Conference Coverage

Adult ADHD in Primary Care: Screening, Treatment Selection, and Referral Strategies

Edited by:
Anthony Calabro, MA

Key Highlights

  • Attention-deficit/hyperactivity disorder (ADHD) screening should be considered in adults with relationship instability, treatment-resistant mood or anxiety disorders, substance use, poor occupational performance, forgetfulness, or a family history of ADHD.
  • The 6-item Adult ADHD Self-Report Scale can support screening but is not diagnostic; the presentation cited a negative predictive value of 97%.
  • Treatment may incorporate pharmacologic therapy and nonpharmacologic strategies, including cognitive behavioral therapy, mindfulness, and exercise, based on individual patient needs.
  • Psychiatry referral may be appropriate when comorbidities interfere with ADHD assessment or patients have poor responses to multiple therapies, mood activation, or an apparent need for high-dose treatment.

Attention-deficit/hyperactivity disorder (ADHD) in adults may be missed since symptoms can present through functional problems rather than a single characteristic complaint, according to Rakesh Jain, MD, MPH, and Laura Melaro, DNP, APRN, FNP-BC, PMHNP-BC, who presented at the August 2026 Practical Updates in Primary Care Virtual Meeting.

Drs. Jain and Melaro highlighted relationship struggles, depression, anxiety, substance use disorder, personal failure, and medication nonadherence among possible presentations of ADHD. They also noted that ADHD symptoms change across the lifespan, with adult presentations commonly characterized by inattention, disorganization, poor planning, forgetfulness, difficulty finishing projects, poor time management, and impulsive decisions.

Screening may be particularly relevant for adults with treatment-resistant major depressive disorder, bipolar disorder, or anxiety; substance overuse, abuse, or dependence; poor school performance in childhood; poor occupational performance in adulthood; motor vehicle issues; or frequent forgetfulness. Drs. Jain and Melaro also highlighted procrastination, distractibility, and forgetfulness as a simple screening prompt.

For patients in whom ADHD is suspected, the 6-item Adult ADHD Self-Report Scale can provide a more structured assessment of symptoms over the previous 6 months. The tool includes 4 inattentive and 2 hyperactive-impulsive items but is intended for screening rather than diagnosis.

Individualizing Adult ADHD Treatment

The presentation went on to review stimulant medications, including amphetamine and methylphenidate formulations, as well as nonstimulant options, such as atomoxetine, viloxazine, clonidine, and guanfacine. The faculty also examined differences in duration of action, dosing time, and pharmacokinetic profiles among stimulant formulations, including immediate-release, extended-release, delayed-release, and prodrug delivery systems.

Nonpharmacologic approaches may also be incorporated into ADHD management, including cognitive behavioral therapy as a potential augmentation strategy, an 8-week mindful awareness practice intervention, and moderate-intensity cardiovascular exercise. The presentation went on to define an optimal treatment response as “early, full, and sustained control over ALL symptoms of ADHD” for as many hours of the day as possible, with good tolerability.

The faculty emphasized a substantial role for primary care in the management of adult ADHD. “The vast majority of patients with ADHD can be diagnosed and managed in the primary care setting,” they noted.

Drs. Jain and Melaro concluded by reiterating that ADHD is highly comorbid with anxiety, depression, and substance use disorders and that both pharmacologic and nonpharmacologic interventions are available. Treatment decisions, the faculty emphasized, should be based on the specific needs of the individual patient.

Reference
Jain R, Melaro L. ADHD in adults: a primary care playbook for diagnosis and treatment. Presented at: Practical Updates in Primary Care Virtual Meeting; August 2026. https://www.hmpglobalevents.com/pupc?utm_source=C360&utm_medium=House+Content+Banner&utm_campaign=PUPC2026