What is ADD diagnosis / testing like as an adult?

August 24, 2012 6:56 AM

Did you go through diagnosis / testing for ADD as an adult? Please tell me about your experience.

Background: certified public accountant out of grad school for 5 years, lost two jobs due to performance issues. Wife of 12 years has long suspected ADD issues, but general care doc said ADD isn't a thing, so I failed to peruse anything. I have a new job, but struggling. The self testing (of which I am very suspect) available leads me to believe I at least should seek evaluation.

I'm worried that I will be labeled as a drug seeker, although I don't have any history of drug use or abuse. My first appointment will be sometime mid September through the mental health unit of a nearby hospital, and any treatment will include ongoing therapy.

What was the diagnosis process like?

Did the diagnosis and treatment have a positive impact on your life?

posted by anonymous to health & fitness (20 answers total)

I didn't have the expensive battery of exams that some of my friends had. I just went to a psychiatrist, he asked me a few questions, had me do a questionnaire, and I left with a prescription for ADHD meds. As far as watershed moments in my life taking me from struggling flaneur to constructive member of society, this was the big one.

(Your general care doctor is an idiot.)
posted by A god with hooves, a god with horns at 6:59 AM on August 24, 2012 [5 favorites]

Yeah, I went to my GP, we talked for maybe 10 minutes, he agreed with my own assessment, and he prescribed me a low dose of adderall.

So far, yeah, it's made a huge difference in my ability to juggle job, new baby, social life, etc.
posted by Oktober at 7:19 AM on August 24, 2012 [1 favorite]

I'm glad you're getting real tests. I think just about everyone on Earth could self-diagnose themselves with ADD but most have no real idea what it's like.

In my 30s I went through a serious of tests from a neuropsychologist (I think that's what she was) who diagnosed me. If I recall the tests were a combination of reading and logic tests. She also found I had a slight reading disability, which surprised me.

From there I then went to a psychiatrist who attempted to find the right dosage and meds for me. After a couple years on and off of trying various meds, none of which had any noticeable effect on me (other than annoying side-effects like restless legs) I stopped taking meds altogether. Don't get me wrong, meds are life-changing for a lot of people, they just didn't really seem to work on me. Coffee doesn't really do much to me either.

Even though I don't take anything and I'm still somewhat scatter-brained, getting an honest-to-god diagnosis was a big thing. I now *know* I need to write everything down. I *know* why I do things a certain way. I *know* why I am the way I am and I make adjustments in my behavior because of it. I also see similar things in my son so it has helped my wife and I understand how to work with him so that he doesn't fall into the same habits I fell into.

It's just nice to know.

Also, you should totally find another PCP. ADD is most certainly a thing.
posted by bondcliff at 7:21 AM on August 24, 2012

You might find some of these previous questions helpful.

No decent doctor is going to label you a drug seeker if you come in and honestly describe your symptoms, your treatment history (or lack thereof), and your therapeutic goals. Doctors understand that, while some people do abuse stimulants, there are a lot of people who need them simply to function normally. Just be honest. In fact, you can tell your doctor about any fears you have about taking medication or about building a relationship of trust with medical professionals. That's part of what they're for. And if, for whatever reason, the first doctor you see doesn't give you meaningful help, you're absolutely entitled to seek out someone else who will.

I did do a full battery of psychological tests as an adult. They asked me a lot of questions, and I did the Rorschach inkblot interpretation, and I put together puzzles. It was actually sort of fun, although it took a long time. And the results of the tests, combined with subsequent treatment, were genuinely useful to me in learning more about myself and how to improve my quality of life.
posted by decathecting at 7:51 AM on August 24, 2012

Look, okay, if you are anything like me, you will never quite know if ADHD is a perfect, spot-on diagnosis for you, or if you are actually just, say, a product of your parents, or a product of the internet, or if Sesame Street when we were kids was just way too disjointed and it messed up our minds.

I think it comes down to this: When you ask yourself if you have ADD, are you asking yourself a big existential question, or are you asking yourself how you can get more shit done and considering medication as an aid to other things in life that you can do to increase productivity?

