Psychiatrist Dr. Elizabeth Baerg Hall explores adult ADHD and why it often becomes visible during major life transitions like starting university, becoming a parent, or retiring. We discuss how to recognize ADHD in primary care settings, overcome diagnostic barriers, including stigma and comorbidities like anxiety and depression, and empower family physicians to confidently diagnose and treat this highly manageable condition. From understanding the role of stimulant medications to accessing new BC resources like the Skills for Success program and upcoming ADHD pathways, this conversation highlights how recognizing and treating ADHD can profoundly improve patients' quality of life across all ages. If you’re interested in learning more about adult ADHD, visit ubccpd.ca/adult-adhd for information about our upcoming conference on March 7, 2026.
Guest: Dr. Elizabeth Baerg Hall
Host: Dr. Chris Morrow
Producer: Craig Ferguson
Music: "Stand With Me" by Adrian Walther licensed via SoundStripe
Episode Timestamps
• [00:00] - Introduction and episode overview
• [02:03] - Life transitions and when ADHD becomes visible in adults
• [04:14] - How ADHD can be masked by structure and support systems
• [05:21] - Red flags for ADHD in primary care settings
• [08:54] - Who can diagnose ADHD and what tools are available
• [12:05] - The importance of impairment in diagnosis and avoiding overdiagnosis
• [16:36] - Common comorbidities: Anxiety, depression, and bipolar disorder
• [19:39] - ADHD and substance use disorder
• [21:26] - Barriers to diagnosis and treatment: Stigma and misconceptions about stimulants
• [24:07] - Inequities in access to care, including Indigenous patients
• [26:26] - Challenges for rural patients and older adults with ADHD
• [29:00] - Resources and support in BC: CADRA, Shared Care, and Skills for Success
• [30:56] - ADHD pathways and UBC CPD educational opportunities
• [32:59] - Closing remarks and conference information
• [33:52] - Knowledge nugget: The history of psychostimulants
Studies & Research Mentioned
• CADDRA – Canadian ADHD Resource Alliance. Canadian ADHD Practice Guidelines, 4.1 Edition. Toronto, ON: CADDRA; 2020. Accessed January 13, 2026. https://adhdlearn.caddra.ca/wp-content/uploads/2022/08/Canadian-ADHD-Practice-Guidelines-4.1-January-6-2021.pdf
• Centers for Disease Control and Prevention. Diagnosing ADHD. Updated 2024. Accessed January 13, 2026. https://www.cdc.gov/adhd/diagnosis/index.html
• The MTA Cooperative Group: A 14-Month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder (ADHD) . Arch Gen Psychiatry 1999;56:1073-1086.
• The MTA Cooperative Group: Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder (ADHD). Arch Gen Psychiatry 1999;56:1088-1096.
• Molina BSG, Kipp HL, Joseph HM, et al. Stimulant Diversion Risk Among College Students Treated for ADHD: Primary Care Provider Prevention Training. Acad Pediatr. 2020;20(1):119-127. doi:10.1016/j.acap.2019.06.002
• National Institute of Mental Health. The Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA): Questions and Answers. Revised November 2009. National Institute of Mental Health website. Accessed January 13, 2026. https://www.nimh.nih.gov/funding/clinical-research/practical/mta/the-multimodal-treatment-of-attention-deficit-hyperactivity-disorder-study-mtaquestions-and-answers
• Ramtekkar UP, Reiersen AM, Todorov AA, Todd RD. Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11. J Am Acad Child Adolesc Psychiatry. 2010;49(3):217-28.e283.
(C) 2025 UBC Medicine Learning Network
S1 E3: ADHD Across Life Transitions: Practical Approaches for Primary Care w/ Dr. Elisabeth Baerg Hall
00:00:00 Chris Morrow
Welcome to UBC CPD In Practice, a podcast for health professionals where we sit down with expert colleagues to learn about leading-edge clinical medicine and share practical tools and knowledge you can apply to your daily work. I'm your host, Dr. Chris Morrow, Executive Medical Director for UBC Continuing Professional Development. The In Practice podcast is recorded on the unceded ancestral territories of the Musqueam, Squamish, and Tsleil-Waututh peoples.
