bridge

weaker

that is there are vulnerabilities these

factors act as vulnerabilities and at

some point this bridge

cracks and breaks that's when the

patient comes to you

and says doctor the medication isn't

working

they might present with depression they

might present anxiety they might present

with a range of other disorders

so the really important aspect is to

think about these vulnerabilities and

address these vulnerabilities as well

because every little thing counts and

it's important that the cumulative

effect

of all these things that we've addressed

results in a

beneficial outcome and this is linked to

the basis

of psychiatric formulation and

management i've covered this

in another video on the channel so

please please do have a listen to it as

well

we've also covered it in on the cycling

hub.com

as an article so really we're following

the sherlock holmes way of thinking

deductive reasoning and not succumbing

to

complementary bias so let's get started

with the evaluation

but as always before getting into the

details it's important that this is not

to be construed as medical advice

any personal issues should always be

discussed with your own doctor

so the first thing i think about is the

organic

aspects what does that mean the medical

aspects now this hierarchy has been

covered in more detail on another video

the psychological formulation management

video

on the channel so please do have a

listen to that one as well

so we in the organic section

a few things that i think about firstly

now this particular patient

was diagnosed with moderate sleep apnea

sleep apnea and sleep difficulties can

impact

significantly on cognition during the

day so we know that adhd is

can be considered really a disorder of

cognition as well because it has

attention concentration issues

other cognitive issues as well that one

identifies so sure cognition

is a faculty right at the top that we

think about

but obstructive sleep apnea because of

hypoxia during the night

the individual can wake up really

unrefreshed fatigue

which impacts on concentration and

attention during the day

so obstructive sleep apnea is one of the

factors to take into account

the other aspects are vascular factors

diabetes hypertension

and we know that vascular factors can

result in

white matter hyperintensities of the

brain and white matter hyperintensities

are associated with cognitive deficits

so it's important to be proactive

in treating those as well now of course

in some cases it is important to carry

out an actual

frontal lobe cognitive examination but

other cognitive examinations such as a

clock drawing test

and if there are abnormalities

identified going into more detail

because in some rare cases it is not

uncommon to identify a neurodegenerative

condition

that might present as adhd such as

frontotemporal dementias

because we know that frontal lobe is a

predominant part of the brain that's

involved

in adhd so the point is it is important

to carry out a thorough cognitive

examination

in individuals with adhd not just the

adhd self-report scale of focusing on

attention concentration

hyperactivity and impulsivity then we

also look at

other aspects such as vitamin b12 folate

deficiencies vitamin d

deficiencies why do we look at that

because we know that

these are involved in the methylation

pathway the first two

and are necessary for the production of

noradrenaline dopamine

two key neurotransmitters that are

involved in the

neurobiology of adhd now this particular

patient that was referred to me had

elevated n a elevated

dsdna the anti-ena was normal but their

esr was

elevated as well so that brings in the

inflammatory hypothesis

we know that when neuroinflammation is

present or systemic inflammation is

present

individuals can present with significant

cognitive disturbances

and the other important aspect of

inflammation is there is an

overlap between fibromyalgia chronic

fatigue syndrome

and cognitive deficits as part of these

particular syndromes

so we know that the inflammation neural

inflammation and systemic inflammation

can result

in fibromyalgia type syndromes chronic

fatigue

syndrome myalgic encephalomyelitis and

we know that cognition is a core feature

of these conditions so we often see this

triad

together so it's important to think

about inflammation as well

the other aspect to think about is

thyroid functions

and also iron because these deficiencies

can present with significant

cognitive issues as well

in females and you know this 42 year old

female i would also be thinking about

polycystic ovarian syndrome why because

estrogen and abnormalities in estrogen

we know that estrogen is very very

crucial for

cognition so sometimes in the

perimenopausal postmenopausal group

we can see symptoms that are very very

suggestive

or can be diagnosed as adhd onset

late but much of this can be due to

estrogen deficiency for example

impacting on cognition so it's crucial

