What would be your approach to managing social anxiety in teenage patients with ADHD, doing well in regards to academic functioning with their stimulant medications?  

Good question! So when the potential for comorbid diagnoses is raised, I take a step back.  Some kids with ADHD become (appropriately) self-conscious and behaviorally inhibited in the academic environment due to their off-task behaviors, reduced academic performance, and challenges with bas...

Social anxiety could be a component of the ADHD spectrum and could improve through a proper treatment course that would include medications, psychoeducation, and behavioral management. If hyperarousal is a component, low-dose PRN propranolol is usually very helpful in bringing the control back inter...

I have had remarkable success with buspirone. I’ve seen NO side effects (which of course are pretty common both with SSRIs and with beta blockers). The toughest thing is getting it in three times a day (which I think is more effective than twice a day. I start with 5 mg TID and go up to 7.5 o...

Psychoeducation and engagement in "a little anxiety focus the mind and too much anxiety destroys the mind" along with "the cure to unhealthy anxiety involves exposure to moderate to mid-intensity stress with response prevention". I also stress that ADHD is not an academic-grade disease but a complex...

There is no ONE approach, and what works for one person may not work for another. It is not like getting a bacterial culture result with antibiotic sensitivities and knowing which antibiotic to use. I explore with the patient "what, when, where, why(?)". This can help us further explore the situati...

In adolescents with mild to moderate anxiety, I may initiate treatment of ADHD, which oftentimes improve social anxiety with or without therapy. If the ADHD medication did not improve the anxiety or in someone with moderate to severe anxiety, especially with comorbid GAD or OCD, I may use an SSRI. I...

Making the distinction between both diagnoses is important because stimulants can have a muting effect, and those with social anxiety might be quieter due to the medication, which only compounds their anxiety. I have found exposure therapy to be the most important component of social anxiety treatme...

I find that many youngsters who have been given multiple diagnoses, especially ADHD, depression, and social anxiety (and especially in girls), suffer from underlying autism, the symptoms of which are typically exacerbated in adolescence by SSRIs as well as by stimulants. These youngsters need a...