00:00:28 Chris Morrow
ADHD isn't just a childhood condition, and for some, it becomes most visible during major life transitions. From starting university to navigating parenthood or retirement, these pinch points can unmask symptoms that were previously unmanaged or overlooked. In this episode, I'm joined by Dr. Elizabeth Berg Hall, a psychiatrist, clinical professor at UBC, and director of the ADHD Center for Education and Training. Dr. Hall is a national leader in ADHD program development and education, and she brings deep expertise in translating evidence-based treatments into practical care. Today, we'll explore how ADHD presents in adults, what this means for primary care in British Columbia, and share concrete strategies and practical tips for family physicians. Let's jump right in!
00:01:21 Chris Morrow
Hello, Dr. Baerg Hall. Thank you so much for joining us. It's so great to have you here. We feel very lucky.
00:01:26 Elisabeth Baerg Hall
Hello, Chris. Happy to join you. Please call me Elizabeth. I'm very happy to have this conversation. I've been looking forward to this.
00:01:33 Chris Morrow
And so are we. So we are going to be talking about ADHD and more specifically, the phenomenon that we're seeing it increasing in people that are not pediatric. So in the older age groups, and this is raising some questions. Some people, there's a little bit of controversy for them. And so today we'll take a bit of a look at this phenomenon and get your insights.
00:01:56 Elisabeth Baerg Hall
Terrific.
00:01:57 Chris Morrow
We've heard this term about transitions and these transitions in life where ADHD is relevant. I wondered if you would share and let our listeners know sort of what that's referring to.
00:02:07 Elisabeth Baerg Hall
Yeah, you know. There's been some amazing studies, of course, lots of research on ADHD in children and more and more now in ADHD in adults. And, you know, there's a historic study, the MTA study that's been following children over time. And what we do know, of course, it's really only been the last like 20 years or so, 25 years, that we've really been kind of understanding that actually ADHD in adults is a thing. The MTA study showed us that ADHD is present with fluctuating course at varying times in people's lives. And so those transitions that you're talking about, Chris, are really the important times. So one of the big ones, you know, for children is when they go from, when they go into high school or grade 9, 8, 9 kind of thing. That's a big transition. Another transition, of course, is again, the graduating from high school into maybe post-secondary training or post-secondary school of any kind. And then there's, you know, a ton of other transitions, not all of them are so predictable, but often a transition like getting a job or a transition like becoming a partner in a longer-term relationship, having children, big transition for ADHD people. Also peripartum, pre, those kind of changes are big issues for people with ADHD. And again, of course, later in life transitions as well, retirement can be a transition time, menopause, the more biological, but also the sociocultural. And basically the idea is that we have a lot of supports that either we built for ourselves or others provided for us, right? It's very obvious the one for emerging adults, right? They go from a high school kind of environment or a family environment into a much less structured environment. So those are kind of obvious. But the continuous feature in a transition is that for some reason, we've lost our scaffolding a little bit, we've lost our structural supports, or we have to redevelop them perhaps, right? They need some tweaking.
00:04:12 Chris Morrow
Right. Oh, I see. That's fascinating. So it might be perhaps a fair thing to say that somebody might have ADHD or traits of ADHD, but it's at these critical moments in our life cycle that it becomes evident because otherwise it was maybe being masked a little bit.
00:04:28 Elisabeth Baerg Hall
Yeah, and that's a really great observation. I think that is actually what trips people up a little bit when a patient may show up in your office, in your primary care setting. And, you know, this is someone you might have known for 10 years and you've known them to be kind of distracted and you've known them to be, change jobs a lot. You've known them to be maybe in and out of relationships a little bit more than they might, but, generally they're doing all right, They might be kind of smart. They might be, pretty well adjusted in some ways, but then they show up and they're like, hey, doc, I think I have ADHD. So it can be really confusing, right? It's like, because, you know, I tend to talk of them as kind of pinch points in a person's life, right? When all of a sudden, you know, that square peg round hole issue becomes obvious, right? It's like, oh, wow, this is whatever I've done before is not working for me.
00:05:20 Chris Morrow
So the symptoms become very apparent. And from a primary care provider's point of view, what are some of the red flags that they might notice or might key them into it?