For some people, it's the former, and that's completely reasonable. bondcliff's answer is the right answer, in that case, because for some people it matters a whole lot that you know as well as you can whether you have a brain chemistry problem that makes you unable to get shit done or whether it's something else about you that you need to work really hard on to change.

For other people, like me, it's purely a practical issue. I have learned to let go of the worry about whether or not I REALLY ought to be taking Rtalin, I have learned to ignore all of the opinionated people of the world that think ADD is really just what lazy people use to excuse themselves from accomplishing things, and all of the fear mongering about the medicine I'm taking. I take it, I get a whole lot more done. I started taking it, it revolutionized my life. I stop taking it, and I lose whole afternoons to a weird time fog (and I don't just mean right after I stop taking it, for those who argue that it makes you dependent). I used to lose whole days to that weird time fog. If I take my medicine, I do not do that. I might lose an hour or two (and then have to struggle not to jump into a pit of self-recrimination), but I get back on track without it taking a week.

I don't care if it's psychosomatic. I don't care if I occasionally get a headache if I forget to take it (and I do, but it's gone in an hour or two and I can basically stop taking it when I want). I do care that it has made getting shit done easier. I can focus! I have better conversations with people because I can pay attention to them! I can get through whole homework assignments in a reasonable amount of time without crying (except when the subject is really hard, but that's an obvious insecurity thing)!

My psychiatrist feels that the best way to diagnose ADD is to start the medicine and see if it helps without causing jitters. Other people say it's a stimulant and that anybody would benefit. I don't know, don't care. It's awesome.

However, I am in therapy, and I also spent years and years and years working on my productivity in various ways before I started taking medication for ADHD. I had done tons of self-improvement and had hit a wall. That's why I finally agreed with a therapist who recommended it to me, though even then, it took me months to get on board. Which is to say, I understand the hesitation, and I agree with the need for therapy, but gosh, there is no need to make this a big deal.

(Mind you, I'd have a lot more qualms if it was my kid, because my kid is tiny and his brain and body are still growing. But that's not the question. I just want to make sure it's clear that I'm usually a big old skeptic about this sort of thing.)
posted by hought20 at 7:55 AM on August 24, 2012 [5 favorites]

Well, technically ADD as a diagnostic term is no longer a thing, it's now under ADHD - inattentive type in the DSM.

Personally, I mentioned to my GP that I thought I might have the inattentive type. He referred me to a psychiatrist, who then had me and some people close to me fill out a couple of questionnaires and had me get an EEG to make sure there wasn't any kind of heart risk due to the stimulants. Changed my life, for sure.
posted by ndfine at 7:57 AM on August 24, 2012

I was diagnosed as a teenager, so my experience was probably different. However, you will probably be sent for some bloodwork as well, to rule out anything else that could be causing those symptoms. I was also sent for an EKG since I was prescribed stimulants.
posted by inertia at 7:58 AM on August 24, 2012

I got ADHD testing as an adult and eventually was diagnosed as not having ADHD. It was a long drawn out affair -- I believe it cost about $1000 that my insurance picked up (I only had to pay the $10 copay). There was an initial appointment, then the day long appointment for tests, and finally another appointment.

I actually enjoyed the tests -- they were a lot like IQ tests with a variety of different types of testing. There were parts where I had to come up with words, or add sequences of numbers in my head with various distractors, some computer based tests. It was quite interesting and I really liked the psychiatrist I had.

At the end he basically advised against medication, saying that he thought I was borderline but that I was very very intelligent and should be able to make up for any deficiencies I had in attention because of my intelligence.

