What Makes ADHD Diagnosis and Treatment Challenging?

Written By Cynthia Hammer, MSW

Comments on Reddit from Dr. Stephen Faraone (www.adhdevidence.org)

When diagnosing a high performing person, the diagnostician should look for evidence that performance lags behind potential. For example, if a person has an IQ of 130 (i.e., is super smart) but is only performing a little above average, they seem to be doing OK, but could do much better. High performers with ADHD also find that it takes them much longer to complete tasks then their peers. Most importantly, the symptoms are the same. The diagnostician can usually recognize the symptoms but they don't count them as serious enough because the high performer does not seem to be impaired.  

Diagnosing ADHD based on neuropsychological testing alone is fraudulent. The only diagnostic tool for ADHD is a clinician who interviews the patient about their symptoms and impairments. Rating scales about symptoms and impairments can be helpful but don't replace an interview. 

There is no simple  rule that tells prescribers what will be the best medication and dose for each patient.  The only way to find out is by trial and error.  For adults, it is typical to start with an amphetamine, like Vyvanse, and to increase the dose until it is optimally effective without causing side effects.  If the patient doesn't respond well to the first medication the prescriber will try another stimulant or non-stimulant.  It can be frustrating for the patient but, because we don't have good predictors of  who responds well to what medication, it is currently best practice.

Cynthia Hammer, MSW

Cynthia Hammer, MSW, was diagnosed with inattentive ADHD in 1992 when she was 49 years old. The following year she created the non-profit organization, ADD Resources, with a mission to educate adults and helping professionals about ADHD in adults. She ran the organization for 15 years before retiring.

During the Covid isolation she wrote a book about her life with inattentive ADHD which should be published by the end of this year. In writing the book, she was dismayed to learn that children with inattentive ADHD continue to be under-diagnosed and adults with inattentive ADHD often are incorrectly diagnosed with depression or anxiety.

She created a new non-profit in 2021, the Inattentive ADHD Coalition (www.iadhd.org), to create more awareness about inattentive ADHD and the need for early diagnosis and treatment.

https://www.iadhd.org
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