Adults seeking a diagnosis and treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) often face significant delays. Traditional behavioral health clinics can have wait times ranging from 20 to 56 weeks for a formal diagnosis, creating a barrier to timely care. To address this challenge, an innovative approach was implemented within a suburban Family Medicine Residency clinic to significantly reduce the time it takes for adults to receive an ADHD diagnosis and begin treatment. This streamlined process aims to make diagnosis more accessible and efficient, particularly for uncomplicated cases of adult ADHD. For additional resources and support, websites like CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) offer valuable information on the diagnosis and management of ADHD in adults.
This innovative model utilizes a two-visit structure within a family medicine setting. The first visit is dedicated to initial screening for ADHD and to identify any potential co-occurring conditions or alternative diagnoses. Clinicians use a set of standardized, self-administered questionnaires to screen for ADHD symptoms and common comorbidities. These screening tools include assessments for depression (PHQ-9), bipolar disorder (Rapid Mood Screener – RMS), anxiety (GAD-7), substance abuse (TAPS part 1), and sleep apnea (Epworth Sleepiness Scale), in addition to ADHD symptoms (ASRS-v1.1). Crucially, the scoring of these instruments can be efficiently performed by any clinic staff member, making the process easily integrated into standard clinic workflows. To ensure clinicians were comfortable and proficient in managing ADHD, including the use of psychostimulant medications and applying DSM-5 diagnostic criteria, lunchtime learning sessions were conducted with a consulting psychiatrist.
During the initial clinic visit, patients complete the battery of six self-screening surveys and discuss their concerns about ADHD with the clinician. It’s important to note that if a patient screens positive for one or more comorbidities – a common occurrence in approximately 75% of adults with ADHD – it does not automatically rule out an ADHD diagnosis. Instead, it signals to the clinician the importance of addressing any underlying conditions as part of a comprehensive treatment plan. If the clinician suspects uncomplicated adult ADHD after the initial screening, the patient is provided with a copy of the DIVA-5 (Diagnostic Interview for ADHD in Adults Version 5) diagnostic interview and an educational handout. This handout focuses on self-care behavioral strategies that patients can implement to manage their ADHD symptoms while undergoing the diagnostic process. Patients are instructed to review and annotate the DIVA-5 at home before their second visit, adding detailed examples of their symptoms and how these symptoms impact their daily functioning. For more complex cases, or when comorbidities require specialized attention, referral pathways to behavioral health specialists remain in place for more in-depth evaluation.
The second visit centers on the clinician’s review and scoring of the completed DIVA-5. The DIVA-5 is a structured, symptom-based diagnostic interview designed to assess both current adult ADHD symptoms and retrospective childhood ADHD symptoms, aligning with the DSM-5 diagnostic criteria. The DIVA-5 is accessible for clinical use through the DIVA Foundation for a one-time, minimal payment, rather than a per-patient charge, making it a cost-effective tool for clinics. If the DIVA-5 confirms a diagnosis of previously undiagnosed adult ADHD (in patients aged 18 and over), the clinic offers the initiation of pharmacotherapy, including stimulant medications, during this same second visit. In a pilot implementation of this two-visit approach, an impressive 80% of 48 patients were diagnosed with ADHD. Of those diagnosed, 72% opted to begin medication treatment during their second visit, demonstrating the efficiency and patient acceptance of this accelerated diagnostic and treatment process. Only 12% of cases were identified as complex and referred for behavioral health care, highlighting the effectiveness of this model for streamlining uncomplicated ADHD diagnosis in family medicine.
The implementation of this two-visit model has proven successful in significantly speeding up both the diagnosis and the initiation of treatment for adult ADHD. Furthermore, the screening process has also facilitated earlier identification and intervention for depression, complex psychiatric conditions, and substance use disorders, ultimately leading to improved overall patient care quality. This innovative approach is not only effective but also low-cost and readily adaptable to the existing structure of standard visits within any family medicine clinic, offering a practical solution to reduce wait times and improve access to care for adults with ADHD.
