The Importance of an Accurate Diagnosis

Many people self-diagnose when it comes to ADD/ADHD. The symptoms can be very obvious. Perhaps you are concerned about the label. Whatever your reason for avoiding a proper diagnosis, it is very important to resist the temptation to go it on your own. First of all you could be wrong and miss another problem such as autism, bipolar disorder, sleep disorders, or even anxiety, all of which can mimic ADD/ADHD.

In addition, there are many advantages to getting an ADD/ADHD diagnosis. The diagnosis can change the life of your child when it comes to accommodations that schools are legally obligated to provide, such as more time on tests, papers and homework, different means of testing and tutoring when needed.

There is also an emotional benefit to having a diagnosis as the symptoms of ADD/ADHD can lead to feelings of guilt, shame, or embarrassment about underachieving. Or, it can lead to a lot of frustration over the amount of time it takes to complete tasks. The diagnosis usually helps normalize the experience and reduce these emotions.

A psychologist, neuropsychologist and in some cases a neurologist can diagnose ADD/ADHD. Before booking an appointment, ask if the provider has experience diagnosing ADD/ADHD and what tests they use.  If they only do an interview keep looking. Because some pediatricians and general practitioners do “diagnose” ADD/ADHD don’t be afraid to ask for a referral to a specialist to conduct further assessment. Brain based behavior is unique in each individual. It is important to know both your strengths and weaknesses and not just that you have the disorder. So although the pediatrician may be able to identify individuals with the disorder, they do not have the tools for evaluating the disorder in such a way as to identify the individuals strengths and weaknesses, which is why most good pediatricians refer for a diagnostic workup.  Again, the only professionals specifically trained to assess ADD/ADHD are neuropsychologists and psychologists who have been trained in neuropsychological testing.

Self-Assessment

While ADD/ADHD cannot be diagnosed online, there are many ADD/ADHD quizzes and questionnaires available online that act as a helpful self-screening process. Taking a quiz can give you the confidence to reach out to a health care professional for a formal diagnosis.

 The Assessment Process

Though it varies, a typical assessment for ADD/ADHD in children or adults may last three to 6 hours. Every practitioner conducts the assessment in their own way, but you can expect an in-person interview covering topics such as development, health, family, and lifestyle history as a start along with standardized testing.

The clinician may request to interview other people. For adults, they might want to talk to their partners or other family members. In the case of children, the clinician will want to talk to a teacher, coach, or daycare provider in addition to the parents.

Questionnaires, rating scales, intellectual screenings, and measures of sustained attention and distractibility may all be part of the assessment. You may be asked to elaborate on things such as:

• How often do you quit a task before you’re done?

• How often do you misplace things?

• How often do you forget appointments or other important matters?

• Do you have trouble sitting still?

• Do you struggle to relax?

• How often are you distracted by things around you?

Your medical history is an important part of the evaluation. If you have not had a medical exam recently, one might be recommended to rule out medical causes for your symptoms.

While psychological testing is not the sole basis for diagnosing ADD/ADHD, it may be recommended to support conclusions and provide a more comprehensive assessment. You may also be screened for learning disabilities at the same time as an ADD/ADHD assessment given that learning disabilities go hand in hand with ADD/ADHD.

Treatment Options

Unfortunately, the most common recommendation for ADD/ADHD is often medication. I am not a fan of medications in general, as I have found that the side effects can be almost as difficult to manage as the condition.

The typical medications prescribed for ADD/ADHD include stimulants such as:

• Adderall (amphetamine and dextroamphetamine)

• Concerta (methylphenidate extended-release)

• Focalin (dexmethylphenidate)

• Ritalin (methylphenidate)

Non-stimulant medications are also available, such as Strattera (atomoxetine) and the one that I prefer and recommend when medication is unavoidable, Wellbutrin XL (bupropion hydrochloride). Wellbutrin has far fewer side effects and also helps with both anxiety and depression.

Behavioral Strategies

Behavioral strategies can really help people with ADD/ADHD improve their focus, reduce distractions, and cope with environmental factors that make it more difficult to stay on task. Such strategies can include having routines, utilizing charts and planners, reminders, getting organized when it comes to one’s room, school supplies, and incorporating timers and alarms to help stay on task. It is amazing how much it helps just to have the ADD individual organize their room and/or work space.

Why Would Someone Get Tested for ADD/ADHD as an Adult?

People with ADD/ADHD are born with brain differences from those who do not have ADD/ADHD. However, these symptoms might not have manifest until later in life. Perhaps they had a super-organized parent or coach and their symptoms were more or less masked.  Another common experience is that the focus is on a secondary issue such as anxiety or depression and the diagnosis is missed or misdiagnosed.

An interesting phenomenon for many individual adults never diagnosed was the COVID-19 pandemic which led to increased stress levels that interfered with their ability to compensate for attention issues. Additionally, working from home for many adults and high school students created increased stress levels and more mental health issues than before the pandemic, leading to an increase in seeking services and evaluations. Eating disorders, which I view as an anxiety disorder with a focus, also shot through the roof during this time.

What Adult ADD/ADHD Tests Exist?

Getting diagnosed with ADD/ADHD as an adult can be challenging because symptoms look different than they do in children. Because so many specialists primarily diagnose children, they may not have the tests on hand needed to diagnose an adult. In addition, adults generally do not look  hyperactive the way that children do because they can manage the behaviors better or because they experience hyperactivity in the form of racing thoughts rather than body movements.

That said, there are several measures that providers can use to assess adults for ADD/ADHD:

• Test of Variable Attention (TOVA): The TOVA measures your ability to attend to a non-preferred task and assesses your attention skills in real time. It compares your performance to others who do and do not have ADD/ADHD. Sometimes the TOVA is inconclusive, or someone with an attention issue can perform well because they are compensating, and so the TOVA is usually not given by itself.

• Conner’s Adult ADD/ADHD Rating Scales (CAARS): The CAARS is a rating scale that measures attention, impulse control, and hyperactivity. It determines whether your symptoms are consistent with ADD/ADHD. There is a self-report scale and an observer scale, which someone who knows you well can complete.

• Adult ADD/ADHD Self-Report Scale (ASRS): The ASRS is another self-report measure that determines how closely your symptoms match the DSM diagnostic criteria for ADD/ADHD.

• The Behavior Rating Inventory of Executive Functioning-Adult Version (BRIEF-A): The BRIEF-A looks at various aspects of executive functioning, such as your ability to follow through on tasks, shift between activities, organize belongings or thoughts, and recall important information. It compares any difficulties you are having to others your age to determine if deficits are present.

• Barkley Adult ADD/ADHD Rating Scales (BAARS): The BAARS is similar to the CAARS and uses both self-report and observer data to measure your symptoms compared ot the DSM diagnostic criteria for ADD/ADHD.

What Happens After You Are Diagnosed?

Many adults benefit from individual or couples therapy to help understand and manage their  symptoms. An ADD/ADHD diagnosis can cause you to feel a flood of emotions. You might feel relieved to finally have an explanation for your symptoms. Or, you may feel overwhelmed by what to do next. These are normal reactions. It’s important to find someone with extensive experience to walk you through the process. Here at Mind and Wellness you are in good hands. I am a trained neuropsychologist with 30 – years’ experience in diagnosing and treating learning disabilities and ADD/ADHD. In addition, I suffer from the condition myself which gives me insight that other practitioners may not have.

Don’t feel rushed to make decisions about treatment; allow yourself a little time to process the new information before moving on to the next steps. Once you’re ready, give us a call. We really can help.