Left to right: J. Russell Ramsay, PhD, Lisa Joy Tuttle, and Anthony Rostain, MD
Jessica Berman is a real estate property manager who is pursuing her real estate license, while raising two children with her husband. Like eight million other adults in the United States, Jessica’s full schedule is regularly challenged by symptoms often found in Attention Deficit Hyperactivity Disorder (ADHD) patients.
Last year, as she felt her symptoms worsen, Berman went to Penn Medicine to be evaluated and was diagnosed with ADHD.
Facing distraction, disorganization, poor time-management, and other symptoms, Berman started attending a 12-week evening cognitive behavioral coaching program titled Improving Executive Functions with Mindful Self-Management.
Part of Penn’s Adult Attention Deficit/Hyperactivity Disorder (ADHD) Treatment and Research Program, the class covers time management, organization, project planning and implementation, mindfulness techniques, and other topics relevant to those 18 and older with ADHD. The first class was offered earlier this year.
Taught by Lisa Joy Tuttle, MA, a board-certified executive skills coach who works with students and professionals with ADHD, the course serves as a community for those who have had longstanding challenges with executive functions resulting from ADHD. All participants must be diagnosed with ADHD, are in the process of being assessed for ADHD, or intend to seek assessment.
“There is a level of relief when these adults talk to each other about the challenges they have with ADHD,” said Tuttle. “The groups become cohesive very quickly.”
Lidia Michaels, a member of the Penn Medicine Radnor class who works in food services, can attest to that. She says she works ‘below’ her training abilities and sees the class as a way towards improvement.
“One of my biggest professional disappointments is how far apart my creative and intellectual potential and my actual life experience has been,” says Michaels. “The class is guiding me, step by step, in ways to schedule my priorities and increase my focus.”
The class includes pre and post testing to measure progress. Tuttle also uses a self-management skills questionnaire she developed that looks at habits related to key areas of executive function to reveal participants’ strengths and determine areas for improvement.
“Group members come in right off the bat knowing where they are great and where they are struggling,” said Tuttle. “They choose their personal goals.”
Adult ADHD Program
The classes, which run concurrently in University City and Penn Medicine Radnor, are part of the Adult ADHD program founded in 1999 by co-directors Anthony Rostain, MD, MA, and J. Russell Ramsay, PhD.
“We specialize in adult ADHD, but we administer a comprehensive evaluation that will help determine if the diagnosis of adult ADHD is relevant, and what else is going on,” said Ramsay. “When ADHD is not the relevant diagnosis, there might be attention problems that stem from a different diagnosis. We can help identify what is going on so people can get the help they need.”
The clinic conducts about 100–150 assessments per year. Sometimes people come in for confirmation of a diagnosis before pursuing treatment. For example, a psychiatrist might make sure his or her patient has ADHD before prescribing stimulants. Ramsay says a third to 40 percent of those screened do not meet the criteria for diagnosis of the condition.
“There is over diagnosis of ADHD out there, but there’s also under diagnosis,” says Ramsay. “The main problem is misdiagnosis, which interferes with people getting on an accurate treatment course.”
Penn was home to one of the first specialty clinics nationwide focused on adult ADHD with an evidence-supported psychosocial component combined with medications.
The group specializes in adult ADHD, but sees a wide range of patients through areas such as the Center for Cognitive Therapy and the outpatient psychiatry clinic, which helps diagnose the range of issues that may be present.
“We have an individualized model that fits the lives of those seeking treatment,” says Rostain.
This case-based approach is applied when working with aging populations, college-aged students, and many other groups. An interdisciplinary approach with others throughout the institution supports care in couples’ issues, family issues, smoking, and managing chronic conditions.
Patients have reported that having the assessment, psychosocial treatment, and medication in one location at Penn helps them follow through with a disciplined treatment plan.
The majority of their patients are complex cases in which the patient seeks a thorough workup and practical, satisfactory treatment, says Rostain.
“ADHD is a misunderstood diagnosis even in the modern age,” said Rostain. “There are a lot of myths and skepticism that wants to cast doubts on the validity of the diagnosis; but we’ve endured in our modest view that it is a lifelong developmental disorder for which, most of the time, people come to us because they’ve developed some other life crisis. It often is not ADHD alone.”
Furthering their commitment to education, Rostain and Ramsay train psychologists, adult psychiatrists, and other health providers to do this work in their own practices so more patients can see physicians in their own communities.
“There’s a growing recognition among psychiatrists that this is real, that it can be treated quite effectively,” said Rostain. “There’s a legitimate concern about faking ADHD for the purposes of obtaining cognitive-enhancing agents.”
Rostain explains that everyone has some ADHD symptoms some of the time; and that those with ADHD have all of the symptoms most of the time. It is not sufficient to simply have the symptoms—it must impair one’s ability to function to qualify for an ADHD diagnosis.
These small group classes taught by Tuttle are an extension of that commitment to comprehensive ADHD care.
“There is a hunger for help and support in this,” says Tuttle. “There are excellent books and audio out there, though when people come into this group they not only get the facilitator’s guidance and expertise, they get each other. That magnifies the effect.”
For more information on the 8-week summer session beginning July 10, and two 12-week classes in the fall, visit the Penn Adult ADHD Treatment & Research Program website, e-mail lisatuttlecoaching@verizon.net, or call 484-843-1569.