What Adults Should Know—Before and After an ADHD Diagnosis
By Cynthia Hammer, MSW, Executive Director, Inattentive ADHD Coalition, www.iadhd.org
DECIDING TO SEEK A DIAGNOSIS FOR ADHD IS FRAUGHT WITH EMOTIONS
Scenario one: You think you have ADHD, but worry you’re wrong and fear being told, “You don’t have ADHD.” You are not alone in this worry. Sadly, it is true, adults are sometimes told they don’t have ADHD even when they do because the physicians and psychologists they see for a diagnosis are unfamiliar with how ADHD presents in adults.
Sometimes, an adult was diagnosed with ADHD in childhood but never sought treatment or stopped treatment. When their lives spiral out of control, they finally want treatment for their ADHD. But even with a record of their childhood diagnosis, they may still encounter scenario one.
Scenario two: You think you have ADHD and fear having it confirmed. You would rather have personality quirks than a disorder. The stigma falsely attached to ADHD affects your willingness to be diagnosed. You fear the diagnosis because you don’t realize how life-changing, in a good way, diagnosis and treatment will be. With diagnosis and treatment, life gets better.
A psychologist experienced in diagnosing adults with ADHD told me that adults who think they have ADHD are usually correct. However, to ease your mind in advance and provide factual information to share with your clinician, print out and complete the ADHD-RS https://add.org/wpcontent/uploads/2015/03/adhd-questionnaire-ASRS111.pdf The maximum score is 54, but the average range for someone with ADHD is between 30-40.
Another good source is the DIVA 5, a structured interview for adult ADHD that is valid and reliable for diagnosing adult ADHD. https://www.divacenter.eu/DIVA.aspx?id=528. The website states it is for clinicians trained in its use. Still, I understood it and completed it. It costs about $10 to download and takes 60-90 minutes to complete. Its detail will teach you the manifestations of ADHD, whether the inattentive or hyperactive/impulsive presentation.
WHY YOU SHOULD BELIEVE YOU HAVE ADHD BEFORE SEEKING A DIAGNOSIS
Reason one: If the physician you see is reluctant to prescribe a long-acting amphetamine, the usual treatment for adult ADHD, you can advocate for the correct treatment. Here are the medications and doses your physician should prescribe after diagnosing your ADHD unless he provides a good reason for not doing so.
*Focalin XR is also an amphetamine, but contains only one amphetamine salt, dexmethylphenidate, while Adderall and Vyvanse contain four kinds of amphetamine salts.
Typically, you would be started at a low dose and slowly increase it every few days. You can track your improvements by completing the ASRS111 or DIVA5 again and again. A good response would be getting your ASRS score below 18 or a DIVA 5 with fewer check marks. Side effects to the medication should resolve within a month, but if not, you should next try a long-acting methylphenidate medication.
From research, we know that stimulants are the most effective treatment for ADHD. It might take several months to find the proper medication or combination of medications at the correct dose for you. There are over 30 medications used to treat ADHD. The two tables list the most popular ones.
Medication dose does not rely on your age, weight, or severity of the condition. What works for one person is not necessarily what works for you. ADHD is very individual in its presentation and treatment. To get a general feel for how people respond to various medications, read reviews at https://www.webmd.com/drugs/2/index . Only after failing with both kinds of stimulant medications should your physician prescribe Strattera or other non-stimulant medications for treating ADHD unless he can explain why he is prescribing something else for you.
Reason two: The longer you went with untreated ADHD, the more likely you are to have co-morbid depression and/or anxiety. If the physician diagnoses depression along with your ADHD, he might want to treat the depression first. About 25% of adults with untreated ADHD have depression. Treatment is more effective if both, not just the depression, get treated together. If you have anxiety, which almost 50% of adults with untreated ADHD report having, treatment of your ADHD may reduce your anxiety. In that case you won’t need a different medication for your anxiety. But if you do, the physician should treat your anxiety after seeing how much it resolves with the ADHD medication.
Reason three: The physician will not diagnose your ADHD and has bizarre explanations for why they won’t. The most common and incorrect explanation is that you are too smart, you did well in school,or you graduated from college. Other times the physician believes you have ADHD but won’t prescribe a stimulant because he fears you are drug-seeking.