I was actually leaning towards not taking medication at this point myself -- I had had a scary experience with Wellbutrin a few months ago (just as I was scheduling the appointment for ADHD testing) and had decided that I wanted to leave my brain chemistry well alone. So it's possible that if I had pressed for drugs more he may have decided to prescribe me some drugs. But a year or so on I'm pretty glad I didn't take the Adderall or Ritalin -- I do still get distracted, but I have developed coping strategies to manage and as someone who studies neuroscience for a living I truly don't think we have the knowledge of what exactly different chemicals and drugs do to our brain for me to personally be comfortable taking ADHD medication.
posted by peacheater at 9:31 AM on August 24, 2012

I was diagnosed twice -- once through an investigational study for a medication (I believe it was Strattera) and again about five years later through a battery of tests with a neuropsychologist. I have ADHD - inattentive type. I am currently not on ADD medication for various reasons, but when I was, I used Vyvanse, which is a controlled substance.

The executive summary here is that no, they will not treat you like a junkie. There are several medications, such as Strattera and others, that are not classified as controlled substances. Even for the stimulants, getting a paper prescription can be a bit of a pain (especially if you, um, have ADD and have trouble remembering such things), but it's not horrible. My doctor has said things like, "You're clearly a low risk for dependence/abuse, and I know you well now, so I'll just send three months' worth to the pharmacy so you can pick them up at once." (I can't do that now, because I'm on a different med, but it was a nice thought.)

So here's the very, very long description of how I got diagnosed.

The first time:
I answered an ad in the paper that said things like, "Are you absent-minded? Do you find it hard to concentrate on some things but focus intently on others? Do you fidget a lot?" (Even as I type this, I'm bouncing both of my legs. It feels GREAT.)

When I went in, they did a lot of face-to-face questionnaires, basically asking the same type of questions as the ad but in more detail. One I remember is "Do you feel like you are constantly moving, as if driven by a motor?" I didn't really get how I might explain that one. I'm a total sloth, but I fidget like crazy.

Another test they did involved showing me a list of colored color names -- so, for example, the entire page had columns of words like RED BLUE GREEN RED GREEN RED RED BLUE GREEN BLUE. But the colors of the words did not correspond to the words themselves; the word RED might be printed in blue, and so on. They'd have me run down the list and tell them the word, or the color, one after another. And then they'd have me do it backwards. Oy.

I also gave them permission to contact my mom. Part of this was because they wanted to know how I'd been when I was a kid; they may have also wanted to hear about my behavior today from someone who knows me.

(You might want to be a little careful here, because I'm pretty sure both of my parents, who are nuts, have a touch of ADD themselves. So my mom would constantly say things like, "But your behavior is what I'd call normal!" and it was hard to tell if that was just her being a doof, or honestly denying that I have reasons for doing what I do, or what.)

Because it was a study, they'd do similar tests every time I came in to measure how well the medication (or the placebo; it was double-blind) was working.

That was in 2003. I don't know if the difference in testing was because they had new methods or just did things differently, period, but in 2008 I got a full workup through a neuropsychologist who worked in the same office as my therapist.

So... the second time:
I came into the office in the morning and brought a guy I'd been dating for a year (we'd recently broken up, but he agreed to come anyway). I also gave the clinician permission to contact my mom, again for confirmation of what I was like as a kid as well as how I acted today.

The clinician would ask me questions (things like, "How often do you feel antsy" or whatever) and then turn to my ex, who ostensibly had been fairly close to me and could comment on my behavior, and ask him similar questions (e.g., "How often have you noticed her being antsy?").

That took about half an hour or so. Then they took me into another room and started with the tests. The person administering the tests was different from the neuropsychologist. He was basically just there to observe and report. The room was comfortable but slightly dim.

They started with this thing where you stare at a computer screen and wait to see where a little blip of a box shows up. You didn't know when it would happen, so you had to pay attention. If the blip showed up inside a larger box, you pressed a button; if it was outside the larger box, you did nothing. (Might have been the other way around... whatever.) The test went on for 20 minutes and was excruciating :P

Here's the really wacky part. After about five minutes, I was practically falling asleep because it was so low-key. I couldn't concentrate to save my life. I asked the tester if he'd mind if I hummed or sang or did something. "Do whatever you feel comfortable doing," he said.