00:05:28 Elisabeth Baerg Hall
Well, you know, I mean, this is why, like, I really am so supportive and spend a lot of time with primary care practitioners trying to talk about ADHD, because I think this is exactly the environment where ADHD can readily be identified, ideally in a longitudinal. As it, as a cross-sectional, it's not that clear, right? But the red flags you might see, and we could take them in various ages, but so the transition, say, to post-secondary or to a more independent adult life, you know, what you might see is that they have a bit of trouble launching, right? They have a bit of trouble organizing all of a sudden, you know, they want to move out of their house, but they might find themselves gaming a lot in the basement. They might find it really hard to keep a job because they're not remembering job responses. There can be conflict, of course, in relationships at that time. You know, in higher performance requirement settings, like if they're training for, you know, say a job, I'm going to skills training and such, they can have a lot of trouble without regular feedback and they start to, you know, flounder a little bit. This certainly happens a lot in the post-secondary, like more university setting as well, where these are the kids that they might go away to school and all of a sudden there's nobody there reminding them of their structure. So the red flags would be in that kind of case, like substance use, depression, anxiety, really taking a while to get sorted and kind of get on your feet. You know, the post-secondary environment is so high pressure, people don't usually have that kind of time anymore. You know, those would be red flags in that. Same kind of thing when patients are coming and talking about being overwhelmed all the time, and they always appear to like nothing seems to be able to get sorted out for them. Those are other kind of red flags that can often happen in family or at work. At work again, maybe some interpersonal conflicts. I mean, ADHD, we know people can have different kinds of impulsivity. And one of those is like verbal impulsivity, right? So it can really get people in trouble.
00:07:27 Chris Morrow
We all know somebody who says things without thinking. Maybe me included.
00:07:31 Elisabeth Baerg Hall
Or me.
00:07:33 Chris Morrow
Yeah. So that's very interesting. It reminds me of criteria for other conditions as well. You notice it's starting to impair their function. And I guess we've already said this, but before they were able to get through because they had structure.
00:07:45 Elisabeth Baerg Hall
Structure, intelligence, creativity, belief in themselves, perhaps, or others believing in them. You know, maybe again, they had the family that was supporting, even as a young adult or a young parent, they might have had like a really amazing family structural supports, often these things are there and we don't even see them, right? If something happens, like say, then mom who's looking after the kids or grandma who's looking after the kids in the family might become ill, and then all of a sudden something falls apart and you don't actually know what happened. Like, why is all of a sudden this person coming in with these problems? And again, I think in family medicine more these days, we hear people come in and say, I think that be ADHD. But often it's more because they're reading and they think this explains some challenges. But often the complaints that people come into family medicine with are interpersonal or they're functional in terms of job-related issues, relationship-related kind of challenges, right? That's often emotional regulation. So they could come in looking like they might be depressed or they might be kind of highly anxious.
00:08:54 Chris Morrow
So I think our listeners are probably thinking, okay, so it's more common. How do I figure out if it's there? How do I diagnose it? So what are some of the tools and who's able to diagnose ADHD?
00:09:06 Elisabeth Baerg Hall
Yeah, I think again, like family medicine or primary care environments, especially longitudinal ones are really great places for basic, not too complicated ADHD to be assessed. And you know, there are a number of really great tools I'm really looking forward to our upcoming conference that you're planning. I think that's going to be a really wonderful opportunity for people to learn. CADRA, of course, Canadian ADHD Resource Alliance has a lot of tools. You know, family doctors could identify it. They can also diagnose it. They really can. Like, I really want us to build that capacity. And I think we are gradually in this province, I think, doing pretty well, actually, building primary care capacity to treat and diagnose it. But I think there are tools, there are also some standardized questionnaires out there that people can use. But I think one of the most important things is to really actually recognize that this population, it's a very treatable condition. It doesn't go away. It's very, very treatable. And it really involves a combination of medications and skills. That's the evidence. You know, if a patient wants just skills, that's also, you know, something that's reasonable to start where your patient is at. But, you know, people get better. People are able to calmly live their lives. They can plan. You know, so for example, one of the classic presentations of ADHD in the early 30s is someone who, you know, who's had entry-level job after entry level job, like kind of just parallel jobs, right? So they went from working at one grocery store as the, nighttime clerk to another grocery store to maybe, something similar in a volunteer organization. But, and then you can see that what happens over time, these people are not moving up any kind of income ladder, right? They're not developing the continuity and they're not developing skills. And so then this leads to lower self-esteem, less capacity in relationships to support another person and stuff. So it can lead to all kinds of like sequelae. And I think one of the things that treating ADHD can really do is to help people manage their lives better. Even their chronic medical conditions, right? Diabetes, you know, health problems, exercise more regularly, like it helps people live better when the ADHD is managed. So I think that's like the real case I'd want to make for people to look for it, see it. I mean, there's a lot more to, you know, some of the red flags you'd notice, but again, it's that thing about something seemed to be working and then it wasn't, or it wasn't working, then it was and then it isn't again, right? It's, ADHD is as a neurodevelopmental condition, it's always there in the background. It just is, you know, sometimes easier to manage for people.
