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Frequently asked questions about Dr. Ryan Sultan: board-certified psychiatrist at Columbia University specializing in ADHD, cannabis research, and digital therapeutics with NIH funding. |
Expert Answers on ADHD, Cannabis, Psychopharmacology & Mental Health
By Dr. Ryan S. Sultan, Assistant Professor of Clinical Psychiatry
Columbia University Irving Medical Center →
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Adult ADHD (Attention-Deficit/Hyperactivity Disorder) is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning. In adults, symptoms often manifest as difficulty organizing tasks, time management challenges, restlessness, and difficulty maintaining focus on work or conversations.
Unlike childhood ADHD, hyperactivity in adults is often experienced as internal restlessness rather than physical hyperactivity. Adult ADHD affects approximately 4-5% of adults and can significantly impact work performance, relationships, and daily functioning. Diagnosis requires evidence that symptoms were present in childhood (before age 12) and cause impairment in multiple settings.
Learn more about ADHD research →
→ Learn More: Complete ADHD Guide | Treatment Options for Young Adults
Stimulant medications for ADHD work by increasing the availability of dopamine and norepinephrine in the brain, particularly in regions involved in attention, impulse control, and executive function. The two main classes are methylphenidate-based medications (Ritalin, Concerta, Focalin) and amphetamine-based medications (Adderall, Vyvanse, Dexedrine).
These medications block the reuptake and increase the release of dopamine and norepinephrine, enhancing signal transmission in neural networks that regulate attention and behavior. Contrary to common misconceptions, stimulants don't simply "speed up" or "calm down" individuals—rather, they normalize neurotransmitter function in specific brain circuits.
Clinical studies show stimulants are effective in 70-80% of individuals with ADHD, improving attention span, reducing impulsivity, and enhancing ability to complete tasks. Formulations range from immediate-release (4-6 hours) to extended-release (8-12 hours), allowing for individualized treatment.
→ Learn More: Complete Medication Guide | Treatment Overview
ADHD has a strong genetic component, with heritability estimates around 70-80%, making it one of the most heritable psychiatric conditions. If a parent has ADHD, their child has approximately a 50% chance of also having ADHD. Twin studies consistently show higher concordance rates in identical twins compared to fraternal twins.
However, ADHD is polygenic—meaning it involves many genes, each contributing a small effect, rather than a single "ADHD gene." Genes involved primarily affect dopamine and norepinephrine neurotransmitter systems, particularly dopamine receptors and transporters.
While genetics play a major role, environmental factors also contribute, including prenatal exposures (smoking, alcohol), premature birth, low birth weight, and early childhood adversity. Currently, genetic testing is not clinically useful for ADHD diagnosis, as no single genetic test can predict or diagnose the condition.
No, for most people ADHD does not simply "go away" with age. Research shows that two-thirds of people with ADHD still have symptoms into adulthood. As I discussed in my PIX11 television interview during ADHD Awareness Month, this challenges an outdated belief from the 1990s that "ADHD doesn't exist in adulthood" - a misconception that prevented many adults from receiving appropriate care.
While symptom presentation often changes - hyperactivity may become more internalized as restlessness, and inattention may manifest more as executive function challenges - the core difficulties persist for the majority. Approximately 60-70% of children with ADHD continue to have clinically significant symptoms as adults, though they may develop better coping strategies over time.
The persistence of symptoms into adulthood is now well-established in research. Adult ADHD affects approximately 4-5% of adults and requires ongoing management. Treatment in adulthood - whether medication, therapy, or skills training - remains important for optimizing functioning.
→ Learn More: Adult ADHD Section | Treatment Options for Young Adults
The ADHD brain shows consistent differences in structure, function, and neurochemistry, particularly in the prefrontal cortex - the region right behind your forehead responsible for executive functions like impulse control, planning, and judgment.
In my PIX11 interview, I explained this using an accessible analogy: "This part of your brain, it's like the brake on a car. So it allows you to sort of slow down control impulsivity." In people with ADHD, brain scans show:
This "brake" dysfunction explains why children with ADHD might call out in class without thinking, or why adults might make impulsive decisions without fully considering consequences. It's not a matter of willpower or discipline - it's a neurobiological difference in how the brain regulates attention and behavior.
The good news: This understanding also explains why ADHD treatments work. Stimulant medications increase dopamine availability in the prefrontal cortex, essentially "strengthening the brake" and improving executive function.
→ Learn More: Neurobiology of ADHD | How Medications Work
While ADHD presents genuine challenges, it's important to recognize that ADHD represents neurodiversity - a different way of thinking that can confer distinct advantages. As I discussed on PIX11: "I actually like to step away from a normal idea. I think people with ADHD, there's sort of an idea of thinking them as not neurotypical, meaning their brains are a little different, but that there are some advantages to that for them."
Key ADHD Strengths:
Evolutionary Perspective: These traits may have been advantageous in ancestral hunter-gatherer societies, where rapid response to threats, exploratory behavior, risk-taking in hunting, and hyperfocus during critical tasks would have supported survival. As I noted on PIX11: "We know probably has been around a long time, like hundreds of thousands years ago, like when we were hunter-gatherers."
Recognizing these strengths should inform treatment planning - identifying careers that leverage creativity and energy, providing interest-based learning opportunities, and supporting entrepreneurial ventures. However, celebrating strengths doesn't negate the need for treatment or support for genuine challenges.
