Episode 5; Understanding ADHD Challenges and Breakthroughs

Muhamad Aly Rifai, MD

Welcome to our fifth episode of the Virtual Psychiatrist I am you host Dr. Muhamad Aly Rifai and we have survived and we are in our fifth episode and we continue strong in 2025, today we will talk about Attention Deficit Hyperactivity Disorder ( ADHD), a pretty common psychiatric illness, thank you for hosting with us Teresa.

Teresa Baron

Hello folks, I am your co-host Teresa and ...thank you Dr. Rifai for inviting to talk about ADHD as I have first hand experience with this illness.

Muhamad Aly Rifai, MD

You know, ADHD is often misunderstood. But the numbers? They’re eye-opening. Recent data shows that approximately 6.0% of U.S. adults currently report an ADHD diagnosis. And—here’s the kicker—about half of those individuals didn’t even receive that diagnosis until adulthood.

Teresa Baron

Wait, half of them? That sounds... I mean honestly, shocking! So, they’re spending, like, how many years just floundering without any answers?

Muhamad Aly Rifai, MD

Exactly, Teresa. Late diagnoses often mean missed opportunities for earlier intervention. Many of these adults likely struggled for years... not just academically, but in their careers, relationships, even their sense of self-worth. ADHD at any point in life can be challenging, but imagine trying to navigate adulthood without really knowing what’s going on with your brain.

Teresa Baron

Wow. And I guess that also explains why untreated ADHD hits the economy so hard, right? Isn’t it something crazy like $200 billion annually?

Muhamad Aly Rifai, MD

That’s correct. The economic cost is staggering—mostly due to lost productivity and higher healthcare expenses. Can you imagine how much potential is wasted simply because these individuals don’t receive proper care?

Teresa Baron

Ugh, it’s tragic. But, like, getting diagnosed and treated sounds like its own uphill battle. I’ve heard it can take... what, five or ten years just to get an appointment in some places?

Muhamad Aly Rifai, MD

Unfortunately, you’re right—especially in places like the UK, but the U.S. isn’t immune either. Long waits, coupled with stigma and lack of understanding, make accessing care a real challenge. And it’s even worse for women.

Teresa Baron

Women? What’s different for them?

Muhamad Aly Rifai, MD

Well, many women with ADHD display symptoms that don’t fit the stereotypical idea of hyperactivity. Instead, they might be labeled as overly emotional, lazy, or—even worse—diagnosed with something entirely different, like personality disorders. This further delays proper treatment.

Teresa Baron

Oof, I hate that. And then there’s this whole "high functioning" label that just... let’s be honest, it sounds like a way of dismissing people’s struggles.

Muhamad Aly Rifai, MD

Absolutely. The "high functioning" label convinces people—and often the individuals themselves—that they can’t possibly need help because they appear to be managing. Yet, behind the scenes, their personal worlds might be collapsing. It’s another barrier to diagnosis and treatment.

Teresa Baron

It’s like, you’re drowning, but everyone just says, “Oh, you’re a strong swimmer; you’ll figure it out.” I mean, how do we get people the help they need if even asking for it feels impossible?

Muhamad Aly Rifai, MD

That’s the question, Teresa. Reducing stigma, improving access to mental health care, and educating both the public and physicians about ADHD in adults is where we need to start.

Teresa Baron

So what about the treatment of ADHD Dr. Rifai

Muhamad Aly Rifai, MD

You know, Teresa, .. just as we were discussing the barriers to diagnosis and treatment, there’s another pressing issue we need to confront: the declared shortage of stimulant medications for ADHD treatment. This isn’t just some logistical hiccup—it's compounded by the DEA’s strict manufacturing quotas, creating yet another barrier for patients already struggling to get the help they need.

Teresa Baron

Wait, so people who legitimately need this medication—like, patients diagnosed with ADHD—just… can’t get it? That is so messed up!