00:11:49 Chris Morrow
That's great. I really appreciate what you've said there and can appreciate that recognizing it allows treatment and that treatment could be, you know, meds, skill-based. And I understand also just having a knowledge of it really helps people, knowing, oh, this is why this is happening. That's part of the skills. I know I've heard some providers say, they're nervous to commit to the meds. I think what I'm hearing is really it's appropriate. It's appropriate for them to feel empowered to diagnose it and start medication. But there's not one specific tool or one specific process, or is there for making that diagnosis.
00:12:23 Elisabeth Baerg Hall
So with the DSM, ADHD is described as, a disorder of attention, also a disorder of impulsivity and hyperactivity. We know that adults don't show that kind of hyperactivity that we're really used to seeing. And we also know the important thing about diagnosing ADHD, as you mentioned earlier, Chris, is that, you know, you've got to have impairment. You know, you can't just be flighty. There has to be implications of impairment in at least two areas of your own functioning. So that I think is really critical. Like you've got to be able to identify a problem. And often I think because ADHD as an executive function skill affects insight and they've had the condition their whole life, often it's really hard for people to actually identify the problem. So it's not until, you know, the new spouse says, honey, you are never listening to me. Like you are forever, like off in another planet, our kids are concerned, you know, like what's going on here? Like when somebody really says those things and starts to notice the interpersonal impairment and, you know, when you're at a party, you are always interrupting everybody else that's. Like what is going on here? You never let anybody finish a sentence. You know, no wonder no one wants to be your friend or no wonder we don't get any social engagements. Like you can see that the trajectory in the story kind of one thing will develop on another. So there's got to be impairment. You really must. And that's the way that we prevent this concern about overdiagnosis, right? People are very concerned, like what's with all these people showing up with ADHD? It's important to acknowledge that historically ADHD has not been identified as frequently in women as in men. So, in childhood, there's considered a three to one ratio, but in adults, it's more like a one to one ratio. What we also haven't paid attention to is the fact that over time, the symptoms change in how they present, right? So I think when we're looking to diagnose it, we might actually be seeing a bit of a correction going on. The other piece is that we know historically that, you know, 20 years or so ago, like there were very, very huge, like 11% of adults were getting treated. really, really low. And again, in inattentive adults, especially those like socialized to be good, to listen, to be facilitative of relationships as we typically find in the, in women in our culture, like of course men do this as well, but as we typically find, it's really hard sometimes to see it. So even psychologists will say that a full neuropsychological assessment for the diagnosis of ADHD is unnecessary. If you are not comfortable doing a diagnosis of ADHD yourself in your primary care setting, first of all, I'd put a plug in for the course that's coming up. But second of all, I would say that it is reasonable, like a psychiatrist can do the diagnosis, a psychologist will do the diagnosis, but they won't do neuropsychological testing. They will do a full battery of questionnaires, a really good childhood history, and they'll help with this diagnosis. But I think care needs to be taken on the behalf of the patients. Like neuropsychological testing is very, very helpful, has many uses, but this isn't one. And it's expensive. Very, very expensive. And like if you're trying to rule out a learning disability, and if the school is really saying we need some learning testing, that's a different story. But again, this. This is more a childhood story than an adult story. when I was working with university students almost exclusively, we'd like, maybe there's a learning disability, but there's also ADHD. So let's treat the ADHD and then see if everything else can go better. And again, generally that doesn't help a learning disability, but it does help attention, concentration, organization, emotion, all those other really important things that are helpful. So you kind of, we're treating around some of those conditions. But just to say that, again, in BC, there are a lot of other places where family doctors will send patients or maybe not send them, but where patients might go or they're charged privately to get an ADHD diagnosis. And it's pretty easy to pick out ADHD symptoms in a story. What's the challenge is to understand ADHD in the context of other co-occurring conditions, which are very common with ADHD.
