I think I have ADHD

April 26, 2007 1:05 PM

Ok, so I am now willing to admit I may have ADHD, but I have no health insurance. Now what?

Most of my life I have had teachers, friends, relatives tell me or my parents that I have ADHD. While I denied this for the longest time, I am beginning to recognize this may be the source to some of my problems at work and school.

I've read two books about the disorder and I certainly illicit many (if not all) of the symptoms.

I am two months behind on a project at work because there are days I just sit and browse random things on the internet all day long. I am not doing as good as I feel I could at school because I procrastinate, don't attend class as I should, and can't force myself to get into the material.

I have never been professionally evaluated. My parents turned down request by my doctors and teachers when I was young to be evaluated for ADHD. The thing is, I don't have health insurance, and I cannot really afford to pay for a doctor or any prescription they might give me.

What can I do? Would paying the $150+ for a doctors consult be worth it? Am I just being paranoid? Are there any "home remedies"? I have read a book called "Healing ADD" and it had some good recommendations, but I have trouble implementing the behavioral changes it asks for.

Thanks for the help.

posted by blueplasticfish to health & fitness (16 comments total)

What can I do? Would paying the $150+ for a doctors consult be worth it?

Doctors are very hesitant to prescribe stimulants due to abuse and a more stringent DEA. I know of two instances of friends going to specialists (neurologists!) before they get their prescription. There are non-scheduled treatment alternatives such as atomoxetine that have been getting good results.
posted by geoff. at 1:15 PM on April 26, 2007

What kind of school is this? If it's a university, there may be resources on campus to help you. Do they have an on-campus mental health center? How about an office of disability services? (You may face a bit of a catch-22 there. They'll probably want you to have a diagnosis before they help you.) I would start there and ask them if they know of any resources to help people in your shoes.
posted by craichead at 1:17 PM on April 26, 2007

First of all, don't be a victim of ADHD. Don't put all the blame of your habits onto it.
Second, I'd try to change your diet around. There is a great book called The LCP Solution, it is great.
You might also look around for an ADHD support group. These are usually very helpful, and cheap (if not free).
Try finding a system (such as Getting Things Done) that works for you to keep track of what you need to get done.
Good luck!
posted by grieserm at 1:19 PM on April 26, 2007

I got caught off. My point being that there isn't an objective test that can be given and given the abuse potential of the drugs it leads to a lot of hoops. Your best bet is to go in, tell the doctor your symptoms and then specifically request one of non-abusable drugs if he wants you to be further evaluated. I imagine that he or she would be more comfortable giving out those prescriptions.
posted by geoff. at 1:20 PM on April 26, 2007

I am not doing as good as I feel I could at school because I procrastinate, don't attend class as I should, and can't force myself to get into the material.

Don't self-diagnose. This describes almost every student I know (and I'm in grad school). Everyone's like this to varying degrees except extreme Type A personalities, and I think they're the ones who should be medicated. ADHD does exist, but it has become kind of a catch-all term for procrastinators.

Even if you do get on medication, it doesn't magically solve all your problems. From what I've seen, it doesn't even give you any more motivation. It just allows you to focus on the things that you are already motivated to do. So, you'll still need some kind of system to get things done. If you haven't tried that, and I mean really tried it, then you can't really know if you have ADHD. Maybe you're just depressed - which would also cause problems in the workplace and school.
posted by desjardins at 1:27 PM on April 26, 2007

Howdy.

The first thing to consider carefully is whether or not you believe you actually have ADD. I've had it for most of my life, and the major differentiator between ADD and what I'd consider "normal" lack of focus and lack of motivation is the chronic nature of the issue.

ADD is not as simple as not being able to focus yourself some of the time. It's a chronic, continuous inability to focus yourself tightly on single tasks or objectives: keeping seventeen things in the air and doing none of them well, being so easily distracted that the slightest interruption in a focused state means a major state change for you, attended by great difficulty returning to the original focus.

ADD, as a diagnosis, is currently in vogue, and very, very frequently an incorrect diagnosis made by people with little or no background in mental and emotional disorders. Be very, very cautious of diagnosing yourself from a book or the Internet.

