ADHD

How To Get an ADHD Diagnosis

If you are an adult who thinks you have ADHD or if you are the parent of a child who you think has ADHD, where do you begin? How do you go about getting a diagnosis?

Caveat: Because I live in the USA, this will be written from the perspective of someone using our medical system here in the US. If you live in a different country, you may have to go about getting your diagnosis in a different way.

First of all, look up ADHD symptoms online and write down every symptom that you or your child has. Check multiple web pages, because one webpage may only list hyperactive type or another might only focus on inattentive type.

If you or your child are female, I recommend looking for pages that list women’s and girl’s symptoms specifically, because the ADHD often manifests itself differently in women and girls who are much less likely to get a diagnosis than boys are.

Write down any and all symptoms.

If the list is for you, an adult, write down any symptoms you had as a child on a separate list. Ask an adult who knew you as a child, if possible. I was surprised to find that my mom remembered me having anxiety as a child when I did not remember, for example.

Go to your primary care doctor and request a physical –a full blood panel including thyroid– and a sleep test. You want to rule out other conditions that could be mimicking the ADHD before you pursue a diagnosis. I would also recommend food allergy testing as some ADHD people find that their symptoms go almost entirely away when they remove trigger foods from their diets. Unfortunately, our PCP refused to do allergy testing for me when I requested it.

I recommend at least thyroid blood tests even on children because many times thyroid problems in children go unaddressed because doctors assume they are too young for thyroid problems. That is a misnomer. Children can have thyroid problems, especially if endocrine problems run in their family. Many ADHD people –including children– have sleep problems which exasperate their ADHD symptoms.

If your bloodwork and sleep test come back normal, or if you are already medicated for a condition such a low thyroid or sleep apnea and are still experiencing ADHD symptoms, I recommend contacting a mental health professional.

Depending on your healthcare plan you may need to go to your primary care doctor first and get a referral to a psychologist. Call the psychologist before setting up the appointment to make sure that this doctor knows about ADHD.

Here is an unfortunate reality: even many mental health professionals do not understand ADHD and do not believe it is real.

ADHD is very complicated. For this reason, it is best if you do not see a primary care physician or a regular pediatrician for ADHD diagnosis and treatment.

Mental health professionals that I would recommend seeing for ADHD diagnosis:

  • Mental Health Nurse Practitioner
  • Psychologist
  • Psychiatrist
  • Developmental pediatrician
  • Neurologist

As I mentioned before, I recommend calling before you set up an appointment –even if it is with a referred doctor.

You want to find out what percent of the doctor’s clients have ADHD and what percent of the doctor’s clients are adults with ADHD.

The reason the percentage of adults matters is that –while children may have no choice as to where their parents take them for treatment– adults do have a choice. ADHD adults have a low tolerance for nonsense and are unlikely to tolerate subpar treatment. If they have adults with ADHD in their care, it is likely that the care will be better quality.

When you go in for the appointment, bring your list of symptoms that you made.

Here are some warning signs to watch for:

  • The doctor prescribes medication without a formal diagnosis.
  • The doctor doesn’t believe in ADHD and refuses to test you.
  • The doctor tries to give the computer-based child’s test to an adult.
  • The doctor refuses to test if the child isn’t struggling with his grades in school.
  • The doctor always only uses one kind of medication to treat ADHD and won’t even discuss other options.
  • The doctor refuses to test for ADHD because he blames the symptoms on the parent’s: parenting style, homeschooling, divorce, low income, etc.
  • The doctor patronizes or dismisses the parents’ concerns because he or she is the expert.
  • The doctor refuses to prescribe ADHD medication but will only give antidepressants.

(The last may be necessary with a young child, but it is common for a doctor to diagnose ADHD adults with depression instead of ADHD. The antidepressants just made me not care that my life was falling apart. It didn’t help my ADHD at all.)

The standard way to test for ADHD, in my experience, is via a set of questionnaires that are filled out by 3 adults in the child’s life –often the parents, a teacher, and an additional adult. If you homeschool, you can have one parent fill out one set, and the other parent the second. We had my children’s questionnaires filled out by one of their grandmothers, a Sunday school teacher, and me. Anyone who works with the child should be able to fill out the form.

Don’t listen to a doctor who says you cannot get a diagnosis if the child is homeschooled or that homeschool children do not have ADHD. That belief represents a misunderstanding of how ADHD works –the causes and severity of ADHD– and you do not need that kind of negativity. Get a new doctor.

Although each doctor has a different way that they go about diagnosis, since the paperwork style evaluation seems to be the most common, that is what I am describing. If you see a doctor who does brain scans and more detailed testing, that is awesome, too.

When you bring the paperwork back, the doctor will evaluate the results and usually interview the child. Our psychologist talked to our children while playing board games, so it was not stressful for the child at all. I recommend cognitive behavioral therapy, too, if you can find someone who really understands ADHD. It can be very helpful if you find someone who actually understands ADHD.

Regardless of how the results of the ADHD screening test come back –whether yes or no to the ADHD diagnosis– I recommend that you get a full psychological evaluation done next. Some doctors will allow you to skip the ADHD screening and go straight to a full psych eval. Other doctors will not.