So I started humming and la-la-la-ing some Bach (B Minor Mass and Cello Suites) with a lot of notes, because it is methodical and has patterns and generally keeps going. Things got less awful. Later in the day, when they showed me the graph of how I had performed, the results had basically flatlined for the first five minutes of the test, until I had started singing. Then they were... not entirely normal, but not awful. Score one for keeping your brain busy.

The next test... this was embarrassingly hilarious. He sat me down at a small table and said, "I'm going to ask you to come up with as many words as possible within a minute that start with a particular letter. Ready? The letter is F. Go."

By this point my brain was mush from trying so hard to concentrate. I felt almost stoned. I reverted to my lizard brain and said, "Fart. Fly." I looked around the room and couldn't find anything to inspire me. Then I said, "I really, really apologize, here, but I have to say it: Fuck." And then... this was the worst part. I thought of the word "faggot," but I really, really, really, really, really didn't want to say it. So I argued with myself, sometimes out loud, over whether or not to say it. Finally I said, "And now I REALLY apologize, because this is a terrible, terrible word, but: Faggot. It starts with F." Annnd... that was it.

There were some other tests, like... maybe? arranging things and adding and subtracting, but that was it. The testing took most of the morning.

So a few hours later I came back and sat down with the neuropsychologist to discuss the results. I was apparently smack in the middle of the spectrum, with an "oh, yeah, you sure do have it." And then we discussed my life a bit -- the kinds of coping mechanisms I used, my past experiences with medication (if any), how my depression and/or anxiety fits into this picture (I don't really have anxiety, per se, but with ADD there is just SO MUCH coping, etc. that you have to deal with, as I'm sure you know).

And then we took that information and set up an appointment with a psychiatrist, and I see her every 6 months or so. The Vyvanse prescription, which needs a paper renewal every month, is available at the front desk without a visit.

TL;DR

Whew! If you have any other questions, please feel free to contact me at any time.
posted by Madamina at 9:38 AM on August 24, 2012 [6 favorites]

general care doc said ADD isn't a thing

You doctor is incompetent.

Get a new one, and ask that one for a referral to an ADHD specialist.

My diagnosis required documented evidence of symptoms going all the way back to early childhood. (I knew those elementary school report cards would come in handy for something! Score one for the hoarder.) Other than that, it's just questionnaires.
posted by Sys Rq at 9:42 AM on August 24, 2012

I'm worried that I will be labeled as a drug seeker, although I don't have any history of drug use or abuse.

I had this fear in a big big way. (I knew some recovering meth addicts back home, which didn't really help any with the worry -- my whole frame of reference for stimulant medications was based around "this is illegal and awful and they will bust you.") But so I was really just flabbergasted by how not-worried my psychiatrist was about the whole thing. And how not-badly they treat me at the pharmacy when I fill my prescription. And how not-nasty about it the nice call center dudes at my insurance company are. And so on.

I've done all sorts of sketchy shit too. Requested 3 months' supply all at once because I was leaving the country. Lost pills in a bag I left on a train and had to ask for a fresh prescription in the middle of a month. Shown up at the office covered in sweat because I sprinted there to pick up a prescription at the last minute rather than wait until tomorrow. Each time in the back of my head I'm going "Okay, this is gonna be the time he calls the cops on me." Nope.

Even when you're taking a Schedule II drug, you've got a right for your medical professionals to treat you, you know, professionally. They should be keeping a close eye on your symptoms and side effects and dosage and all that. They shouldn't be acting like extras in a cop drama. If you end up with a doctor who treats you like scum because you ask "What if I have ADHD," that's not standard practice, you just ended up with an asshole doctor -- find a new one.
posted by nebulawindphone at 10:13 AM on August 24, 2012

I sought out a diagnosis in my early 30s. Like you, I was skeptical of self-diagnosing and worried about seeming like a drug-seeker, but I had read that epic AskMe about ADHD and it was like reading not just a biography, but, like, the secret code that explained my life.