Also recognize that conformity, as a general trait, is valued in American society, and that the weight of public opinion is against choices and paths that do not seem to be "productive" in terms of producing quantifiable results (like money). Were I an artist today, I would be...frustrated.

I don't want to sound excessively fluffy, or wind up singing "every sperm is special", but it's important to note that most of the major forces in your life are likely to be structured systems (work, school) within which you will function more happily if you can adapt to a structured environment. You may have difficulty reaching a working compromise with those structured environments, and that's fine: it's just the way some folks are made, and doesn't necessarily mean you have ADD.

All that said, let me actually address your question:

If you believe that ADD is a genuine possibility, your best option, given that you lack health insurance, is to go through your school. The health center there should be able to give you a referral to a psychiatrist who can render a diagnosis and, if appropriate, prescribe the correct medications. Hopefully, the school will have a relationship with the psychiatrist that will keep fees low.

The "solution" to living with ADD is not as simple as medication by itself: you will most likely need to reorganize and restructure your life in combination with pharmacological therapy to treat the disorder.

The primary recognized medications for the treatment of ADD are generally controlled substances, because the most effective pharmacological treatments for ADD are CNS stimulants such as amphetamines. This means that you will be required to have a prescription for these medications, as they are subject to abuse, and often that the medications cannot be automatically refilled, requiring a new prescription each month.

Above all, be extraordinarily skeptical of extraordinary claims about how ADD can be "cured" using natural cures or medications that do not appear here. The list shown includes only medications that have been shown, empirically, to actually affect ADD. The plural of anecdote is not data, and you should be profoundly suspicious of anyone who attempts to tell you that if you just take X and Y herb, it'll take care of "your ADD".

Hope this helps: feel free to email me if you want to correspond further.
posted by scrump at 1:46 PM on April 26, 2007 [2 favorites]

You are not alone. I've taken twice as long to finish school because I couldn't study, would get distracted by "ooh look, shiny" things, or the devil the internet. I've failed this semester because I couldn't make myself go to class, because it's boring. Now I have to repeat my final semester. As for things that have helped, I've tried Strattera, Ridalin, Provigil, and Adderall. For me, the semesters I was using adderall, were my most productive, followed by the one using provigil. The other meds didn't help at all. GTD is a great program, but having ADD means I read the book (3x), listen to the book (2x), get the stuff and rearrange the silverware drawer. The best hope that I can offer is to find someone to help keep you on task if possible (BF/GF/spouse). Also there are a few programs that can help you have a timer on the internet--look at lifehacker.com.
posted by xyberspam at 1:52 PM on April 26, 2007

Is the $150 the fee you'd be charged at the student health center on campus or from a doctor? If it is the latter, check out the student health center.

If medication is the route for you, be aware that you will have to see the doctor to get more prescriptions. Depending on the medication s/he prescribes, you might have to go back monthly. Most of the non-stimulant ADD meds do not have generic versions and they are expensive. You could easily expect to pay 100 or more each month for medicine and "medicine management" appointments at the doctor.

So, before you go the medical route, you might want to go to the counseling center on campus and see if they'll screen you for ADD and give you some methods to try to overcome the ADD without medicine. If that doesn't work, then try the medical route.

If you do try the medical route, find out about student insurance. The premium and co-pays might end up being less than what you'd spend out of pocket.

As for solutions for ADD . . . I don't have an answer for that.
posted by necessitas at 2:14 PM on April 26, 2007

I was in your position about six months ago, except that I suspect I am a bit older than you.

First, if you are interested in getting an evaluation, budget for it. The best way to go about it is through a doctor recommended by the local CHADD. This will probably be a psychiatrist, sometimes a neurologist. Part of the guy's practice is doing ADD evaluations. They can take somewhere between two and six hours, sometimes they want you to get additional testing, which is maybe $300 or so more. The hourly rate will be somewhere in the neighborhood of $200 or so. Mention that you have no insurance and they might cut you some slack. If you can get an evaluation done by a medical doctor for $150, I don't think you will find cheaper. Also, I have heard, that school clinics are very difficult places to get amphetamine prescriptions.

This route is a better choice than mentioning your symptoms to a general practitioner as a GP may not want to diagnose and prescribe ADD medication because of the scrutiny that these prescriptions can get. A GP will also know less about the condition and be more prone to error in diagnosing you. The most likely outcome in seeing a GP is being referred to a specialist anyway in which case you've spent extra money and wasted time.

