Getting an ADHD Diagnosis: Why, Where, How?
Getting an ADHD diagnosis is rarely a cut and dry affair. Not only are there a number of health problems that can mimic the signs of ADHD, there is also confusion as to what constitutes a proper diagnosis. Here’s what you should know…
What adds Confusion to getting a Diagnosis?
To date (sept. 2013) there are no laboratory or imaging tests available to evaluate ADHD. In fact, there is no conclusive way to determine if someone actually has ADHD. Therefore the diagnostic process depends on each professional’s familiarity with ADHD symptoms and the different ways they manifest.
There are no specific qualifications required of a health care professional before they can make an ADHD diagnosis. However, there are restrictions as to who can officially diagnose ADHD – those qualified include physicians, clinical psychologists, neuropsychologists, educational psychologists, school psychologists and psychiatrists.
The Age Issue
As of the most recent DSM publishing date, current requirements state that ADHD symptoms must clearly manifest before age 12 (it had previously been set at age 7). However, some ADHD experts (i.e. Barkley and Brown) believe that in certain cases, signs of ADHD may not be noticeable until middle school, college or even later in adulthood.
This is primarily because parents can provide so much support that symptoms do not become obvious until later in life. In some cases, highly intelligent children are able to compensate for their ADHD behavior, masking the condition for years before any real difficulties appear.
Adding to the difficulty, ADHD symptoms are easily confused with signs of many other physical and mental health problems. These include thyroid disorders, bipolar disorder and hypoglycemia. In order to rule out other possible causes, a physical exam as well as a blood test are recommended.
In some cases, ADHD-like symptoms can be caused by lifestyle and/or dietary choices. Here are other possible, underlying reasons for ADHD-like symptoms to appear:
• chronic stress
• overconsumption of caffeine (coffee, energy drinks)
• food preservatives, colorings and aspartame
• sleep deprivation
Additional issues that could also be contributing to the problem are:
• over-exposure to technology (always being “online”)
• lack of quality family time
• lack of communication in the family
• and what Dr. David A. Sousa calls “School induced ADHD”
According to Dr. Sousa, today people are trained at an early age to reach out for information and actively participate in a continual learning process. The outdated school environment where we “sit down and listen” to a teacher is outdated and under stimulating for young people – we’re attempting to educate 21st century brains with 20th century teaching methods.
It’s clear that relating the onset of ADHD to age can lead to people falling between the cracks and missing a proper ADHD diagnosis. Another fact many health care professionals overlook is that girls (who often have the inattentive type of ADHD) and adults often don’t show overt signs of hyperactivity. In his book “Is it you, me or adult ADHD?”, Dr. Russel Barkley also mentions that you can have ADHD without any signs of impulsivity. Another contributor to the problem is the fact that impairments of executive functioning are often difficult to observe.
Co-existing conditions (aka comorbidities)
It’s the rule rather than the exception that if you have ADHD you have a 75% chance of having one or more co-morbid or co-existing conditions. The longer the patient lives with ADHD, the higher the chances of this happening, especially in adults.
In some cases the co-existing condition is treated while the cause of the problem – being ADHD – remains unaddressed.
Here’s a comprehensive List of ADHD comorbidities and associated problems.
Depending on where you live (US, Europe, Asia…), you may encounter increased difficulty getting an ADHD diagnosis. In Europe, for example, many countries are still in disagreement about the disorder and which criteria to apply for diagnosis.
An article in the Financial Times (May, 2013) stated that there is currently no specific ADHD diagnosis for adult ADHD in France, although there is more acceptance for the disorder in Northern European countries like Germany, Holland, Sweden and the UK.
Who Can I Turn To For a Proper ADHD Diagnosis?
You may have to do some research to find a qualified professional trained in diagnosing ADHD. Here are some tips on how to get started in your search:
Get recommendations: Ask around your personal and professional network – a good place to start is with your general physician, therapist, co-workers, friends etc… Chances are someone will be able to make a recommendation or point you in the right direction. Also check out the resources at the bottom of this page!
Ask questions and check your comfort level: Ask any and all specialists you find for their qualifications. Also, inquire about how many patients they’ve actually evaluated. Don’t forget that, when choosing a health care professional, it’s crucial for you to feel comfortable. If you don’t feel at ease or understood by this person, think twice before proceeding; follow your instinct.
What To Consider Before Getting An ADHD Diagnosis
Everyone has trouble focusing or getting organized at times. On their own, these typical ADHD symptoms can seem perfectly normal. So how do you know if it makes sense to get an ADHD diagnosis?
Do the symptoms have a significant negative impact on your life?