→ Learn More: Complete ADHD Strengths Section | Strength-Based Treatment Approaches
Cannabis use disorder treatment typically involves a combination of evidence-based psychotherapy and supportive interventions. Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET) are first-line treatments, helping individuals identify triggers, develop coping strategies, and build motivation for change.
Contingency management, which provides incentives for maintaining abstinence, has shown strong evidence of effectiveness. Currently, there are no FDA-approved medications specifically for cannabis use disorder, though research is ongoing.
Digital therapeutics and mobile health interventions are emerging as promising adjunctive treatments, particularly for young adults. Dr. Sultan's NIH-funded PAWS project is developing an AI-based digital therapeutic for this purpose.
Treatment is most effective when tailored to the individual's specific needs, co-occurring conditions, and stage of readiness for change. Early intervention in adolescents and young adults is particularly important given the potential impact on brain development.
→ Learn More: Evidence-Based Treatment Guide | PAWS Digital Therapeutic Project
Cannabis use in adolescents carries several significant risks due to ongoing brain development. The adolescent brain, particularly the prefrontal cortex responsible for executive function and decision-making, continues developing into the mid-20s. Regular cannabis use during this critical period is associated with:
Key Risks:
Research, including Dr. Sultan's recent work in Pediatrics (2026), shows that despite legalization trends, adolescent cannabis use patterns require careful monitoring and early intervention strategies are critical.
→ Learn More: Complete Adolescent Risk Guide | Cannabis and Psychosis Research
Clozapine is an atypical antipsychotic medication considered the gold standard treatment for treatment-resistant schizophrenia. It is uniquely effective for individuals who have not responded adequately to at least two other antipsychotic medications.
Clozapine is indicated for:
Clozapine requires careful monitoring due to risk of agranulocytosis (severe reduction in white blood cells), which occurs in approximately 1% of patients. Historically, this required frequent blood tests through a restrictive Risk Evaluation and Mitigation Strategy (REMS) program.
Dr. Sultan's research contributed to FDA policy changes in 2017 that reduced monitoring burdens while maintaining safety, improving access to this life-saving medication.
Ketamine therapy represents a significant advancement in treatment for severe, treatment-resistant depression. Ketamine works differently from traditional antidepressants—rather than slowly building up levels of serotonin or norepinephrine over weeks, ketamine acts on the glutamate system and can produce rapid antidepressant effects, often within hours to days.
The FDA-approved form, esketamine (Spravato), is administered as a nasal spray in certified clinics under medical supervision. Intravenous ketamine infusions are also used off-label for treatment-resistant depression. Research shows approximately 50-70% of individuals with treatment-resistant depression show significant improvement with ketamine treatment.
Effects are typically rapid but may be temporary, requiring repeated treatments for maintenance. Ketamine therapy is reserved for individuals who have not responded to multiple conventional antidepressant trials. Treatment requires careful patient selection, medical monitoring during administration, and integration with ongoing psychiatric care.
Psychopharmacoepidemiology is the study of the use and effects of psychotropic medications in large populations. This field combines principles from pharmacology, epidemiology, and psychiatry to examine patterns of medication prescribing, effectiveness in real-world settings, safety profiles, and outcomes across diverse patient populations.
Unlike controlled clinical trials, psychopharmacoepidemiology research uses large databases of health records to study how medications perform in routine clinical practice, identifying rare adverse events, comparing treatment outcomes, and examining factors that influence prescribing patterns.
This research is essential for understanding medication safety, optimizing treatment guidelines, and identifying disparities in mental health care delivery. Dr. Sultan's research in this area has examined antipsychotic prescribing patterns in youth with ADHD and the relationship between cannabis policies and mental health outcomes.
Digital therapeutics are evidence-based software interventions that prevent, manage, or treat medical or psychiatric conditions. Unlike general mental health apps, digital therapeutics undergo rigorous clinical testing and regulatory review.
For mental health, these include:
Dr. Sultan's current NIH-funded research includes developing PAWS (Personalized Adaptive Wellness System), an AI-based digital therapeutic for cannabis use disorder in young adults. Digital therapeutics offer several advantages: increased accessibility, reduced cost, ability to provide support between clinical visits, objective symptom tracking, and scalability. For more on integrating digital mental health technologies into clinical practice, see Dr. Sultan's JAMA Psychiatry viewpoint on telepsychiatry.
Child and adolescent psychiatry differs from adult psychiatry in several fundamental ways. First, developmental considerations are paramount—children's and adolescents' brains are still developing, requiring specialized understanding of age-appropriate behaviors, cognitive capacities, and emotional regulation.
Assessment involves multiple informants (parents, teachers, pediatricians) rather than relying solely on patient report. Treatment planning must account for family systems, school environment, and peer relationships. Psychopharmacology in youth requires specialized training as medication effects, dosing, and safety profiles differ significantly from adults.
Child psychiatrists receive additional fellowship training (typically 2 years) after completing adult psychiatry residency (4 years). Dr. Sultan is double board-certified in both adult and child/adolescent psychiatry, providing expertise across the developmental spectrum.
These frequently asked questions are answered by Dr. Ryan S. Sultan, a double board-certified psychiatrist (Adult & Child/Adolescent) and Assistant Professor of Clinical Psychiatry at Columbia University Irving Medical Center. Dr. Sultan's expertise spans ADHD, cannabis use disorders, psychopharmacology, and digital therapeutics, with over 100 peer-reviewed publications and NIH-funded research. He maintains a clinical practice at Integrative Psych NYC, offering comprehensive psychiatric care with a mind-body medicine approach.
For professional consultation, see contact information.
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