00:16:35 Chris Morrow
Right. So it sounds like you're bringing up comorbidities here, and I'd love to hear you talk more about that, because I think that's what will make a primary care provider a little nervous or make me a little nervous as well. You know, am I missing something?
00:16:46 Elisabeth Baerg Hall
Great question. And you're right, it comes up all the time. They're very common, right? Over 80% will have coexisting other conditions. And the most common mental health one is anxiety. So like it's something family medicine is so good at identifying and assessing. And just to talk about that for a second, so they co-occur frequently. Yet if you listen to a patient's story, you're going to hear the story of the ADHD right through the whole episodic anxiety kinds of conditions. They may have social anxiety because of the impulsivity, the verbal impulsivity we talked about, right? Because I say stuff that really gets me in trouble. So I think the important thing with anxiety is that we don't have to be exactly right. You can know that they can co-occur together. The thing is just to make sure that you always treat the ADHD too. So if the anxiety seems really problematic, you know, treat the anxiety, but don't forget about the ADHD, right?
00:17:47 Chris Morrow
So we have anxiety, I'm guessing depression is also quite frequently.
00:17:50 Elisabeth Baerg Hall
Yeah, so anxiety, depression, you know, again, episodic depression, you can have also a history of impulsive suicidality or non-suicidal self-injury. Right. So again, those are very, very common bipolar. Polar disorder also is very common with ADHD, so this, I think is more concerning. For family medicine, how do we rule out the bipolar disorder? And again, this is where I do believe our psychiatry colleagues can really support us. But just one of, like, just to give you an example of one of the things to think about, like in a bipolar story, you're going to get episodic problems with not needing sleep, for example, right? You'll get episodic racing thoughts. You may have someone who always runs a little bit fast, but they're going to be episodic, like really, really racing thoughts, tangential ideas and such. With ADHD, they're always like that. With ADHD, they've been kind of like that through their whole life and they can get super excited about things, but it's not going to be, you know, four or five days or a week or something like that that's going to be going on. It's going to be a story over their lives where, and again, ADHD people often, it's not so much having trouble falling to sleep, but they can't, they don't want to put themselves to sleep because it's boring, the boring kind of idea of stopping whatever they're doing. So those are, executive function tasks. To stop a task is a complex executive function skill, like response inhibition, you know, stopping the dopamine. Stopping, right? he's starting a new task of getting ready for bed, right? So again, there are other, there are lots of sleep conditions associated with ADHD. It's not that simple, but just to give you an example, right? There are ways to sort these things out, but just to say the one thing with bipolar disorder, if it's there, it really has to be treated before you're doing any pharmacological treatments.
00:19:37 Chris Morrow
Yeah, absolutely. I can see that. And then the other thing I think we already touched on is there's a link with substance use disorder.
00:19:45 Elisabeth Baerg Hall
Yeah, thanks. You know, we worry about the really bad ones like stimulant use disorder and such, but common substances that ADHD people might use are usually common substances that people use. Cannabis, alcohol, tobacco. And yes, when there is co-occurring stimulant use disorder, that is also a much different problem. It requires a specialist for management. I think one of the things that I've noticed in my work with ADHD people is that they can be self-medicating with cannabis, right? They're using the cannabis to kind of relax and help them calm down. But so far, we don't have evidence that suggests that this is particularly helpful. And when you think about it, one of the big ADHD problems is lack of motivation. Of course, we know that cannabis can also cause—
00:20:34 Chris Morrow
But Ken found that, yeah.
00:20:36 Elisabeth Baerg Hall
So, and it can also cause issues with emotion regulation. So again, in family medicine, I think the important thing is that when the ADHD is there in the background, it's important to identify it and get people to the right kind of treatment. And sometimes they need the ADHD treatment in order to go through the treatment programs.
