- assessment means checking for ADHD symptoms
- we need to rule out any other diagnosis
- we need feedback from family, and in the case of kids, from teachers
Assessing whether someone has adhd is about a lot more than checking boxes. Not only does it involve looking for symptoms and assessing their severity and impact, it’s also about looking for other diagnoses that could confuse the assessment, or which must be dealt with before considering treatment for ADHD. It’s about looking at what is it costing the patient to not look like they are adhd and looking behind the mask of competence.
All this takes time. Normally I’m able to get a strong opinion in a one hour assessment, but sometimes several hours and repeated visits and corroborating evidence. Sometimes I’ll get it wrong till I hear from the partner. It’s common for doctors to not medicate on a first visit, no matter how much time is spent or how sure they are of the diagnosis, though I do tend to medicate if I’m confident in my assessment.
In children, I find feedback from teachers invaluable. If symptoms only exist in one part of life – home vs. school for example, then we need to dig deeper to see what’s going on. Is it helicopter parenting, or in fact ADHD parents who think this is all normal since they themselves are like this so it must be normal. On the other hand, symptoms only at school can be related to bullying, or autism spectrum, or just being incredibly shy or anxious. Symptoms only at home are more suggestive of a parent who isn’t coping. While it might be ADHD, it could well be relationship problems, alcoholism, depression or any number of reasons other than simply ADHD.
I’m going to be asking general questions like age and marital status, work, substance use, and previous experience with ADHD. I’ll want to know about any previous use of stimulants or antidepressants, any previous assessments and by whom, and any experiments with medication that were made, and with what.
We’ll look at anxiety and depression and especially look at how well you’re coping even if you do have adhd. Treatment isn’t about the diagnosis, it’s about the consequences of being ADHD- the worse the impact, the more inclined we are to recommend medication.
New patients will need to arrive 15 minutes early to register and may not have a definitive diagnosis at the end of the one hour appointment.
It really is helpful to have someone with you for an ADHD assessment. If you’re an adult, I find friends, room mates, partners and exes more helpful than parents unless you still live at home.
If there are any hints of bipolar disorder then we need to divert and settle that question before considering ADHD treatment. Many of my patients are what I’d call obcessive compulsive personality – neat freaks who like things just so and not messed with, and irritate others with all their rules, but it doesn’t interfere with the patient’s life. Occasionally though it’s severe enough that it does interfere with quality of life and that needs to be recognized.
If a patient presents with Autism spectrum, or what used to be called Aspergers syndrome, it doesn’t affect treatment of ADHD but can make the assessment more challenging.