Getting Diagnosed with ADHD As An Adult
Over and over again other people “joked” that you have problems paying attention. While you intend to do your best to remember the three things you have to pick up at the store, you do a happy dance when you even remember that there was something you were supposed to get at the store. Then you wander the aisles hoping to remember even one of the items. While novel, new, and exciting tasks are easy, once something becomes familiar, rote or is bound to take a long time you have a hard time making your brain engage- even if it’s something you have done well in the past. If you’re “interested” in something you are motivated and can stay focused on it for hours. If not, forget it- procrastination, forgetting, or doing half the job is your MO.
Now you have come to the realization that all of these challenges might actually have a cause. Perhaps your child or another relative was recently diagnosed. (ADHD has a 77% rate of heritability) Or, perhaps you took an online screening quiz and scored REALLY high. So now what?
While the question of ADHD in a child is usually addressed by an evaluation through the school, once you are out of high school, this is no longer an option. One of the first questions to ask is, “Why do I want the evaluation?” Are you considering trying medication if you get diagnosed? Do you want a diagnosis to have a framework to understand your symptoms so you can better manage them? Or are you hoping to get accommodations in college or in the workplace?
If you think you might benefit from school or workplace accommodations, the first thing to do is to find out what your employer or school requires in order for you to get accommodations. Some require testing. Some even require specific tests. Others just want a letter from a mental health professional attesting to the fact that they have diagnosed you with ADHD.
If you want to get prescription medication to manage symptoms of ADHD many savvy medical practitioners will also ask that you have a diagnostic evaluation by a psychologist or another qualified mental health professional. Reality is that many medical practitioners will only ask you to complete an ADHD screening test before they prescribe medications. I do not recommend this route, as there are many other causes for symptoms that look like ADHD (PTSD, Anxiety, Depression, substance use, Thyroid conditions, to name just a few). Additionally, ADHD is often accompanied by other problems that might need to be addressed first or at the same time.
If you are ready to get an evaluation you can ask your doctor, a friend, search online or call your insurance to get a referral to a local provider who specializes in ADHD evaluations and diagnosis. **Note that any practitioner can say they “specialize” in ADHD- it’s up to you, as a consumer to interview them and make sure they know more than the basics. Practitioners who truly specialize in diagnosing and working with clients who have ADHD, know the nuances of ADHD. Symptoms and challenges that might not be described in the Diagnostic and Statistical Manual (currently, DSM-5).
Again, if you need testing for accommodations or to get a prescription for ADHD medications, make sure the provider does neuropsychological evaluations. These can be lengthy and may take more than one appointment. (**Note: Check with your insurance to see if any of the cost will be covered. Most do not cover this, except in very specific circumstances). If, on the other hand, you just need a diagnosis the mental health practitioner (usually a Psychologist, Psychiatrist, or Nurse Practitioner) will typically conduct a lengthy interview; ask to talk to and get some brief surveys completed by at least one other person close to you; might ask if you have any old school records; and may ask you to fill out some self-report tests. In this situation, the provider will gather historical information and look for a pattern of symptoms across your lifetime that impact your functioning and that meet the DSM-5 criteria for ADHD. They will also ask questions and gather information to rule out other potential causes for the symptoms and co-occurring disorders. The person may not always exhibit the symptoms of ADHD during the office visit, and the diagnostician needs to take a thorough history of the individual’s life.
Whichever type of evaluation you have (neuropsychological testing or a diagnostic evaluation), you will get a report from the practitioner stating the diagnosis and identifying the symptoms of ADHD that have the most impact on your functioning. Not every case of ADHD looks alike. In fact, there are more than 17,000 combinations of symptoms that meet the diagnostic criteria. Depending on the depth of the evaluation, the report may take up to 4 week to complete. You should have a feedback meeting with the practitioner to discuss whether (or not) your symptoms meet the criteria for ADHD. If you don’t have ADHD, the practitioner may have insight into another explanation for your symptoms. If you do have ADHD, that may not be the whole picture. It is common for people with ADHD to have depression, anxiety, or another learning disorder.
Keep in mind that if the practitioner does not diagnose you with ADHD, this does not mean that your symptoms are not real, or don’t impact your life. Sometimes there is another explanation. Sometimes there is information missing that would change the diagnosis. And sometimes the practitioner gets it wrong (it happens). If you are given a full neuropsychological exam and not diagnosed with ADHD, you might not have it or you might enjoy the challenge of taking a test or simply do really well on tests. In the latter two instances, the practitioner should be encouraged to weigh more heavily your historical data.
After discussing your diagnosis the provider will give you some basic education about what ADHD is and isn’t. They may also give you some suggestions about which treatment options might be most appropriate for you. Not everyone with ADHD needs prescription medication. Many people with ADHD benefit from coaching, cognitive-behavioral therapy, or making lifestyle changes to sleep, diet and exercise. Some have found supplements that they swear by.
If you are diagnosed with ADHD- welcome to the tribe!! Likely the first few weeks or month are going to involve reflections on your life and realizations about how ADHD has impacted you in various ways. The thought, “Oh, that’s why I…..” may occur frequently. While you may have gotten the basics from the diagnosing provider, I strongly suggest that you do your own investigation to learn more about ADHD symptoms, how they can impact your life, and how to manage them. Find a local or online resource or support group. Trust me, there are A LOT of people facing the same challenges you are. Connecting with your new tribe is the best way to learn about ADHD and to get real-life strategies to manage it.
Getting diagnosed is only the beginning of the process. Learning about your “brand” of ADHD will take time. Learning the best strategies to manage the symptoms and maximize your strengths will take time.
**** Wait- did I forget to mention that some of the “symptoms” might be strengths? ***
Enjoy the journey!
Don’t hesitate to reach out to me with any questions you might have. I also love welcoming people to the tribe!!