Should you get an evaluation is a trickier question. If you aren't willing to go on medication then no, don't bother. I haven't heard of any diet changes showing results. The two DIY remedies that have shown results are aerobic exercise and meditation. Since these are free, seeing if you get sufficient results from them will save you the money and time investment in seeing a doctor and trying various medications and dosages.

If the symptoms aren't present in multiple areas of your life, work, school, social and leisure then you don't have it. Be honest with yourself. For me, it was my distractability during leisure activities and my slowness in learning subjects I was picking up out of interest that really convinced me an evaluation was worthwhile. So, if you see the same pattern in different spheres, you are willing to try a medication and you can figure out a way to make it work financially then yeah, go ahead and do it.

Some more approaches. Omega fats, especially EPA, have wide support but I don't think there are any studies. Neurofeedback is controversial, there aren't any studies supporting it, but there is much anecdotal evidence. I know that the plural of anecdote is not evidence but in my opinion there is something there. You can buy home units or see a neurofeedback provider. Either one is expensive. OpenEEG is a cheap alternative. Dr. Les Fehmi was one of the early pioneers of neurofeedback and alpha training back in the 70s. He developed a set of objectless visualizations (tough to describe) that induce synchronous alpha waves. His website is openfocus.com. The book, _A Symphony in the Brain_, gives a brief discussion of him, his method, and the effects of following his program.

Drugs. The brand names are all pretty expensive. If you have a Costco in your area, you can get generics of some of the amphetamines for $20-40 a month's supply. I don't have any experience with the non-amphetamines but I've heard some real horror stories about Strattera. Amantadine is not typically prescribed for ADD but some doctors will. It's got a pretty good record, few side effects and is pretty cheap. Might be worth bringing up with your Dr. if you are diagnosed and the front line treatments aren't effective. One issue with getting on amphetamines is having to get a new prescription every month. Some doctors will flat out use you on this, requiring you to come in and pay for an office visit to get a new prescription. Others with a kinder, gentler approach to your wallet, will put you on a maintenance schedule for visits, like every couple of months, and give you your prescriptions inbetween for free.

And yes, medication won't solve everything. Follow someone's recommendations for organization. GTD is a good choice.

Best wishes.
posted by BigSky at 2:20 PM on April 26, 2007 [2 favorites]

I was diagnosed (after exhaustive screening) through my school, and it was free. If you're a student, that's your best resource. Some of the ADD drugs - Adderall and Ritalin, at least - have generics available, so that might be an avenue worth pursuing. Yes, you'll have to go back every month for prescription refills, which is incredibly annoying. My psychiatrist slyly (and kindly) prescribed me a double-dose (2 20 mg pills supposedly taken daily) of Adderall so that I'd get two months at a time instead of one.

I've been off health insurance for the past couple months, and until the benefits from my new job kick in, I've been using caffeine pills. They don't work as well and I feel like Jessie Spano ("I'M SO EXCITED..."), but they're better than nothing. But I definitely had no tolerance to caffeine beforehand, so if you've already been self-medicating with that, more probably wouldn't be better. Otherwise, it's a suggestion.

Honestly, while I'm sure the "don't blame everything on ADD, don't rely on medication, etc" people mean well, if you really feel that you have ADD, don't take them too seriously. I'm going to guess that the books you've mentioned are Driven to Distraction and its sequel. One fabulous point the author makes is that people with ADD are already well-versed in coping mechanisms to deal with their problems, already continually doubt themselves and beat themselves up for things they can't control, and already have tried and tried and tried to work with and conquer their symptoms and bootstrap themselves to success. It's really tiresome and irritating to spend your life this way, and then to have the peanut gallery pop up and say, "Man, medication is for pussies! You just aren't trying hard enough!" when finally you admit you have a problem. There's absolutely no shame in taking medication to alleviate suffering, and those with ADD indeed suffer. If you need meds, you need meds. That $150 investment might be a great one - it's your life we're talking about here.
posted by granted at 2:39 PM on April 26, 2007 [1 favorite]

I don't have ADD myself, but my son (now 17) was diagnosed with it when he was 10. He's used Adderall pretty successfully.