While some people with undiagnosed ADHD have substance abuse histories, this shouldn’t prevent a physician from prescribing stimulant medication. The physician can supervise its use. Even people in a drug treatment program have fewer relapses when their ADHD is treated.
If you encounter either of these responses, know that you have seen a physician not knowledgeable about ADHD. You need to find another physician to diagnose and treat you.
If you are evaluated by a physician who doesn’t know the latest research on diagnosing and treating adult ADHD, getting help for your troubled life can be delayed for years. This is why it is crucial to work with a knowledgeable clinician. You might find a psychologist to diagnose your ADHD and a physician to treat it, or a physician who both diagnoses and treats you. In either scenario, you want knowledgeable providers who have evaluated and/or treated many adults with ADHD.
How will you find knowledgeable clinicians? Search online ADHD directories, such as chadd.org/professionaldirectory/, https://directory.additudemag.com/ and add.org/professional-directory/ but realize providers pay for their listings. Do further research by visiting the websites of possible candidates and reading online reviews by former patients. If you cannot locate an experienced provider near you, explore providers that diagnose and treat adult ADHD remotely via telemed.
ASK THESE QUESTIONS TO EVALUATE TELEMED SOURCES FOR ADHD
• Can you diagnose and treat ADHD in adults
• Who will make my diagnosis and what is their experience diagnosing and treating adults with ADHD?
• Can you prescribe stimulants or only non-stimulant medications?
• Are you approved to provide service in the state where I reside?
• What insurance companies cover your services?
• What percentage of the charges do they pay?
• Do you bill insurance or am I expected to?
• How much does an evaluation cost?
• What are the costs of follow-up appointments?
When you go for an evaluation, bring someone with you who has known you for a while. People with ADHD typically have poor memories, especially of their childhood.
AFTER YOUR DIAGNOSIS
Stay the course. Don’t give up on finding a medication that helps you. Too many get discouraged and don’t persist when the first medication doesn’t help. Don’t let alternate treatments, which research has shown are not effective, tempt you. Persistence usually pays off as over 80% of people with ADHD are helped by medication. People online often ask others what medicine they take or which didn’t help them. Remember, an effective medication and dose for someone else with ADHD may not be the proper medication for you.
Get educated about ADHD from reliable sources, such as the websites of ADHDevidence.org, CHADD, ADDA, the Inattentive ADHD Coalition, and ADDitude Magazine. Read recommended books, watch videos by Russell Barkley, Ph.D., and Jessica McCabe, and participate in webinars featuring noted ADHD providers and researchers.
Focus on creating good habits: eight hours of sleep each night, one hour of exercise at least three times a week, nutritious meals in moderate amounts, along with mindfulness training to reduce your stress.
Seek support and guidance from others with ADHD. There are several ADHD groups on Facebook and Reddit where people share their experiences.
Consider adding individual coaching or cognitive behavioral therapy to the mix if you struggle to implement new behaviors, continue feeling overwhelmed, or are not making progress. The website of the ADHD Coaches Association has a directory of coaches while Psychology Today lists therapists. Most coaches work via Zoom, and many therapists do as well.
Addendum:
Dr. Oren Mason, a family physician who specializes in treating ADHD and related disorders advises physicians to screen for ADHD when a patient presents with any of the following problems. If you have issues in any of these areas, you might want to discuss a possible ADHD diagnosis with your family physician.
Clinical
• Depression, bipolar
• Anxiety, OCD, PTSD
• Poor SSRI response
• Alcoholism or alcohol abuse
• Substance abuse
• Nicotine addiction
• Multiple serious injuries
• 2 or more STD’s
• Crisis pregnancy
• Medical non-compliance
Social
• Pattern of unstable relationships
• Few friends
• Poor social support network
• School disciplinary problems
• Divorce
• Marital discord
• Unresolved marital issues
• Job loss and underemployment
• Frequent job change
• Arrest or incarceration
Self-Management
• Late for appointments
• Educational under-performance or curtailment
• Multiple MVA’s/moving violations
• Impulsive shopping
• Burdensome debts
• Credit overextension
• Financial mismanagement
The information in this article is not intended to be medical advice.
*This article may be freely copied and distributed.