For example, the other day, I saw a patient, Ricardo*, whom I had been treating for the past two months for Adult ADHD. He was on the verge of tears out of happiness and relief. "I never thought I would ever get on my feet. I have been pushing and pushing for years with NO results. But, after I started on treatment, I suddenly feel like how other people must feel. I can read a newspaper and understand what I'm reading. I can focus on my work rather than getting distracted by my co-workers or looking at Facebook". I always thought I was just lazy. I just wish I had sought treatment sooner.
Ricardo is a 47 year-old real estate agent who has suspected ADHD since he was in college. He was ashamed to see a psychiatrist. However, his wife was becoming increasingly frustrated with him and insisted that he have an evaluation.
She knew that he was very intelligent, but he had changed careers four times over the past 15 years and his frenetic chaotic life was driving her insane. In addition, six months ago, he had been laid off due to a series of poor performance reviews.
Also, he often would be late to pick up their two children and would frequently forget appointments and wait to the last minute to do any projects. The daily life of the family was in shambles and his wife felt that she had three children instead of two. He would frequently spend hours surfing the internet or starting tasks but not completing them when he became distracted.
Ever since childhood, Ricardo had been called "the absent-minded professor". He would frequently forget or lose his homework. He often had trouble prioritizing what was important and was told repeatedly by teachers that he would "miss the forest for the trees". He often would daydream and feel in a fog and would become easily distracted by thoughts in his head or by external noises. His report cards always stated that he was a smart and great kid, but wasn't living up to his potential.
During our evaluation, he was on the verge of tears because he had tried so many tricks to try to get his life together. He felt ashamed at his repeated "failures" and worried about the affect it was having on his family.
It is so rewarding to help someone who has been suffering with Adult ADHD for years. It has a heritability rate of 87%. Only a small percentage of professionals feel confidently diagnosing Adult ADHD, and yet it is highly responsive to effective treatment. This is why I have a passion for treating people with Adult ADHD. It can make an enormous difference in an person's life.
I want to help you become more comfortable in assessing and diagnosing Adult ADHD because it make an impact with your patients. Below are five easy and effective steps for making a diagnosis.
5 Easy Steps for Diagnosing Adult ADHD
The proper diagnosis of Adult ADHD can be confusing and overwhelming; many of the symptoms overlap with other disorders and many of the symptoms are set along a wide spectrum. Additionally, most clinicians have not been extensively trained in the accurate diagnosis of Adult ADHD.
This is a brief and simple step-by-step guide to the diagnosis of Adult ADHD so that you can feel more confident in assigning the diagnosis and referring to a therapist and/or psychiatrist who specializes in the comprehensive treatment of Adult ADHD.
Step 1: Ask these key screening questions:
1. Do you have difficulty reading magazines, books, or maps?
2. Do you have a messy office or home?
3. Do you have trouble starting and/or completing projects?
4. Do you often feel mentally “foggy” or “in a haze”?
5. Do others say you tend to jump from topic to topic in conversation?
6. Have you received negative feedback, such as inconsistent performance, in your school or work reviews?
7. Have you had any or all of these problems since childhood?
8. Which family members, if any, have depression, anxiety, mood swings, or problems with attention and focus?
Step 2: Administer the ADHD Screening Exams called the ASRS v1.1 and the Epsworth inventory on all patients.
Step 3: Gather collaborative information:
Many young adults may try to receive a diagnosis of ADHD in order to get stimulant medications even when they do not have ADHD, so it is critical to review collaborative information whenever practical.
Assess past report cards and performance reviews for clues pointing toward ADHD.
Always speak to family members, whenever possible.
Step 4: Administer the Conners Test
This is the gold standard for inventories and is, in fact, superior to neuropsychiatric testing. The diagnosis of ADHD is a clinical diagnosis and does not require neuropsychiatric testing unless you are also evaluating for learning disabilities.
The Conners Test can be found at www.adhdwarehouse.com.
Step 5: Rule out medical or psychiatric disorders that can mimic or coexist with Adult ADHD:
There are many medical and psychiatric disorders that can mimic the symptoms of Adult ADHD. These are a few conditions that may exhibit similar symptoms:
3. Sleep apnea
6. Medications such as blood pressure medications and antibiotics
7. Multiple Sclerosis, seizures, HIV, head injuries
How do you distinguish these scenarios from Adult ADHD? After taking a detailed history, determine whether the symptoms began after early adolescence. If so, it is NOT ADHD. If the symptoms fluctuate, it is NOT ADHD.
It should be noted that in certain situations, such as menopause, depression, or chemotherapy, stimulants are commonly used and are effective for the treatment of poor focus and attention, distractibility, and low motivation.
Following these simple steps, you as a clinician can more effectively diagnosis and refer your patients who likely have Adult ADHD or present with similar symptoms. It is important that this provider has had specialized training in the diagnosis and treatment of Adult ADHD.
I hope this article has been helpful. Please feel free to contact me if you have any questions or comments.
Scott Shapiro, MD
Assistant Professor of Psychiatry
New York Medical College
Specializing in Adult ADHD,
Depression and Anxiety
Diplomate, Psychiatry and Neurology
Diplomate, Psychosomatic Medicine
286 Fifth Avenue, 10H
New York, NY 10010
* Details of patient case have been completely changed to protect confidentiality of patient.