that the hormonal aspect

is also evaluated so that's sort of the

the organic evaluation

then we think about substances and here

we think about

substance misuse so for example

excessive alcohol use or cannabis use or

other illicit substances

and the reason why that's important is

because these substances can

impact on the subcortical area the basal

ganglia and the connections to the

frontal lobe the same pathways that can

be involved

in adhd you can have a more detailed

read of the neurobiology of adhd which

we covered in the cycling hub.com

we've also covered the diagnosis and

management of adhd with a focus on adult

adhd

do have a read of that one as well

with substances we've also got to think

about any medications that have been

prescribed

by physicians or psychiatrists because

certain medications can impact

on cognition the next aspect we think

about is psychotic spectrum

and when i think about psychotic

spectrum it's not just about psychosis

in the form of delusions and

hallucinations

but really we're thinking about the

mesolimbic pathway and if the mesolimbic

pathway is activated

it results in hyperarousal symptoms

heightened emotional reactivity racing

thoughts

and we know that these symptoms can

impact impact on

cognition so the functioning during the

day but it can also impact on

sleep resulting in middle insomnia

early insomnia difficulty falling asleep

or early morning awakening

all of which can impact on cognitive

functioning during the day and can look

like adhd

so it is important to address any mixed

features

but the other aspect that's important in

psychotic spectrum is a thorough

evaluation

of ruling out psychotic disorders

by taking a family history looking at

the genetic

aspects because individuals with

prodromal psychosis can have

neurodevelopmental abnormalities

so developmental delay for example or

attention concentration problems

learning difficulty in school etc

and much of this can one can fall in the

trap

of misdiagnosis they can be prescribed a

stimulant and it can result in

a psychotic episode so it's really

really important to rule out

underlying vulnerabilities towards

psychosis to avoid misdiagnosis

and a prescription of a stimulant that

could result in

detrimental sort of consequences the

next one is the affective syndrome and

here really

once focusing on ruling out the severe

forms of depression

for example melancholic type depressions

that

have dopamine and noradrenaline as key

underpinnings in the genesis

so we're looking at you know dopamine

not adrenaline sort of abnormalities

melancholic depression because we know

that

in melancholic depression decision

making attention concentration issues

cognitive issues

are a core feature of course adhd and

depression can be co-morbid

and both need to be treated and the

reason why that can happen particularly

in adulthood is that

they might initially have adhd but

because of difficulty coping through

life

it's resulted in lots of losses

it's resulted in difficulty coping and

it resulted in additional sort of

depressive elements being added on top

of the adhd so that's where the

co-morbidity comes in

moving lower down we think about trauma

now with particular trauma we think

about

past trauma during childhood and why is

this important because trauma

impacts on the neurodevelopment the

development of the brain and can result

in not only cognitive

issues but also impulse just regulation

and impact

on emotional dysregulation so

trauma and looking at those aspects is

important we know that trauma can also

result in

ongoing heightened sympathetic drive so

therefore hyperarousal

can be present so it's linked to mixed

features as well

but we know that trauma is also linked

to fibromyalgia

and chronic fatigue syndrome so we see

this complex picture of

trauma fibromyalgia chronic fatigue

syndrome impacting on cognition

but also many individuals with

fibromyalgia chronic fatigue syndrome

have mixed features

so one's really got to think about

deconstructing the problem and

addressing each one rather than

trying to search for a single diagnosis

so

trauma is really important but of course

we look at current stresses as well

because current stresses

when added on to an underlying

vulnerability can result in worsening of

cognitive status next we look at ocd

they can often be ocd comorbid

i have seen cases of resistant ocd

that actually were treated that had a

diagnosis of adhd

and responded very well well to

stimulants why does that happen it

happens because in ocd one of the

neurotransmitters that's involved

is dopamine so you can have a read of

the neurobiology of ocd as well in

detail in the cycling

hub so in resistant cases one's got to

think about the possibility of adhd and

many individuals with adult adhd

can have severe procrastination as a key

feature the other aspect is anxiety now

this is really crucial because we know

that in childhood hyperactivity is a

symptom but only 30