Muhamad Aly Rifai, MD

That’s exactly the issue, Teresa. Without access, many patients are left without the tools they need to function safely. And when you factor in untreated ADHD, you’re looking at risks of self-harm, higher rates of traffic accidents, and even fatalities. In fact, a notable Swedish study found that starting ADHD medication significantly reduces the risk of unnatural mortality, particularly from things like accidental poisonings.

Teresa Baron

Whoa, accidental poisonings? That... I wasn’t expecting you to say that Do you mean overdoses ?

Muhamad Aly Rifai, MD

Yes Teresa we are talking about overdoses, I know you have a personal story about a family member.

Teresa Baron

That is a sad story we will leave this for another time but tell me more .....

Muhamad Aly Rifai, MD

I know, it surprises many people. But think about the impulsivity that’s a hallmark of ADHD—mixing medications, accidental overdoses, risky behaviors. Proper treatment stabilizes many of these tendencies.

Teresa Baron

And yet, here we are making it harder for them to even get treatment. Like, are we sabotaging patients on purpose?

Muhamad Aly Rifai, MD

It feels that way sometimes. And it doesn’t stop there. Patients face stigma, too. Seeking stimulant medications often labels them as “drug seekers.” They’re assumed to be manipulative, even when they just want help.

Teresa Baron

That’s… wow. It’s so unfair. So, like, people walk in, already anxious or overwhelmed, and this is the reception they get?

Muhamad Aly Rifai, MD

Yes, exactly. This stigma discourages many patients from seeking care. And then they’re left untreated, which leads to worse outcomes not only for themselves but also for society as a whole. It's a vicious cycle.

Teresa Baron

Okay, but it’s not all bad news, right? What about telehealth? Isn’t that helping people bypass some of those awkward in-person confrontations?

Muhamad Aly Rifai, MD

Thankfully, yes. Telehealth has been a lifeline for many. It provides a layer of anonymity, reducing the judgment factor patients might feel walking into a clinic. Plus, it expands access, especially for people in areas with long waitlists for ADHD specialists.

Teresa Baron

Hmm, love that. It’s like, one small piece of the puzzle finally working as it should. But that medication shortage, though, it’s... it’s not going away anytime soon, is it?

Muhamad Aly Rifai, MD

Not unless there’s meaningful collaboration between regulators, clinicians, and patients. For now, we have to work within the constraints and advocate for change.

Teresa Baron

What regulators Dr. Rifai are you talking about the dreaded DEA ?

Muhamad Aly Rifai, MD

Well yea... we are building on what we just discussed about the barriers and stigma tied to medication access, let’s pivot to something equally important—the way we understand ADHD itself. Traditionally, the medical model views ADHD as a deficit, focusing on what’s ‘wrong.’ It’s usually tied to inattention, hyperactivity, and impulsivity. And while that’s accurate in a clinical sense, it leaves out an important piece of the puzzle—the strengths that often come with it.

Teresa Baron

Strengths? Okay, now you’re really piquing my interest. Like, are we talking about superpowers here or...?

Muhamad Aly Rifai, MD

Not exactly superpowers, but there’s this social model that highlights abilities like creative problem-solving, hyperfocus on passions, and out-of-the-box thinking. The idea is, if you adapt the environment to a person's strengths, their differences become assets rather than barriers.

Teresa Baron

Hmm, I like that. I have this pianist friend, right? A brilliant musician. But keeping track of auditions? Or remembering her sheet music? Total chaos. Her family’s always like, “You’re so lazy,” when—hello—she’s playing Rachmaninoff flawlessly. ADHD, maybe?

Muhamad Aly Rifai, MD

It’s very possible, Teresa. Stories like hers actually highlight the limitations of our societal expectations. When people don’t neatly fit the mold, it’s often mislabeled as laziness or irresponsibility. That’s why understanding how ADHD can coexist with strengths is so important.

Teresa Baron

Right. And this is where telehealth could, like, swoop in and save the day, right? I mean, almost half of ADHD patients are using it now. That’s pretty promising, no?

