Episode Transcript
Interviewer: For people who may suspect that they have attention deficit hyperactivity disorder, the path to recognizing it and diagnosing it in adulthood can often be filled with challenges. Today, we're uncovering some of the steps and the struggles and triumphs that are involved in getting diagnosed with adult ADHD.
We're joined by Doctor of Psychology Britt Holmes, with University of Utah Health and Huntsman Mental Health Institute and an expert in the field of ADHD assessment.
Now, Dr. Holmes, what are some of the key symptoms that a patient might be experiencing that might warrant further investigation and maybe even a diagnosis of ADHD?
Recognizing Adult ADHD Symptoms and Diagnosis
Dr. Holmes: For an adult with concern for ADHD, some of the most prominent symptoms will be things that the person experiences internally: becoming easily distracted, having trouble paying attention, having trouble following through with a task or activity, spacing out during a conversation.
Some may be more evident to others, like if you can't finish a task at work, for example, or you're very fidgety, or you interrupt other people or blurt things out.
If you're someone who may have noticed some of the problems with inattention or getting easily distracted yourself, or then if you also have others in your life who are noticing some of these outward signs, those may be situations to consider whether that is actually a disorder, a condition, or then the other question, is that a result of life stress or day-to-day situations where we may have more or less trouble with those things.
Diagnostic Process for Adult ADHD
Interviewer: So if a person or a listener maybe suspects they might have something like this, they're experiencing some of these symptoms, what is that journey to diagnosis? Where does it start, and how do you get to that final step?
Dr. Holmes: I think the first step is speaking with your doctor. If you already have a mental health provider, you're seeing a therapist, a psychiatrist, or a nurse practitioner, that is where I would start.
If not, I would start with a primary care doctor and say these are the symptoms that you notice or the things that are causing you challenges. Coming to your healthcare provider with a list of the symptoms you notice, when they're causing problems, what makes them better or worse, that's going to be really crucial information for them in helping determine, "Is this actually a disorder? Is there a life stress cause? Is this ADHD or is it something else?"
They'll also be considering things like the possibility of a sleep problem causing inattention. We all have more trouble paying attention when we haven't gotten a good night's sleep. If we're stressed about something, if we have pain, if we have a medical condition that's causing pain, that can make it very difficult to pay attention too.
And so considering those pieces will be very important for your doctor or therapist in exploring the possibility of ADHD.
They may have someone complete different checklists or forms that rate their symptoms. Often, it's on a scale of 1 to 4, how common the person experiences that.
Some of those may be asking questions about childhood. So it's really helpful if you can provide any information about whether you had these problems growing up.
Maybe you even have teachers who made comments to your parents and your parents can provide that information. "Yes, teachers were always saying that you had these difficulties, or you struggled in certain subjects because you couldn't pay attention." That is all very, very helpful to look at the possibility of ADHD and differentiate it from other conditions.
The final step that isn't always needed, but sometimes can be helpful, would be getting a formal assessment, doing neuropsychological tests that are aimed at looking at attention or memory, and your overall cognitive strengths and weaknesses.
It's not necessary for most people, and it does take a while to do. Often there are long waitlists, but in some cases, that's a necessary part to help determine if someone may have ADHD.
Common Barriers to Diagnosis: Misconceptions and Challenges
Interviewer: Got you. So you start your conversation with one of your providers and there are a lot of different steps. And again, you don't need that formal assessment necessarily.
But when you're trying to get a diagnosis as an adult, sometimes there can be misconceptions, challenges, and certain barriers that can stop a person from actually getting the diagnosis that could get them the help they need. What are some of these barriers and what are some of the ways we can maybe overcome them?
Dr. Holmes: I think the number one barrier is that there are providers who believe that certain tests or assessments are mandatory to make a diagnosis. It's a common misconception, but it can lead people to end up on a lengthy waitlist before they can get even a diagnosis, and then often they're waiting after that to get treatment.