of individuals sort of move to have

hyperactivity as a symptom

in adulthood so a lot of the

hyperactivity dissipates the external

hyperactivity but sometimes the internal

hyperactivity remains and this can

present

as internal agitation or internal

anxiety

so sometimes in resistant anxiety

disorders it's worth thinking about the

possibility

of adhd but the other aspect with

anxiety is that we know that sometimes

when a stimulant

is prescribed it can actually worsen

anxiety

so a thorough evaluation of the

possibility of hyperarousal

needs to be taken into account in adhd

and hyperarousal is linked to as we saw

mixed features but also

anxiety so if there is significant

hyperarousal

then one can actually combine the

stimulant to treat

the cognitive elements of of

sort of the frontal lobe aspects

noradrenaline dopamine by using a

stimulant

but then treating the hyperarousal

during other periods or the side effects

by

considering clonidine or guanfacine

which is an alpha-2 agonist

but it's important of course any

combination therapy should be a

specialist treatment

as far as possible we try to avoid

combination therapies because we want to

ensure that we prescribe one medication

but again these are things that need to

be discussed

there are individualized treatments but

just to outline that

in some cases reduction of hyperarousal

is absolutely crucial because there are

two elements going on

and i'll come to that in a sec when i

talk about sleep uh of course

it's important to think that individual

eating disorder can also have adhd type

symptomatology

but of course then prescription of

stimulants one's got to be very very

cautious because they drop appetite

we know that uh personality there may be

certain personality traits that can

sort of be associated with adhd but when

there's lots going on here i'm not going

to jump to the diagnosis of a

personality disorder but high levels of

perfectionism

sort of anal casting personality

obsessive compulsive personalities

can sometimes of course add on that

extra stress for an individual with

adhd and one of the important things

that i want to touch on

is sleep a very very large proportion of

individuals

tend to have sleep disturbances

individuals adhd have sleep disturbances

we touched on obstructive sleep apnea

which is important to address

but circadian rhythm disturbance is very

crucial as well

you can have a listen to the

neurobiology of sleep video that i did

on this channel

to really think about what is

hyperarousal and what

are circadian rhythms and how they

impact on

on sleep now when there is significant

hype arousal

at nighttime it can sort of present with

vivid dreams difficulty falling asleep

waking up several times in the middle of

the night

early morning awakening etc now this can

impact significantly on cognition during

the day

because the individual wakes up

unrefreshed and extended periods of hype

arousal and sleep difficulties

impact on cognition so there is good

evidence that

sleep disturbances impact on cognition

therefore it becomes important in some

cases

simply addressing sleep by good sleep

hygiene

may actually improve cognitive function

so that is one of the important things

to take into account as part of

management not just simply prescribing a

stimulant

because if there's ongoing sleep

difficulties the stimulants might stop

working and in many cases to address the

um hyperarousal at nighttime circadian

rhythm disturbances

that's where clonadine and one facing

may be utilized

because they reduce that heightened

sympathetic

overdrive heightened nor adrenaline at

night time

and assist and sleep treat the vivid

dreams of the nightmares and improve

daytime functioning so in some cases a

combination might be required where

treating the hyperarousal at nighttime

but and improving cognition during the

demo be required

but as i mentioned earlier that's really

really individualized

and you know sleep is important and of

course diet is also important

and of course in children and

adolescents the link between

dietary interventions and adhd is

something that is

considered um and it's something to take

into account similarly in adults as well

a healthy diet

becomes very very important so

the purpose of this interview is to

highlight that

it's important to carry out a thorough

evaluation when presented

with an adhd type picture

the reason is because we want to ensure

that these vulnerabilities are

treated before jumping into the

diagnosis of adhd so

adhd is a diagnosis of exclusion it's

important to run through the hierarchy a

proper

thorough deductive reasoning because

when we rule out

the impossible what must remain is as

close to the truth

as possible so i hope that you found

this video useful if you've liked it

please of course click the like button

subscribe to the channel

i look forward to seeing you in another

edition of hub bites take care and stay

[Music]

safe

you