00:20:54 Chris Morrow
Yeah, or maybe even to understand what's really going on, treat the one thing and then see what's left, as you sort of alluded to before.
00:21:01 Elisabeth Baerg Hall
And I actually, require people to cut back somewhat, as we're going through the process of, you, I think it's reasonable to, monitor use and to try to cut back. But, again, like these are, we're talking about the more common substance use conditions, right?
00:21:17 Chris Morrow
Great. And so really focusing on sort of uncomplicated ADHD, that's really in the primary care wheelhouse, if you're concerned that there's a comorbidity, it might still might be okay to make the diagnosis and start, but then get them extra help, make sure you're getting the whole picture. I love it. That sounds really helpful to me. What kind of barriers are there that we're needing to overcome, maybe for patients or even for providers?
00:21:43 Elisabeth Baerg Hall
Yeah, barriers for patients and providers, I think stigma is still really alive and well. People are worried about what a stimulant will do to someone, right? People are worried about addiction, like can someone become addicted if I treat them with a stimulant? And again, the answer to this, it's fairly well established that in general, when you have a general ADHD population without other addictions, that it's reasonable to treat within the limits of how you you treat ADHD, you're not making addicts. It is true, though, that we know that if you treat kids right through, you actually don't necessarily delay or prevent totally that this person might develop a substance use disorder. It's just that I think there's this common stigma that we think every time we give a person a stimulant, that they might become an addict, or every time we give a person a stimulant, they might be diverting the medication and giving it to someone else, right? I think there are higher risk populations, so it's an important issue in student health to think carefully about how we're prescribing, how we're monitoring, and also to have the conversation. We know actually the evidence is very clear to talk with students who have ADHD in advance about, do not talk to your friends about this. But you know, some of that education, there's actually some really interesting studies that's been done about how primary care is critically important to prevent stimulant misuse or diversion in these kinds of populations. So one of the barriers for students or young people or adults themselves is that a lot of people don't believe that you could possibly have ADHD if you have a good job or if you have. Right. And this actually is something that physicians hold as well internally. I said, we can't help it. We were kind of trained like all to think about the seven-year-old boy who's. Bouncing off the walls. Or whatever, right? So I do think that it's important to the stigma is what's going on and also a misunderstanding of what stimulants do for people. People don't get high on stimulants when they're using them as prescribed. There may be an initial period of mild euphoria, but that will calm down and what people get is a better capacity to direct attention, right? We know ADHD isn't actually inattention, it's just misdirected attention.
00:24:00 Chris Morrow
So better focus. Yeah, exactly. Well, I think it's also important to talk about a few other things about ADHD. I understand that there remains some significant inequities for access and treatment. I've heard that indigenous patients are facing some barriers. Did you want to talk about the inequities a little?
00:24:17 Elisabeth Baerg Hall
Yeah. I mean, I think if we just go right to the basic, the inequity of not being able necessarily to get a diagnosis for ADHD as a mental health condition is problematic, right? And having to pay for that is already an equity issue just right off the bat.
00:24:32 Chris Morrow
Absolutely.
00:24:32 Elisabeth Baerg Hall
And so I think that's really key. I think that just as there is a stigma that ADHD doesn't exist, I think in some populations, people might believe that ADHD, while ADHD can get confused with trauma and the trauma story that a population may carry, for example, as we talk about Indigenous culture in BC with the, you know, with residential schools, like this kind of a story can set people up to get confused about the relationship between trauma and ADHD and also how to understand these things. FNHA has done a lot of work within their own doctor of the day to help these physicians be able to diagnose ADHD in the context of very intense trauma and to know that in these cases, a rigidity in the diagnostician, for example, of saying everybody has to have a report card, you have to look at, you know, we have to have a ton of collateral and everyone has to agree that there was childhood ADHD, for example, it's not necessarily the case. I think we do know that there's a relationship, for example, between ADHD and trauma. We also know that people with ADHD may be a little bit more likely to experience trauma, partly because of the core ADHD symptoms. The really important thing is if you can actually understand that there is an ADHD component, you may be helping, may, qualitative word, a person, longstanding trauma function better in the world, but other barriers to access is that sometimes, again, if a diagnosis is made by a knowledgeable physician through, say, FNHA, and then people are transferred back to the care of a primary care provider, it may be that sometimes it's hard to understand those. So I think it's really important, you know, to know that relationship exists and yet it doesn't mean that there can't be ADHD in the background.