If you suspected ADHD and the test came back negative, then what else is going on that made you think ADHD? Could it be bipolar? Oppositional Defiance Disorder? Something else? A full psych eval will tell you.

If you got a positive ADHD diagnosis, now you need to know what other mental health conditions the child has. 50% of people with ADHD have an additional psychiatric condition. Those conditions can significantly complicate the treatment of the ADHD even if you choose not to medicate. Either way –medication or not– you need to know what is going on so you can help your child or yourself.

A full psychological evaluation is worth every penny even if your insurance will not cover it. It could save you from tons of heartache later, such as when you try to medicate the ADHD with a stimulant and find your child in fetal position in the living room floor having panic attacks for hours or days and unable to function because he has a separate anxiety disorder that was just made significantly worse by a stimulant. This is a true story. This is why you need to know about the comorbidities.

Another example: if you have bipolar, going on a stimulant can send you manic –something you really don’t want to happen. Another reason for a full psych eval.

Maybe your child doesn’t have comorbidities, but you need to know for sure before pursuing treatment of any kind.

Dr. Russell Barkley explains (in the video series that I recommend every person with ADHD or parent of an ADHD child watch) that ADHD is a neurogenetic disorder –ie a genetic disorder affecting the brain. ADHD medication is a neurogenetic treatment. It fixes the problem cause in the brain by the genetics.

Since ADHD is genetic, there is a genetic test –called Genesite— available which will tell you based on your genetics which medication will work to treat your ADHD. I wish such a thing had been available when my children were trying medications! The cost varies based on what percentage your insurance will pay. I have heard prices from free all the way up to $350. But, it is definitely worth asking your doctor about.

If you have a child with ADHD, do not be surprised if the doctor wishes to evaluate you and the child’s other parent as well. ADHD is genetic and runs in families. This means that there is a high probability that you or the other parent have ADHD. Since 20% of adults with ADHD do not get diagnosed and treated, doctors try to make sure the parents have access to answers. Also, 50% of people with ADHD who take ADHD medications are able to function like a completely neurotypical person, and 80% see improvement in their condition. According to Dr. Barkley, ADHD is the most treatable condition in psychiatry. The doctor would be remiss in his duties if he didn’t at least bring it to the attention of the potentially-ADHD parent(s).

Medication for ADHD is tricky –especially when comorbidities are involved. This is why a trained mental health professional and not just a general practitioner is so important. Dosing medications, knowing side effects, and having experience with multiple medications and how they interact are all things that you get when you opt for a mental health professional.

It is unreasonable to expect your primary care physician to stay up-to-date on all the various special conditions that his clients have. He undoubtedly does not have the time to dedicate to educating himself on the complexities of ADHD in addition to all his other duties as a doctor. It is really unfair to expect him to –this is why we have specialists like mental health professionals. I do know some people who have had good luck with primary care physicians, but these are usually people who have only ADHD and no comorbidities.

How complicated is ADHD to treat by itself? Well, one researcher proposed that ADHD should be divided into different categories based on how the executive function issues affect the person with ADHD. He came up with 36 different kinds of ADHD based on the different executive function deficits. His proposal was rejected because of its complexity, but it goes to show how complicated and varied ADHD is. This is why one medication will not work for everyone with ADHD and why one medication works great for one person but will not work for another.

You need to be treated by someone who understands the complexity of ADHD –not someone who thinks all ADHD people look like Tigger from Winnie the Pooh (yes, a doctor actually told me that).

When you begin medication, you can use this chart to evaluate your child’s symptoms and see if the symptoms have improved on the medication.

Never hesitate to fire a doctor who will not listen to you, dismisses you, belittles you, ignores your or otherwise marginalizes your opinions. If you are the parent, you should not be treated like you are not important. If you are the patient, you know yourself better than anyone else. Don’t let an arrogant doctor undermine your confidence.

The first mental health nurse practitioner we saw for our children was a nightmare. She treated me like I was an idiot –the patronizing should have been a warning to me (but she came highly recommended). She only used one medication to treat children and wouldn’t even consider any other options. She refused to treat my children’s comorbidities even though we had the results of a full psych eval showing that there were other conditions which needed to be treated. It was horrible, and some of the worst few days of my entire life were while he was on that medication that she claimed: “always worked for ADHD.”

I fired her and found a new doctor. It was the best choice I could have made –I wish I had made it the first time I had doubts about her. My son’s experience on that medication was so traumatic that he actually blocked them out and has no memory of them.

Advocate for yourself.

Advocate for your child.

And don’t stop advocating until you get the answers you are looking for and the treatment you need.

Keep looking for a doctor who will listen to you. I went through six doctors in about five years trying to find someone who would just diagnose me with adult ADHD. I have no regrets about firing doctors and moving on to the next until I found someone who actually knew how to diagnose ADHD in adults.

The diagnosis was life-changing even though I am not medicated. Just understanding that my brain is different has been so impactful in my life that I lack the words to accurately articulate it.

I am not broken.

It is not my fault.

I have a unique brain that works differently –and I have discovered that along with that different, abnormal, unconventional brain comes beauty that I couldn’t see until I stopped shaming myself for all the things I thought I should be but couldn’t.

I found answers to questions I had been asking my whole life.

I found beauty in the ashes.

Blessings,

Sarah Forbes

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