Many people experience ADHD symptoms on occasion. However, when you have ADHD, you are probably having serious difficulty managing the aspects of life that require proper executive functioning. These include:
Work: holding a job, successfully organizing, planning and executing tasks
School: difficulty following the rules, paying attention, finishing assignments, not performing up to your capacity, frequently changing schools
Home: difficulty managing and organizing household chores, financial planning, etc…
Relationships: difficulty communicating emotions and sustaining partnerships, getting upset easily, forgetting important commitments
Duration of symptoms?
This is another good way to gauge the likelihood of having ADHD. According to the DSM V, one needs to exhibit symptoms for a minimum of 6 months to be positively diagnosed. In my experience, those who genuinely have ADHD have likely been dealing with ADHD issues their entire lives.
Do you only experience difficulty in one particular area of your life?
Generally, for someone to have ADHD, symptoms must be present in multiple settings (work, home,…). If one only suffers within a single, isolated area of their lives, it is likely that there are other factors at play.
What does an ADHD diagnosis typically entail?
- a general physical and neurological exam to rule out any other causes for your symptoms (hypoglycemia, thyroid disorders, head injuries, …)
- a thorough interview where the evaluating professional asks questions about your symptoms including how long you’ve been experiencing them, when they started and how they exhibit themselves. You will also be asked questions about your life/family history. Sometimes partners, parents, and other family members are asked to participate in the inquiry. This is because ADHD often distorts recall and self observation.
- several questionnaires designed to rate the severity of your ADHD symptoms. These rating scales may include: WURS (Wender Utah Rating Scale), CARS (Conner Adult Rating Scale), BADDS (Brown Attention Deficit Disorder Scale), SASI (Self Assessment Symptom Inventory for girls).
- measurement of your symptoms according to the current criteria for ADHD in the DSM V.
- a Test Of Variables of Attention or T.O.V.A. (only given by some professionals). The T.O.V.A. takes about 20 minutes and is presented as a simple computer game. (I can’t testify personally as to how widely accepted this test is, but even though I live in Belgium and my sister lives in the US, we were both asked to perform this test as part of our ADHD diagnosis.)
- a Neuropsychiatric EEG Based Assessment Aid (NEBA). The FDA (US only) has recently approved a medical device that measures brain function to help assess ADHD. It is certainly not an infallible diagnostic tool – as some studies have revealed – but it can be part of a complete medical and psychological evaluation.
- in some cases, psychological tests are conducted to measure IQ as well as social and emotional adjustments.
- when diagnosing children, a psychologist may observe a child while he/she is at school. Teachers may also be requested to provide feedback.
After the ADHD Diagnosis?
For many people, it can be upsetting to find out that they’ve got ADHD. No one enjoys being labeled. Lets face it, being told that you have some sort of deficit or disorder isn’t really cause for celebration. On the other hand, it can be the first step towards a better life.
When I received my ADHD diagnosis, I actually felt relieved. As I proceeded to read up about the disorder and recognized myself in so many people’s stories, I began to see myself for the unique person I am. I didn’t feel so out of place anymore – and that was a good thing.
Going undiagnosed for years on end can have a detrimental effect on your self-esteem and your life in general. That’s why I personally believe it’s better to know what you’re dealing with than to postpone getting a diagnosis.
Also, receiving an ADHD diagnosis doesn’t mean you are doomed to a lifetime of suffering. Keep in mind that ADHD is a spectral disorder. For some people the symptoms are minor while for others they can be more severe. Whatever you do, never lose heart – despite the challenges you might face, there are plenty of things you can do to live a joy-filled, productive life!
There are many things you can do to introduce more balance into your system by better managing your ADHD symptoms. Besides all the other information on this site, here are some other ways to hit the road running:
Medication: There are several medications on the market that can help control ADHD symptoms. Although many people have benefited from taking medication, on its own it will not resolve your problems. It can, however, be part of a comprehensive strategy to manage and minimize your symptoms. I personally don’t advocate the use of medication – especially not in children – but this is ultimately a personal choice.
Support Groups: It can be quite uplifting to discover like-minded spirits. Support groups can be a way to help you feel less alone in your particular situation. Groups are the perfect place to share tips on how to better manage ADHD challenges.
Therapy: For some people there is still a stigma attached to seeing a therapist. However, if you have ADHD, especially when you’re diagnosed later in life, therapy will likely be an essential part of the healing process. Self-esteem issues can be particularly difficult to heal without the help of a professional. Some therapists specialize in cognitive behavioral therapy, a technique that helps people with ADHD change certain patterns of conduct through self-observation (alternatively, mindfulness can also help you with behavioral issues).
Information: Take some time to read up about the disorder. There are literally tons& of books on the subject… considering the fact that people with ADHD have difficulty making choices, that might not actually be such a good thing.
Coaching: If you can afford it, an ADHD coach can help you in many ways. Coaches of this sort are trained to help you de-clutter your life, get organized, crystalize your goals and more. Just a few sessions can already make a big difference in getting you on your way.