ADHD

Karen Sargeant, founder of First Aid for Mental Health training provider Charlie Oscar, discusses considerations when assessing patients with ADHD for aesthetic treatments

As an aesthetics practitioner, you have honed and crafted your skills to ensure safety, efficacy, and patient satisfaction. A large proportion of this skill lies in your consultation, planning and expectation management, and this is long before a patient gets any physical treatment.

Consultation skills often focus on assessment through an in-depth knowledge of skin ageing, anatomy, and product selection. Matching expectations to outcomes and satisfying the legality around consent is also considered when constructing an effective consultation.

The consultation is often considered an art form, with communication being key when balancing the commercial background to offering medical treatments for cosmetic and elective purposes.

However, one consultation protocol doesn’t fit all. Often, we are required to adjust our communication skills, how we present the information, and the structure to accommodate diverse patient types.

One of the joys of aesthetic practice is the diversity of patients it attracts, bringing with them a range of motives and challenges. This, in turn, creates challenges for the practitioner, but it also creates the potential for additional risk.

In this article, we are going to consider the condition of ADHD. We will look at how to recognise the signs and possible risk factors these patients present and how to plan and deliver effective aesthetic procedures through consultation techniques that adapt and consider this specific patient group.

Attention Deficit Hyperactivity Disorder (ADHD). What is it?

Attention Deficit Hyperactivity Disorder, ADHD, is often attributed to younger children exhibiting disruptive behaviour. Thankfully, we’ve come a long way in understanding this neurodevelopmental disorder. However, a better understanding has brought misdiagnosis and overdiagnosis.

Once considered a neurodevelopmental mental health disorder, most experts agree that ADHD is not a mental health disorder but a neurobehavioral condition. This has helped go some way to destigmatise the condition.

ADHD affects both sexes but is more common in boys. Diagnosis in later life can be a huge relief and help the adult understand why they reacted or behaved in certain ways. It may also help them and those close to them reconcile relationships that may have been affected by the condition.

There is no ‘cure’ for ADHD. However, symptoms can become less impactful at different points in someone’s lifetime, and this can be supported with cognitive therapy, medication, and a better understanding of the condition.

It’s extremely rare for the condition to start in later life, and an adult diagnosis means that it was almost certainly present in childhood. It’s possible that certain stressors made the symptoms more obvious in later years, which could have been masked or compensated for in childhood.

With an estimated 3.5 % of adults in the UK having ADHD, as aesthetic practitioners, we will likely come across patients with the condition, whether that be diagnosed or not. As a business owner, you may employ somebody with the condition. Either way, it’s essential to understand how it impacts behaviour and how to accommodate and adjust to ensure we avoid missed expectations and complaints.

Signs and symptoms of ADHD

The NHS defines ADHD into two types of behaviours.

Symptoms of ADHD in children are clearly defined but are less clear in adults, and inattentiveness, hyperactivity and impulsiveness can affect adults very differently from how they affect children. In adults, hyperactivity tends to decrease, with inattentiveness being predominant.

The main signs of inattentiveness are:

The main signs of hyperactivity and impulsiveness are:

Adults with ADHD may also have problems with sleep, anxiety disorders and cognitive restlessness. Some may have issues with relationships or social interaction. There may be a tendency for addictive personalities with impulsive decision-making. Other symptoms that may present include low self-esteem, chronic procrastination, and a lack of fulfilling one’s true potential.

Adults with ADHD are also at a high risk of suffering from other conditions, including:

We’ve considered some of the challenges that ADHD presents. However, there are many positive attributes that people with ADHD have. For example, they tend to be great problem-solvers, often solving problems that others have struggled with. They are affable, likeable people with good conversational skills and a good sense of humour. They can be hyper-focused when doing something they enjoy, in which case they can multi-task at a rate others find difficult to keep up with. They are often resilient, creative, spontaneous and have abundant energy.

Managing a patient with ADHD in aesthetic practice

Patients diagnosed with ADHD may be happy to share this with you, in which case you can manage it accordingly. For those patients who do not wish to share this information or are undiagnosed, you may pick up on some signs and symptoms. While the role of an aesthetic practitioner is not to ‘diagnose’ these types of conditions (that’s the job of a professional), it is important that you adapt your consultation and communication techniques and provide an environment conducive to an effective and professional patient care pathway.

You may be alerted to a patient with ADHD from their medical questionnaire. You should familiarise yourself with the medications used for managing ADHD and understand their mechanism of action.