I understand the hesitance of some providers. They don't want to prescribe certain medicines unless they're absolutely sure. Mental health providers, because they have more expertise in general, are going to feel more confident in a diagnosis without extra testing than a primary care provider.
Costs can be a factor. Some insurances will cover certain types of assessments or visits with your doctors, but not others. They may cover certain medications and not others for barriers to treatment.
Self-Advocacy and Seeking Second Opinions
Interviewer: As a patient, sometimes it feels strange when a doctor tells you one thing, but maybe your research says otherwise. I mean, what role does, say, self-advocacy kind of play when we are talking about getting the diagnosis and treatment that you need?
Dr. Holmes: I do think it's important to advocate for yourself as a patient in any situation in which you're feeling you have a problem and you may feel dismissed. Maybe the doctor isn't as familiar with adult ADHD. And so getting a second opinion in that case may be really helpful.
If a doctor doesn't feel that it's ADHD and it isn't, and that doctor is providing an accurate, comprehensive diagnosis, they're talking with you about all your symptoms, they're really hearing you try to sort through this, that doctor should also be explaining the reasoning.
And so if you feel that you are not getting kind of as much information about why the doctor does not think that this is ADHD, I think it's important to advocate for yourself and ask those questions to better understand.
Maybe the doctor is saying your depression is actually the cause of attention problems. Depression can mimic ADHD. We see fidgeting with depression sometimes. We see trouble concentrating. Anxiety, maybe your doctor says it's that you have anxiety. You have a different condition, and that's the root cause. I'd mentioned sleep. You have a sleep problem, something else.
But it's important for you to understand that reasoning, and so I would ask for that. Ultimately, if you feel what the doctor was explaining didn't make sense to you, or you felt that they maybe didn't actually hear all of the concerns that you had, maybe they didn't understand it the way you do, seeing a second provider to get a second opinion may be a good idea.
Post-Diagnosis: Exploring Treatment Options and Next Steps
Interviewer: So now the patient has got their diagnosis. What's next?
Dr. Holmes: I think it's very different for different people. Some people want to pursue some type of treatment. That might be consideration of medicines, and they would want to talk with their doctor, whether that's the primary care doctor or someone who's a psychiatric specialist, psychiatrist, or nurse practitioner.
Some people might be more interested in therapy to learn techniques to manage ADHD. That could be done one-on-one with a therapist or in a group, and that can be more helpful.
And I recommend thinking through those things or talking with a professional, even if someone wants to talk about medicine, because many of those strategies and techniques will be helpful even with a medicine that may also provide benefit.
For some people, the next step would be getting accommodations in school or work if needed. Maybe they don't want to do other types of interventions, but having that diagnosis then means that they're able to access more resources or more accommodations.
But I do think it's very dependent on the individual what feels best for them. How problematic is ADHD for that person in that stage of life? Maybe they only need certain interventions at certain times, so you have to kind of think through what would be most impactful for you and choose from those options to look at interventions.
Resources and Support for Adult ADHD
Interviewer: Now, for that adult who maybe is curious about getting a diagnosis, or maybe even someone who has just freshly, newly got their diagnosis, what resources or support is available for them to get more information?
Dr. Holmes: I would encourage people to focus on getting resources from places that are research-focused or based. So the National Institute of Health or the CDC has information both about the diagnosis of ADHD and some about treatment. I would say maybe less on treatment, but it's a good place to start. ADD.org also has fairly reliable information about ADHD and some ideas for interventions.
Many people look to social media for tips and tricks to manage ADHD. I definitely caution against relying too much on social media because there's misinformation out there. There's a lot of misinformation.
On the other hand, if you happen to see someone say, "I have ADHD and this works for me," and it's kind of a daily life hack that's not going to cause a problem for you to test drive, there's no reason not to. What works for one person might work for someone else. Just always take anything you see on social media with a grain of salt.