A 40-Year-Old Man Arrives at the Office for an Examination

A 40-year-old man arrives at the office for an examination of concentration problems. He believes he has ADHD after reading a book about adult attention deficit hyperactivity disorder (ADHD) and demands stimulant therapy. The patient had no history of ADHD as a youngster, but his parents were ignorant of the disease and never had him assessed. He does not now exhibit hyperactivity or impulsivity, but he does admit, "I simply get easily sidetracked certain days and know I might be more effective at work." The patient does not drink alcohol or use recreational drugs. Medical history is irrelevant. The vital signs and physical exam are normal. The doctor explains that the patient's symptoms are not compatible with an ADHD diagnosis. The patient insists that he will benefit from stimulants.  Which of the following is the most appropriate statement?

A) "A trial of stimulant medication may be helpful for what you're experiencing, but I think psychotherapy may be more appropriate to try first."
B) "Based on my evaluation, you don't have a condition that would warrant a stimulant; I suggest getting a second opinion if you do not agree."
C) "I understand that you want to improve your ability to focus at work; I can prescribe a nonstimulant ADHD medication that can sometimes help with concentration difficulties."
D) "Prescribing a stimulant medication is not indicated based on your evaluation; let's discuss some nonmedication treatment options that may help you focus more."
E) "Your symptoms are not consistent with ADHD and do not require medication, but please schedule a follow-up to discuss treatment options if your symptoms worsen."