Considering some of the personality traits described, we can see some of the pitfalls that can arise when offering aesthetic treatments to this patient group. Being aware of the potential problems and anticipating them by making adaptations and adjustments to your standard protocols will protect you and your patient. Individuals with ADHD are constantly being disrupted by the ‘noise’ in their brains in a way that people without ADHD cannot imagine. This disruption can make the patient appear ‘odd’ or prickly, demanding, or high maintenance. As aesthetic practitioners, we must acknowledge this as ‘their normal’ and embrace the difference.

Strategies to support patients with ADHD coming for aesthetic treatments.

Some ways you can support a patient with ADHD or ADHD tendencies include.

Appointment reminders

Reminders of appointments are essential for this patient group. A text reminder a week before their appointment and then again the day before will be helpful. Last-minute cancellations or forgetting appointments can result from poor organisational skills, so more frequent text reminders can avoid these problems.

Timekeeping

The concept of time is often a challenge for patients with ADHD, which must be considered when scheduling appointments and treatment planning. They are often running late, for which there are usually many reasons, none of which are their making, so they see no reason why they

cannot still be seen at the time they arrive. Managing these situations takes a great deal of skill and diplomacy. Training your staff in these scenarios will help the smooth running of your diary and ensure you keep all your patients happy.

Conversely, because their brains are running much faster and they usually are juggling many balls in the air at one time, they do not like being kept waiting. They can quickly become irritated and agitated if their appointment does not run to schedule. As with all patients, any delay in their scheduled appointment time must be managed sensitively.

Consultation techniques

Lack of attention and becoming bored quickly can cause problems with the consultation and assessment process. Practitioners can easily be pushed ‘off track’ by a patient with ADHD. The aesthetic consultation should be practitioner-led, structured, and follow specific protocols to ensure safety,

ultimately avoiding missed expectations that could result in patient dissatisfaction. The practitioner must steer the consultation back on course if it diverts and may ask the patient to return for a second consultation to ensure they fully understand the information.

Consultations can cover many topics, and the patient must fully engage with the verbal, visual and written information given to them. The information presented to patients will support their informed decisions and consent. Ensure this information is presented to suit their learning styles.

The risks of any aesthetic procedure are discussed in the consultation as well as documented in the patient information and consent. We must remember that adults with ADHD view risk differently. They are generally not risk averse and will not weigh up risk against the outcome.

Realistic and expected outcomes are discussed during the consultation, which may include a less-than-satisfactory result.

The indications for treatments are explored based on the practitioner’s experience and limitations. There is always a danger that these expectations do not align with the marketing information that patients have seen or heard. It is important that a practitioner is satisfied that the patient’s expectations are realistic and that they understand the risks and limitations of the procedure.

Questioning techniques

Gaining feedback is important to assess understanding, and using open questioning techniques is key with a patient with ADHD. Asking closed questions such as “Do you understand how the treatment works?” will not accurately ascertain patient understanding. An open question might be, “Tell me what you think this treatment will achieve for you?” That way, you can better understand what the patient has understood.

For impulsive patients who might have switched off during the consultation, they may have missed some important and relevant information, which then leads to a problem.

Their impulsiveness makes their decision-making process less subjective and more emotionally based. This could ultimately result in missed expectations, which they attribute to the practitioner.

The practitioner must ensure the patient has considered all the information before agreeing to treatment. If they are in any doubt, then this is a valid reason not to offer treatment.

Aftercare and follow-up appointments

Compliance with aftercare can sometimes be an issue for those patients who do not follow instructions well. When giving instructions on aftercare, provide a clear, simple, step-by-step guide and demonstrate how to perform any specific techniques and get them to practice these

in the clinic with your guidance. Compliance can also affect patient follow-up schedules as they may not be considered ‘important’. Review-only appointments could be regarded as ‘a waste of time’. Patients who don’t come for these scheduled follow-ups may have a sub-optimal outcome that could have been rectified. This could impact unfavourably on the clinic and the practitioner. One way to avoid this is to call the patient by telephone or set up a virtual review. Document the outcomes and recall the patient for a face-to-face appointment if they are unsatisfied.

Tips for performing an effective consultation and treatment for a patient with ADHD

Supporting a colleague with ADHD

Understanding how the ADHD brain works will help you support colleagues with the condition (or with ADHD tendencies), and it will help them, too. Creating an environment where they thrive, utilising their strengths and where their difficulties are accepted can make all the difference. Harnessing the ‘superpowers’ of ADHD can be an asset to the business.

We all have things we enjoy doing, along with things we struggle with. Understanding the strengths of all your employees allows you to distribute the workload effectively and efficiently.

For staff members who struggle to organise themselves, create checklists and set time limits. Create a supportive work environment that accepts differences and diversity, and most of all, be kind.

If you and your staff want further training on Assessing Patients for Aesthetic Treatments or want to qualify in First Aid for Mental Health, please contact info@charlieoscar.co.uk

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