I'd like to say, though, that he has a lot of problems making use tools to help him live with the condition. Making lists, setting alarms, etc. are things he simply refuses to do. So his mother and I help him out, reminding him of things he needs to do, keeping him on track when we can. I'd rather he remembered things himself, but I don't mind helping him out, and I think having people around to help is a legitimate mechanism.
posted by lhauser at 3:37 PM on April 26, 2007

granted: "Honestly, while I'm sure the "don't blame everything on ADD, don't rely on medication, etc" people mean well, if you really feel that you have ADD, don't take them too seriously. (...) It's really tiresome and irritating to spend your life this way, and then to have the peanut gallery pop up and say, "Man, medication is for pussies! You just aren't trying hard enough!" when finally you admit you have a problem."

THANK YOU!

So many people have their theories about other people's conditions. But unless they have walked in the patient's shoes it is not for them to judge.
posted by loiseau at 3:53 PM on April 26, 2007

Let me just ADD (sorry...) that I have gotten huge improvements in my ADD symptoms using NLP techniques. I was on medications for years (they did help, btw). The more I dealt with my internal conflicts the less I needed the meds until one day I just stopped taking it altogether. It took a long time to work through all of that but I really like missing out on the side-effects from the drugs.
posted by trinity8-director at 5:28 PM on April 26, 2007

Following in the string of recent "I have ADD posts" (evidently us ADDers have issues responding first for some reason), I was recently diagnosed with ADD while living with no insurance. My school, a posh private ivy, didn't pay for shit. They sent me to their usual ADD tester, who cost me 550 big ones. However, the great side of this is that with her diagnosis sheet, I can walk into any psychiatrist's office and snag whatever schedule drugs I want (however, I mostly don't do this).
I recommend (if your school is a non-paying asshole) that you go to a tester they DON'T recommend. Everyone at my school wants to have ADD, so they can spend less on the Adderall they blow on a daily basis. Therefore, our school's local tester is very expensive. I bet I could have done better.
I have been on Focalin (sp?), Straterra, Adderall XR, Adderall and Ritalin. I'm only on the Straterra now cause the Adderall was giving me tachycardia. I prefer the Adderall though, because it actually worked. As a side note, Straterra is an absolutely fantastic anxiolytic. It's just miserable at relieving symptoms.

I suggest you get tested. It's a relief either way to find out what a professional thinks. Almost every single mental health professional (and most of my teachers at nursing school, all of them nurse practitioners) have said something like, "Yeah, you're a textbook case of ADD-inattentive type". It was good to have an actual diagnosis though, so I could start working towards fixing it.

Oh, and read "Driven To Distraction" if you haven't already. It's fantastic. It answered questions and dispelled common misconceptions, like "people with ADD are always unfocused"- WRONG. Sometimes we hyperfocus.

Wow, can you tell I'm off my medication right now? Good luck.
posted by nursegracer at 7:19 PM on April 26, 2007 [1 favorite]

I was diagnosed with ADHD at the age of five, and have been taking stimulant medication ever since (almost 15 years). I can't, can't function with out it. True, some people do well with cognitive behavioral therapy, but for others like me, medication is really a requirement for living a normal life.

I love the fact I have ADHD, it has so many benefits, that I'm sure you're aware of, but it can totally fuck with you if you don't get it under control. It is very much worth it to get yourself checked out by a psychiatrist, even if you have to borrow the money or something like that. You might also want to look into AD/HD advocacy groups such as CHADD.

Good luck, and feel free to ping me if you have any other questions.
posted by dantekgeek at 1:22 PM on April 27, 2007

I have been on Straterra (horrible) and Focalin. They both worked, but Straterra made my life a living hell with the side effects. Im off meds now, and what seems to work to help me manage the symptoms is getting over 8 hours of sleep per night. Sometime 9 or 10. If I get less than 8 all my symptoms get much worse.

Also, I use coffee. 6oz at a time, about every 2 hours. None on the weekends. It works pretty well, and is a good fix for when I really need to get stuff done at work. Until you get into a Dr, you can always try that.
posted by misswiss at 1:21 PM on May 11, 2007