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In my March 2014 blog, I mentioned some of the problems related to accurately diagnosing an adult with ADHD. These included clinician biases, imperfect patient recall of symptoms and problems in the far and recent past, and lack of recognition about other psychological and medical problems that might look like ADHD. My suggestions were for clinicians to become more knowledgeable and familiar with adult ADHD, and for patients to undergo detailed assessment to confirm (or not) a diagnosis of ADHD, as well other frequently co-occurring problems, such as depression, anxiety, and learning disabilities.
In this blog I will look more at assessment methods that are used to help determine if someone might have ADHD. Assessment for ADHD may be done from a variety of perspectives and schools of thought, such as clinical psychology, neuropsychology, developmental psychology, and psychoeducation. Each of these bring strengths to the table, and my own personal approach comes from neuropsychology. However, the suggestions I make here are not about these approaches and disciplines within psychology; rather, they are general guidelines and points to consider when getting evaluated for possible adult ADHD.
Some Suggestions When Getting Assessed for Adult ADHD
The following suggestions are general in nature. They are offered as points to consider when getting evaluated for ADHD, but are not by themselves laws or mandates. When looking for an evaluation for adult ADHD, ask about the following:
How Detailed is the Interview? A clinical interview for possible adult ADHD should be fairly detailed and comprehensive, since it is a complicated developmental disorder and it often occurs along with other problems and challenges. In particular, a history of past educational experiences, childhood development, and more recent occupational and relationship functioning should be explored. A complete medical and psychiatric history should also be fully obtained, as a number of other disorders frequently occur with ADHD, or can mimic the symptoms of adult ADHD.
Is Collateral Information Collected? Clinicians typically rely heavily on self-report from their patients. This has its advantages and its disadvantages. To obtain a more complete history, it is usually helpful to get additional or collateral information from other sources. This is especially true for adult ADHD, since much of the information involved requires recollection of past events. Secondary information from knowledgeable others (parents, romantic partners, friends, etc.) can be invaluable to the assessment process. Moreover, prior documentation such as old grade and high school report cards, previous standardized test scores, and other documents are frequently helpful when available for clinicians to review.
Are Specific DSM-5 Criteria Met or Not Met for the Diagnosis? Although the DSM-5 criteria have been criticized, and they rely on self-report, they still constitute a core consensus of how most mental health providers define ADHD. This is important if we are going to agree on what specifically ADHD in adults is and is not. The DSM-5 criteria for ADHD should therefore be screened during the evaluation process in either a written or verbal format.
Is There a Full Assessment of Other Possible or Co-occurring Conditions? Because ADHD so often occurs along with other challenges (learning disabilities, OCD, tic disorders, depression, anxiety, sensory processing issues), and because some of its symptoms can closely resemble those of other neurological and psychiatric conditions (head trauma, thyroid dysfunction, diabetes, sleep apnea), assessing for ADHD is really examining for a diagnosis of exclusion. In other words, other conditions that often occur with ADHD or that look like ADHD should be either ruled out or identified in the evaluation through a detailed interview, collateral information, and standardized tests. This is crucial not only for an accurate diagnosis but to develop the best possible treatment plan.
Are Cognitive and Personality Tests Given for Supporting Evidence? Unlike intellectual disability (formerly called mental retardation) or Alzheimer’s disease, cognitive tests and specific test patterns are not core diagnostic components of adult ADHD. However, certain cognitive domains do reliably tend to be negatively impacted by ADHD in adults. The administration of a range of cognitive tests is therefore helpful in providing objective data for the presence or absence of ADHD in an adult, separate from self-report and collateral information. Additionally, personality assessment can help document the impact of ADHD on the individual, if other diagnoses might be present along with ADHD, or if another diagnosis can better explain the person’s ADHD-like symptoms.
Is A Comprehensive Treatment Plan Provided? In some ways, this is really the most important question of all. Given the assessment itself was accurate, what can be done about it? Walking away with a new label and a store-bought self-help book is not particularly beneficial for most people seeking professional help. In reality, the patient, as a healthcare consumer, deserves a comprehensive and achievable plan of action to address all of the problems and conditions identified in the evaluation, to the extent that they can be addressed. This might mean medication, therapy, social skills training, support groups, education about the disorders, family interventions, couples work, and/or many other helpful or established methods of intervention available in their community. The treatment plan will of course depend on the problem(s) that have been identified in the evaluation, but all problems should be addressed in some way in the treatment plan for it to be maximally helpful to the person seeking the evaluation.