00:26:17 Chris Morrow
Yeah, it sounds like it's quite complex and that certainly ADHD can coexist with trauma and there's a relationship there to consider. How about those that live in rural areas? We always like to consider our rural providers and patients. I imagine it's harder for them to get access to care and perhaps therapy or maybe online modalities are helping with that.
00:26:38 Elisabeth Baerg Hall
I think online modalities are really helping with that. And a lot of people provide assessment online. I think, you know, one of the challenges is that an assessment for ADHD has to be done in a context. It has to be done knowledgeably, which is why I would prefer that it be their rural primary care physician, and I understand that people can be terribly, terribly busy, but again, you're in a better position to know your patient than to have them go on a Zoom call and get a diagnosis of ADHD in one session. You know, what often happens in these things is that the patient themselves don't feel heard, right? They're like, I don't know if I have ADHD, right? And then they end up still waiting on a list to see a psychiatrist or to see a psychologist. So having said that, I've seen some, you know, there are some online assessments that can be very, very good. Again, usually you'd want something that that's more than one visit, right? you want some follow-up opportunities. But those aren't the only criteria. Sometimes good skilled people can do it. But I think if people want in-person treatment, of course, rural, you know, rural challenges are going to be very, very significant, right?
00:27:40 Chris Morrow
It's a lot harder, yeah.
00:27:41 Elisabeth Baerg Hall
One of the things I think we do need to talk about, like older people with ADHD again, like it's always, there's always stigma, right? So I've seen family doctors who are like, well, yes, you're 70 years old. What could treating your ADHD even with executive function skills do for you at this point. But again, to me, that's kind of ageism, right? Like, I think we have to be really careful about our own values, about our patients, and that treating a person with psychostimulants isn't just to make them more efficient and, you know, a better person in society. It's to make them feel better as a human being, right?
00:28:16 Chris Morrow
Quality of life, function.
00:28:18 Elisabeth Baerg Hall
Right, and live their lives as they want to. And I think there are, of course, challenges with this, but again, to keep an open mind, as physicians to really hear where our patients are coming from. And as you said yourself, sometimes just having a diagnosis is what people want. It's like, you know, that just helped everything come together for me. And I start to understand, you know, the last years of my life and how all these weird things happened to me, like it made a lot of sense. And that's all I need. But also to keep in mind that often comes with a fair bit of grief, right? So they need other kinds of counseling and support that again, primary care practitioners are able to provide and obtain for people.
00:28:57 Chris Morrow
So we've talked about a lot already and some of the barriers. So what are some good things that we're doing right now? I know there's some learning opportunities around this and maybe do you have anything to share about that?
00:29:09 Elisabeth Baerg Hall
Yeah, I mean, I think there's some really exciting things going on in BC in particular, but also need to really acknowledge that CADRA, very committed to education and to primary care diagnosis of ADHD. And, just to say the kinds of things that we talk about in BC are very much within the CADRA guidelines, right? We adhere to those guidelines as well that are really well respected the world over. So that's one thing. But within BC, really shared care is actually the star, in my opinion, of addressing a gap in care. Years ago, we approached them to ask about developing a group medical visit program for people with ADHD that was both medication prescribing and skills-based. You know, so, important that people get access to executive function skills. This was a long time ago. I don't want to date myself, but like over 50, almost 15 years ago. That's not so long at all. Well, they were visionaries, right? And, you know, like really stepped in. And so what happened out of that is is a program that is called Skills for Success that people can access for your patients through Mindspace, who offer a number of MSP-funded programs for our patients. And Skills for Success is one that they're offering now for adults. So in this province, this kind of pool that with really minimum financial barriers, as a family doc, you can send your patient to one of those groups going on.
00:30:33 Chris Morrow
That's fantastic. And I bet you it's a new thing to hear for some people that Mindspace not only does cognitive behavioral therapy, but also skills groups for ADHD. That's really fantastic.
