Is it ADHD?: Case Study

Lukenotes, Winter 2017

Father Alex came to Saint Luke Institute for an evaluation at the request of his diocese’s vicar for clergy. Father had gone to him, feeling his priesthood was falling apart. He was stressed, could not seem to manage time, kept jumping between projects, and felt completely overwhelmed.

 

 During his evaluation, the 42-year-old priest’s speech was rambling and a little impulsive. He had a clinical interview, psychosocial interview and spirituality assessment, allowing the evaluation team to gather a thorough history.

 

School had always been relatively difficult for him. Though he never got into trouble, teachers consistently complained of his inattention and disorganization. Summer school and tutors helped him stay on course through high school. In college, he struggled and ended up on academic probation one semester after getting an incomplete and failing grades. He had missed many classes and turned in assignments late, if at all. What he did hand in was poorly done and incomplete. 

 

With the help of more tutoring and coaching on organization techniques, Fr. Alex graduated and went to seminary. He again struggled, but did well enough to complete his studies. 

 

Shortly after he arrived at his first parish assignment, the pastor started getting complaints from the parish staff and several parishioners that Fr. Alex was often late, forgot to make important phone calls and left the parish office a disorganized mess. The staff liked him and would remind him of appointments and help him out when they could.

 

His struggles with organization – in the office and rectory – continued after he was made a pastor three years later. 

 

Issues with the parish staff and with some of the parishioners continued to mount. Fr. Alex was confronted several times because he was late, missed deadlines and generally was perceived as being unreliable and even incompetent as an administrator. Twice, he also blurted out harsh criticisms about the parish director of religious education. 

 

Fr. Alex shared that he smoked two packs of cigarettes per day, a habit he had since high school, and drank caffeinated coffee throughout day. He said he nearly was charged with a DUI and had reduced his alcohol consumption. 

 

Depression or ADHD?

 

Fr. Alex described himself as unpredictably irritable. He felt like a failure and was not sure what to do. He felt little energy for anything but his work. 

 

His primary care doctor thought he might be depressed and tried an anti-depressant medication, with little relief.

 

He was vague during his Saint Luke evaluation when the physician asked if he had taken the medication regularly. The physician suspected that Fr. Alex did not have an adequate therapeutic trial of antidepressants. Progress notes from his primary doctor’s record confirmed the suspicion of noncompliance. Still, he slept well and maintained a good appetite. 

 

During his evaluation he participated in a neuropsychological assessment that indicated a diagnosis of ADHD. During the clinical and psychosocial interviews, he self-reported symptoms of ADHD. Collateral information regarding observed ADHD symptoms was gathered from his contact person.

 

Fr. Alex was diagnosed with depression and ADHD. ADHD treatment for adults requires a multi-pronged approach that addresses the symptoms and the skills needed to organize life and to work on the emotional issues that often accompany this diagnosis. 

 

While in residential treatment, Fr. Alex was prescribed a stimulant medication to treat his ADHD. He engaged in individual and group therapies, including Cognitive Behavioral Therapy (CBT) that helped him learn time management and how to cope with emotions and handle stress. He began to address a negative self-image that resulted from years of feeling that he did not measure up to expectations and to learn how to think things through before acting.

 

Saint Luke’s physical therapist and registered dietician helped him learn other ways of managing his symptoms of ADHD and depression. These included eating healthy meals, getting regular exercise and plenty of sleep, and finding ways to manage stress. 

 

As  he prepared to return home, he and his primary therapist developed an aftercare plan that would mimic some of these treatment modalities. He received help setting up a group of peers to give him feedback on signs of lapses with his ADHD or depression, and help with finding a local therapist and a psychiatrist to manage his medications. He also found a support group that allowed him to connect with other adults who are living with ADHD.

 

With this holistic treatment approach and new lifestyle in hand, Fr. Alex felt more confident and encouraged about his prospects for successful ministry upon his return home.

Kathleen Glufling, Psy.D., is a therapist for the residential program at Saint Luke Institute. To ensure confidentiality, names, identifying data and other details of treatment have been altered.