Navigating ADHD Treatment Amid the Rise of Social Media and Self-Diagnosis

Join Tim Wilens, MD, co-director of the Center for Addiction Medicine at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School, as he discusses innovative, multidisciplinary approaches for managing ADHD beyond traditional medications. Learn about the benefits of cognitive behavioral therapy, exercise, and alternative pharmacological strategies that enhance long-term outcomes for ADHD patients. Dr Wilens also explores the impact of social media on self-diagnosis, sharing his thoughts on how clinicians can navigate the rise of mental health discussions on platforms like TikTok and Instagram. Discover practical solutions for addressing ADHD and comorbidities in this Q&A.

Psych Congress Network: In cases where traditional pharmacological interventions may have limited efficacy, what are some innovative or multidisciplinary approaches you recommend for managing ADHD and improving patient outcomes?

Tim Wilens, MD: There are a number of things we can do to optimize or improve outcome in individuals across the lifespan who have ADHD. There are empirically based, cognitive-based therapies, for example, that have been demonstrated in large multi-site studies in the United States and overseas that really enhance the response to ADHD treatment. If you take somebody who's been medicated and you add cognitive behavioral therapy, what you find is a better overall outcome, and that isn't just short-term, that's over 1 to 2 years in some follow-up studies. Other things that you can do is to enhance other issues that may be problematic with ADHD. For example, if there's a comorbidity, you address that comorbidity either using psychosocial treatments or medications. One of the most common co-occurring issues that's very tough to treat is difficulties with executive function or as I call it, Wilensism, the secretary of the brain.
If that's problematic, organization, time management, hierarchical thinking, there's a number of things you can do for that. We've recently compiled the world's literature on treatments for executive function in that, and there are a number of buckets and they work more or less pretty similarly in terms of the effect. That can be using cognitive behavioral therapies. It could be using things like biofeedback, which can be helpful for some of the executive functions. Things such as physiology-based interactions such as exercise.
The interesting thing about exercise is it typically works on the day that you do the exercise, but not a whole lot the next day or the day after. But there is a prominent effect there. And then there's a number of other things such as alternative medication strategies using stimulants, non-stimulants and using some of other types of medicines like anti-Alzheimer medicines, noradrenergic agents with these medicines, etc. 

There are strategies that exist to help some of the residual problems that people have with ADHD that I think are promising. More and more will be presented about this in the future years.

Psych Congress Network: Have you noticed a change in ADHD presentation or even patients’ self-diagnosis with the rise of social media and Instagram? If so, how do you recommend clinicians navigate this question?

Dr Wilens: I think there's a good news, bad news story to this. The good news is that people are talking about mental health, they're viewing it, they're seeing it in a very different light, and now it's becoming part of the common vernacular. People are talking to each other about it, they're asking about it, and they're talking about their own, they're kind of open about it and now discussion. It's no longer stigmatized and put in the closet. The bad news part of it is people are basing their conclusions on a 10-second or 15-second TikTok and decided that they have an eating disorder, they have familial Mediterranean fever, they have these whole host of different disorders.

And in fact, you really have to be suspicious that 1 or 2 symptoms is not adequate to make a diagnosis. For people that I'm seeing who are coming in because of a concern that they have ADHD, and they picked this up because of TikTok, what I recommend is most practices have screeners. There's a number of different ADHD screeners that people can do. They can do those online or you can give the screeners to them. And if they're positive on the screeners, then at least you're suspicious. These screeners to remind people are very sensitive, which means they pick up the disorder, not so great in terms of specificity. That is, it may be something else. It may not be ADHD. And what you want in a screener is sensitivity. They could have the disorder.

Then you go through all of the symptoms of ADHD based on the DSM criteria, and you look at are there other psychiatric comorbidities? Is there psychosocial stressors? What's going on in the environment? Is this somebody who's had it as a track from childhood through their early adult years to adult? Or if they're a kid, an older adolescent, did they have it in middle school and now it's in high school? And really sort of track that down. I use it as sort of a, “yeah, it got you in the door, but that's probably where it's going to stop.”

I will end this by saying that most of the people I've seen who've self-identified have something going on. And it may not be ADHD, it could be a mimic disorder. It could be really anxiety, which is by the way, one of the most common overlaps with ADHD—symptoms of anxiety can make you think you have ADHD. Often anxiety starts very early in life. But they came for a problem. It wasn't this problem, it was this problem. And when you work with people and you explain it to them, what you find is that they then will buy into it and then you can treat them for that. So in the end, I find the TikTok and social media much more favorable than disfavorable.

Timothy Wilens, MD, is chief of the Division of Child and Adolescent Psychiatry and is co-director of the Center for Addiction Medicine at Massachusetts General Hospital. He is the MGH Trustees Chair in Addiction Medicine and a professor of psychiatry at Harvard Medical School. Dr Wilens earned his MD at the University of Michigan Medical School in Ann Arbor and completed his residency in child, adolescent and adult psychiatry at Mass General.