00:30:44 Elisabeth Baerg Hall
So that's one. The other thing through shared care is that this project that we started together with the Vancouver Coastal Adult ADHD Clinic, together with the North Shore Division, we've been working to do this primary care education program. So what we did is we started with eight primary care practitioners. And we said, hey, we're going to do a few educational sessions. And we did those. And then in between, like maybe look for a couple of patients in your office that you think might have ADHD and then treat them just one, just one, look for one patient. And they ended up finding and treating 54 patients.
00:31:16 Chris Morrow
Oh my gosh.
00:31:17 Elisabeth Baerg Hall
So I think this really proves the point, right? And so out of that program, again, with shared care funding, developed an ADHD pathway, which is going live very, very soon on Pathways BC. where a physician can be walked through the process of doing a diagnosis and much more comprehensive tool that's really BC specific, but also really user friendly. So that's there. And then the other cool thing is your group, UBC CPD, doing this educational piece that's coming up soon, which really will, I think, again, provide services for family docs, like provide the educational environment and hopefully will be very much based on, again, the pathway tool is something most people will teach across the country how to diagnose ADHD. It's kind of typical and also really cool resource that people are going to have. And also to say that shared care is also supported development of a pediatric pathway.
00:32:19 Chris Morrow
Yeah, this is fantastic news. So there's some help out there. So we're going to have pathways. We've got the adult ADHD skills. We've got Mindspace with their skills for success. And yeah, we're excited at UBC CPD to be weaving this podcast together with the conference and then an online learning module as well. So that's great. I've really enjoyed our conversation today. We could have probably talked for hours, but we only have a short period of time. So I look forward to seeing you at the conference and maybe we'll have you back. Thanks for your time.
00:32:51 Elisabeth Baerg Hall
Thank you so much for having me, Chris. It's great, and thank you for summarizing so well. I get kind of excited when we talk about this.
00:32:58 Chris Morrow
It was fantastic. Thank you. A big thank you to Dr. Elizabeth Berg Hall for sharing her insights on adult ADHD. As we've heard, recognizing ADHD, especially during life transitions, can make a profound difference in patients' lives. With the right combination of medication, skills, and support, this treatable condition doesn't have to stand in the way of achieving improved mental health and quality of life. And for primary care providers, building confidence in diagnosis and treatment is key to closing gaps in care. If you found this conversation interesting, and you'd like to learn more about the diagnosis, treatment, and management of ADHD, please join me at UBC CPD's Adult ADHD Conference on March 7, 2026. Learn more and register at ubccpd.ca/adult-adhd.
00:33:52 Chris Morrow
All right, it's time for our knowledge nugget. We humans have a long history with psychostimulants. One that cycles between medicine, inappropriate use, and medicine again. For millennia, humans sought substances that could sharpen the mind, delay fatigue, and lift the spirit. The earliest documented psychostimulant is tea, containing caffeine, which appears in Chinese records around the 3rd century BCE, although legend places it much earlier. Jumping all the way to the 30s and 50s, we see that stimulants were utilized for a wide variety of indications, including depression, fatigue, obesity, low libido, menstrual cramps, even nasal congestion. You name it, people thought stimulants were the answer. Then came World War II, and stimulants entered a darker chapter. Both sides used them extensively to keep soldiers alert and aggressive. Tens of millions of doses were handed out. So at one point in history, the most powerful armies on earth were running on psychostimulants. But in the middle of that era, something unexpected happened. In 1937, pediatrician Charles Bradley gave benzedrine to children with severe behavioral and learning problems. What he observed surprised him. He saw improved attention, better school performance, reduced impulsivity, and calmer behavior. He published his findings in the American Journal of Psychiatry that same year, marking a key moment in what would eventually lead to the formal definition of ADHD as a clinical condition and its treatment. Today, psychostimulants have formal indications for just a handful of conditions, ADHD being most prominent, but also narcolepsy, certain sleep disorders, binge eating disorder, and selected cases of severe depression or cancer-related fatigue. Compared to their history, that's a remarkably narrow lane.
00:35:41 Chris Morrow
This activity meets the certification criteria for the College of Family Physicians of Canada and has been certified by UBC CPD for 0.5 main Pro Plus certified activity credits. Go to ubccpd.ca/inpractice to claim your credits and find related resources and references in the show notes. The In Practice podcast is Produced by Craig Ferguson with research and administrative support from Camilla Ho. I'm Dr. Chris Morrow. Thanks for listening.