So I talked to my GP about it, which made me even more nervous, because it was actually my first time seeing her (I had recently moved). Anyway, she said she was happy to prescribe me something, but that she needed a diagnosis first, and referred me to a psychologist.

I spent about 3-4 hours with the psychologist over two sessions. In the first session, he asked me a battery of questions about my life and habits from childhood on. The questions were mostly ADHD related, but there were some anxiety and depression-related questions, because both of those conditions can present with ADHD-like symptoms (there's also a high rate of comorbidity).

At the first session, he gave me a questionnaire to be filled out by my mother (to determine if my symptoms had been present before age 6) and a non-related acquaintance (I guess to make sure it wasn't just all in my head). Incidentally, when I told my mother about this, she was like "you're fine!" But then after she did some more research, she was like "oh, yes, I can see how you have ADHD."

At the second session, he asked me some more questions and then gave me the Continuous Performance Test, a computer test to measure sustained attention (I think). At the end of the second session, he told me he thought I had a moderate case and could probably be helped by some sort of treatment.

After that, I went back to my GP and she prescribed me the lowest dose of Ritalin to see how it went. I've pretty much stuck with that regimen for the last 2 years, although now I'm on the lowest dose of Concerta (slow-release ritalin).

And yes, the diagnosis and treatment had a hugely positive impact on my life. First, it was such a relief to have a scientific explanation for things that had previously seemed like personal failings. And ritalin has just been really, really amazing for me. The impact was not dramatic at first, but it's helped in subtle ways that have added up to a huge improvement in my quality of life. My finances are on track after being a mess for years, I'm able to keep a reasonably clean house (though it's a mess now - it didn't make me perfect!), and my career has completely taken off in the last 2 years.

If you think you might have ADHD, it really doesn't hurt to get screened.
posted by lunasol at 11:09 AM on August 24, 2012 [1 favorite]

Oh, and: did your primary care physician really say ADHD doesn't exist? If so, that's insane. Time for a new doc.
posted by lunasol at 11:14 AM on August 24, 2012

I self-diagnosed. My psychiatrist said he was concerned that meds might exacerbate my anxiety. I told him how once in the past I had tried Adderal and it didn't make me anxious, that in fact it made me less anxious about doing things wrong. He wrote me a prescription.

At some point I thought I could transfer all of that to my GP and it might be cheaper/easier. Despite having my records transferred over, my GP (as she, or her occasional sub ALWAYS do) treated me like a drug-seeking addict and grilled me hard and said a lot of judge-y things. She said her goal was to get me off of any meds within a month. They also made me take a urinalysis which I thought was just for general health but then they called me later to tell me how I wasn't on drugs! They failed to respond to my concerns that I did not consent to be tested for drugs.

This had happened in the past with my GP. I went in for anxiety around flying, which I was doing a lot, like 2-4 times per month. They wrote me a prescription for the lowest dosage of Xanax, and only FOUR pills, and said if I needed more they would need me to meet with an addiction counselor.

Also, the office visit cost (with insurance) about 4x what my already expensive psychiatrist cost (without insurance).

So that was the last time I went to my GP. I just see my psychiatrist every other month or so and he will mail me a prescription if I run out in between.

So be careful and don't be discouraged if you do get tarred as drug-seeking by one doctor.
posted by MonsieurBon at 11:20 AM on August 24, 2012

I was seeing a counselor for some of the same issues you mention and she suggested that a big part of my struggle with procrastination and focus could be due to ADD.

I went to a psychiatrist who asked me a series of questions and gave me a prescription for Adderall that day. It has made a huge difference in my focus and productivity. She basically wanted to know about my history in regards to certain things like planning, time management, procrastination, focus and so on. I started off on a low dose and gradually upped.

Part of my evaluation included some questions about my history of drug use as well as my family history of addictive behaviors. Oddly enough, even though I don't smoke and rarely drink, she mentioned that because my father had a drinking problem, she would have to monitor me for signs of addiction. No real issues there so far. The psychiatrist checked in with me to make sure I wasn't having jitters, insomnia or anxiety from the Adderall. She also warned me that since the prescriptions had to be hand-written & delivered to the pharmacy in person, I had to report any loss or theft of prescription slips to the police.

