A 40-Year-Old Man Comes to the Office for Evaluation of Difficulty

A 40-year-old man comes to the office for evaluation of difficulty with concentration.  After reading a book on adult attention deficit hyperactivity disorder (ADHD) , he thinks that he has ADHD and requests treatment with stimulants.  The patient has no history of childhood ADHD but states that his parents were unaware of the disorder and never had him evaluated.  He currently does not experience hyperactivity or impulsivity but says, "I just get easily distracted some days and know I could be more productive at work."  The patient does not use alcohol or use recreational substances.  Medical history is noncontributory.  Vital signs and physical examination are normal.  The physician shares that the patient's symptoms are not consistent with a diagnosis of ADHD.  The patient insists that he will benefit from stimulants.  Which of the following is the most appropriate statement?

A) "A trial of stimulant medication may be helpful for what you're experiencing, but I think psychotherapy may be more appropriate to try first."
B) "Based on my evaluation, you don't have a condition that would warrant a stimulant; I suggest getting a second opinion if you do not agree."
C) "I understand that you want to improve your ability to focus at work; I can prescribe a nonstimulant ADHD medication that can sometimes help with concentration difficulties."
D) "Prescribing a stimulant medication is not indicated based on your evaluation; let's discuss some nonmedication treatment options that may help you focus more."
E) "Your symptoms are not consistent with ADHD and do not require medication, but please schedule a follow-up to discuss treatment options if your symptoms worsen."

Correct Answer:

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