Adult ADD

Copyright AdultADD.Info, Branford, CT, 2009

If you have plans to be evaluated by a clinician, you might want to print this questionnaire, answer the questions, and bring the completed questionnaire to the clinician when you have your evaluation appointment.

Medical Issues

thyroid problems (which)? ___________________________________________
thyroid problems can mimic ADHD. Both thyroid meds and stimulants can cause weight loss

glaucoma?_______________________________________
stimulants can increase eye pressure in people with narrow angle glaucoma

seizures? ___________________________________________
stimulants may cause seizures in people who have already had them

been knocked unconscious? ___________________________________________
brain injury can mimic ADD or make it worse

neurological disorder? ___________________________________________
brain disorders can mimic ADD or make it worse

liver problems? ___________________________________________
many medications are metabolized in the kidneys. Some medications, like Strattera, may cause liver problems.

Reynaud’s? ___________________________________________
stimulants can make Raynaud’s worse or cause it (cold and white or blue fingers and toes)

heart problems? ___________________________________________
stimulants are contraindicated in people with heart problems. Very rare deaths from the use of stimulants have been associated with a history of structural heart disease or cardiac dysrhythmias.

migraines. if so, what medication do you take for them, if any? ___________________________________________
stimulants may increase blood pressure. An increase in blood pressure medication may be required by patients taking stimulants or Wellbutrin (buproprion)

what is your blood pressure?  When was it last taken? ___________________________________________
bring blood pressure down to normal before starting stimulants

is your pulse is less than 50 per minute when resting? ___________________________________________
may need cardiac work-up unless low pulse is from good physical conditioning

is your pulse is more than 95 per minute when resting? ___________________________________________
stimulants can further increase the pulse and are contraindicated in people with pulse this rapid

did a blood relative die at an early age of heart problems? ___________________________________________
this may be a contraindication to taking stimulants since this fatal vulnerability may be genetic

do you have twitches or tics? ___________________________________________
tics and twitches may be made better or worse by stimulants

Sleep
do you have sleep apnea? ___________________________________________
sleep apnea may cause ADD like symptoms or make ADD worse

If so, what evaluation or treatment have you had for sleep apnea?__________________________________
a sleep study may be indicated for those with major sleeping problems. if person is using CPAP, are they using it regularly and with good effect?

do you have difficulty falling sleeping? ___________________________________________
chronic tiredness can mimic ADD or make it worse

difficulty staying asleep? ___________________________________________
may be due to sleep apnea or depression

find yourself tired during the day, yawning a lot? ___________________________________________
these symptoms may be caused by sleep apnea. Overtiredness may make ADD symptoms worse or mimic ADD

do you nap at least a few times a week to stay alert? ___________________________________________
this may be a sign of sleep apnea

do you awaken during the night feeling frightened? ___________________________________________
this may be a sign of sleep apnea

do you snore? ___________________________________________
slightly suggestive of sleep apnea

have you been observed to stop breathing during sleep, and then awaken with a start? ___________________________________________
this is a symptom very suggestive of sleep apnea

Medication reactions
Are you allergic to a medication (medication? reaction)? ___________________________________________
Have you had a bad reaction to a medication?

Do you take an MAOI antidepressant medication? ___________________________________________
stimulants and SSRI’s are contraindicated in persons taking MAOI’s

Diet Supplements
Do you take fish oil? ___________________________________________
this may be mildly helpful to people with ADD but good research support for this is still lacking

Vitamin C? ___________________________________________
this decreases the absorption and increases the excretion of amphetamines and thereby reduces its effect

Do you take an herbal medicine? If so which? ___________________________________________
there are some interactions with stimulants

Do you take over the counter medications (which)? ___________________________________________
aspirin taken at the same time as stimulants can reduce the absorption of stimulants.  OTC medications containing ephedrine or pseudoephine can make the cardiac side effects of the stimulants worse

Substance history
Have you been addicted to or abused drugs? ___________________________________________
persons with such a history may require more careful oversight if stimulants are prescribed

Have you used “speed” or uppers (Dexedrine or others)? ___________________________________________
people’s previous experience taking these medications can suggest how they will respond now

Have you ever taken a stimulant?  What effect did it have on you? ___________________________________________
the person’s reaction to stimulant medication taken in the past may predict his or her response to its therapeutic use

Drugs/alcohol
Do you smoke marijuana fairly regularly? ___________________________________________
marijuana often interferes with the use of medications for ADD.

Do you smoke cigarettes or cigars (how many per day)? ___________________________________________
people with ADD find it harder to stop smoking. It is possible that successful treatment of the ADD may make it easier to stop. Buproprion, which of some help to some patients with ADD, is a fairly good smoking cessation aid.

Do you drink caffeinated drinks (if so, how much per day)? ___________________________________________
Caffeine may worsen some of the side effects of stimulants like difficulty sleeping, headache, and atrial fibrillation.

Do you have at least one drink almost every day (how many)? ___________________________________________
alcohol can interfere with the effects of stimulants.

Have you sometimes had too much alcohol to drink? ___________________________________________
people taking stimulants may be less likely to realize when their judgment and reflexes are impaired by alcohol. This may make driving more dangerous.

Is there someone in your home who has abused drugs or who might use drugs prescribed for you? ___________________________________________
if this is so, the patient must be very careful to keep the stimulant medication in a secure place where it will not tempt the other person in the home to use it.

Females only
Are you pregnant or planning to get pregnant? ___________________________________________
stimulants may adversely affect fetal development:

Are you using protection against getting pregnant? ___________________________________________
such protection will reduce the concern about the need for stimulants during pregnancy

Are you breast feeding or considering breast feeding? ___________________________________________
stimulants are carried in breast milk and may adversely affect the infant