Doctors may have varying levels of caution when it comes to prescribing ADD drugs, but I haven't encountered any resistance or been labeled as a drug-seeker (yet).

Oh, I should mention that I found this psychiatrist by calling my insurance company and asking for a referral to a psychiatrist that could evaluate me for ADD. You can definitely find someone more open to your input than your current GP.
posted by Kitty Stardust at 11:34 AM on August 24, 2012

i was diagnosed through a strattera study, too (possibly the same one as madamina). one thing i'll add that i didn't see through skimming the above is that an important part of the criteria for diagnosis in the study involved my behavior prior to age 6, as best as i could remember. ADHD is considered a developmental disease, meaning that most kids develop abilities to sit still and focus at a certain age, while those with ADHD don't, and so true ADHD is present from childhood. however, i couldn't remember age 6 with enough detail to answer most of the questions, and from what i did remember, my desire to please adults vastly overpowered any restlessness, hyperactivity, or inattention. (i suspect this is the case for many girls, in particular.) so i made up the answers they wanted to hear in order to qualify for the study.

strattera did seem to help me, but it also made me feel a bit robotic/less creative and made it hard to sleep. i tried adderal, but it made me extremely irritable. these days i am unmedicated, but having the dx does help me frame my problems with disorganization and time management in more useful ways that before.
posted by nevers at 11:55 AM on August 24, 2012

I was part of a clinical trial at UCLA, nearly 25 years ago. I did have ADD, didn't do anything about it, and got re-tested when my son was diagnosed. Changed my life. The first time around was very much like being a lab rat--cognition tests, driving around LA with and without maps, all sorts of stuff. Second time around, neurologist asked me some questions and made the diagnosis. Well worth the time and money, I think.
posted by Ideefixe at 1:09 PM on August 24, 2012

Quick tip: when contacting an expert to help you solve a problem, it is best and most respectful to couch it in terms of the problems you are having.
posted by gjc at 5:58 PM on August 24, 2012

I was diagnosed in January of this year (I am in my mid-thirties). I had tossed around the idea of getting tested for a couple of years before I committed. What finally motivated me to do so was, after years of jobs that bored me to tears (in an effort to keep my brain from exploding), I stumbled into a wonderful, but demanding job, and was mentally hanging on by my fingertips.

Anyway, my testing appointment was with a psychologist, and it lasted for a couple of hours. We talked about what had motivated me to get tested, family history, what school had been like, what work was like. The main thrust of her questions was to determine whether or not my perceived ADHD was negatively affecting my life. Then I had to fill out several questionnaires, which mainly consisted of how often certain feelings or behaviors cropped up in my everyday existence.

I went back about two weeks later and we discussed my diagnosis of severe ADHD. The immediate feeling was profound relief. While all this time I had thought I was a human being who was too lazy to properly get my shit together, there was actually a real problem, a treatable problem, at the bottom of it.

I saw a psychiatrist (well, still do) and am currently taking Adderall, as well as seeing a counselor once a week. Surprisingly, spending years thinking of yourself as a human being defined by a permanent inability to get their shit together is not the most positive mode of existence.

Treatment is amazing. No, things aren't perfect, squirrel brain happens, but the ability to say, "Hey, I need to get X done," and then immediately sitting down and DOING IT is still the best thing ever.
posted by fairfax at 8:06 PM on August 24, 2012

I saw a psychiatrist to get help with medicating depression. Also got diagnosed with ADD. 15mg of Adderall XR/daily. I've developed good skills to deal with ADD, but with the Adderall, I'm more focused, less likely to have to go back for my glasses, then my keys, etc. Lots of people use Adderall as a performance enhancer, even if they don't have a diagnosis. I also have Chronic Fatigue, and the Adderall helps with that, as well.
posted by Mom at 8:31 PM on August 24, 2012