Adult ADHD and Uninformed Clinicians---Enough Already!

By Cynthia Hammer, MSW, Executive Director, Inattentive ADHD Coalition, www.iadhd.org

We have known, for over 30 years, that adults have ADHD. Why are there still clinicians unable or unwilling to diagnose or treat adult ADHD? Why, when I visit online ADHD groups, make complaints about uninformed clinicians dominate the discussions?

It is hard to know how many individuals who seek an ADHD diagnosis are misled or misdiagnosed, but even one feels like too many.

I am not advocating throwing out the baby with the bathwater. There are many well-informed psychologists and physicians who provide excellent service to their patients with ADHD.

But one bad apple can spoil the whole bushel.

ADHD is the most common neurological disorder in childhood. With ADHD continuing into adulthood 90% of the time, we can surmise that adult ADHD is the most common neurological disorder of adulthood. Professional organizations and training programs for psychologists and physicians need to do more to educate their members about adult ADHD. It is past time for clinicians to continue being uninformed about adult ADHD.

"Doctors [and psychologists] need to accept that it's their responsibility to educate themselves about something that is quietly becoming a public health crisis." ~~~~~~Ellen Littman, Ph.D.

Here is a post about an uninformed psychologist.

She told me. "ADHD is supposed to get diagnosed when you're a kid. ADHD in adults is difficult to diagnose." She even said, "You graduated with good grades. How do you have ADHD?" Later she said, "There's no medication for ADHD, only for anxiety and depression."

Here are the responses to this post.

I would not trust any psychologist unaware of first-line treatments (stimulant medication) for ADHD.

My psychologist said that all of my symptoms are valid and are ADHD, but denied the existence of ADHD and just called it me being brilliant and easily distracted.

Since psychologists cannot prescribe meds in most states, I feel like some people who choose psychology/counseling as a profession may be prone to discount the importance and effectiveness of the medication.

My therapist recently told me I could not have ADHD because "everyone with ADHD fails their classes and drops out of school."

It makes me so angry to see a mental health person question how you can have ADHD and still get good grades.

Here is a scenario with an uninformed physician.

After a lifetime of arriving late, missing deadlines, and having friends call her a flake, Suzie wanted to know whether her chronic distraction meant she had attention-deficit/hyperactivity disorder, ADHD.

Over three visits with her managed-care plan doctor, Suzie completed urine and blood tests some doctors require to rule out drug abuse. Her physician checked her for any preexisting heart condition that might make stimulants risky, although recent research says this is no longer a concern.

Then came the last step: a telephone interview.

"What kind of student were you in elementary school?" the psychiatrist asked.

"I was an A student," Crawford answered.

"I'm sorry," he said, "You don't meet the qualification for ADHD, and we can't prescribe medication to treat it."

Here are responses to posts similar to this one.

You will meet many people dismissive of ADHD. Leave when a doctor does the same.

I asked the doctor about being tested for it during my physical exam. He said, "To be honest, I don't think you have ADHD," one minute after I met him for the first time.

I would not trust any arrogant person on anything, no matter what "training," "education," or "experience" they have. Arrogance means they choose what to believe and do not listen to others, making their education, training, and experience far less valuable than intended.

Doctors do not get to choose what conditions are actual.

Do you realize how demeaning it is to seek help, only to be told, "You can't have ADHD?"

The psychiatrist told me she does not think I have ADHD and that my symptoms result from depression. She said, “You wouldn't have been able to graduate from University if I had ADHD."

I am paying out of pocket for my mental health care and meds because the provider covered by my insurance did not think I had ADHD. After all, I was a good student in school, and he did not believe ADHD could manifest differently in women than men, and he had grown up with "severe ADHD" (and, by implication, knew all there was to know about it).

It is insane. The absolute audacity of doctors who think, "hmm, Here is a patient that undoubtedly spent years of their lives trying every medication and every combination in the book until they finally found one that worked, and it worked for a long time, but you know what? After talking to them for five minutes, I know better and should take them off everything they spent years trying to figure out because I assign a weird morality to certain medications."

I blame my psychiatrist for not taking me seriously.

The most common response to posts of unhappy diagnostic experiences is, "Find an experienced clinician." However, good luck with that.

How do you find experienced clinicians? Ask online. Ask someone with ADHD. Search online ADHD directories. None of these avenues seems to satisfy. (Watch for my article on the shortcomings of online ADHD Directories.)

If you do not find an experienced clinician, I recommend exploring telehealth services. They are less costly, more convenient, more available, and, I believe, can produce accurate adult ADHD diagnoses. Many people have used them and are well satisfied.

Do your research and ask questions:

• Do you provide a diagnosis and treatment for adult ADHD?

• Can you prescribe stimulants or only non-stimulant medications?

• Are you an approved provider in the state where I reside?

• What insurance companies cover your services? What percentage of the charges will they pay?

• Do you bill insurance, or will I need to?

• How much does an evaluation cost? What are the costs of follow-up appointments?

Years ago, Dr. Thomas Phelan said that most adults who think they have ADHD do. If you believe you have undiagnosed ADHD, don't give up. There is a clinician out there who will believe you and help you.

*This article may be freely copied and distributed.