Muhamad Aly Rifai, MD

It is. Telehealth opens up access to care in ways that were unimaginable before. It’s especially effective for rural communities or anyone facing long waitlists for ADHD evaluations. Plus, patients often feel less judged when they’re in their own space.

Teresa Baron

But that judgment, though, it’s still...like, so baked into all of this. Makes me wonder if everyone’s just pretending only boys with ants in their pants can have ADHD, when it’s—what’s the word—so much more nuanced?

Muhamad Aly Rifai, MD

Exactly. And it’s not just societal assumptions; medical professionals can be part of the problem, too. Misdiagnosis, particularly in women and minority groups, is alarmingly common. The models we apply need to evolve alongside our understanding of the condition.

Teresa Baron

And by evolve, you mean... what? Teach doctors to look for the symphony instead of just the sour notes?

Muhamad Aly Rifai, MD

That’s a beautiful way to put it. We need to adopt both medical and social models to capture a fuller picture—and then use that to tailor treatments and support systems appropriately.

Muhamad Aly Rifai, MD

After considering how our understanding of ADHD continues to grow, it’s frustrating to see how such a fundamental issue—like medication shortages—still stands as a hurdle. Imagine, Teresa, you’ve worked through stigma, received a diagnosis, and finally started on treatment, only to find pharmacies can’t provide your prescribed medication.

Teresa Baron

It’s so frustrating. Like, what do they even do? Go pharmacy-hopping all over the city, hoping someone has it in stock?

Muhamad Aly Rifai, MD

Pretty much. It turns into a scavenger hunt, and for people who already struggle with executive function—that's a major challenge. This isn’t just inconvenient; it’s dangerous. Untreated ADHD contributes to significant risks. Studies have linked it to higher mortality rates, shorter life expectancy, and an increased chance of accidents.

Teresa Baron

Yikes. That’s... terrifying. It really drives home how life-changing those meds can be, huh?

Muhamad Aly Rifai, MD

Absolutely. And the benefits are transformative. I’ve seen patients reclaim their lives, their productivity, and even their relationships thanks to effective medication and support.

Teresa Baron

Speaking of which, my cousin—she has ADHD. Started meds last year, and the change has been... Wow! She’s more productive at work, and, get this, she even got promoted. But, really, she says what matters most is how much calmer her mind feels.

Muhamad Aly Rifai, MD

That’s a powerful testament. And you know, stories like hers show that the right tools don’t just manage symptoms—they unlock potential. But it’s not just meds; diagnosis itself is a hurdle. Neuropsychological testing, and tools like the TOVA test, help us confirm ADHD. They're vital in tailoring individualized treatment plans.

Teresa Baron

So, it’s like, these tests strip away the guesswork, yeah? They help separate ADHD from, say, someone who’s just super stressed at work.

Muhamad Aly Rifai, MD

Exactly. They give us clear, measurable data. Combined with clinical evaluations, they ensure patients get accurate diagnoses instead of being dismissed—or worse, misdiagnosed with something entirely different.

Teresa Baron

It’s amazing, really. But it still feels like the system kinda places a burden on people to prove they’re struggling, doesn’t it?

Muhamad Aly Rifai, MD

That’s a fair point. A lot needs to change—not just in how we diagnose and treat ADHD, but also in dismantling stigma and making access easier for everyone.

Teresa Baron

And what’s the takeaway for listeners today? Any... final words of wisdom?

Muhamad Aly Rifai, MD

I would say this: ADHD is real, it’s complex, and it’s manageable. If you or someone you love is struggling, don’t ignore the signs. The path might not be simple, but the results—when you get the right support—are worth it. Let’s keep these conversations going, because together, we can change how ADHD is seen and treated.

Teresa Baron

And on that note, we’re wrapping up. Thanks for tuning in, everyone! Until next time, stay curious, stay kind, and don’t forget to take care of yourself. Bye for now!

Muhamad Aly Rifai, MD

Goodbye, everyone. And remember, your challenges don’t define you—your potential does. This is Dr. Rifai the Virtual Psychiatrist please stay safe and remember as our cohost Norm Clement says ... you are within the norms...