Talk to me about talking to my doctor about ADD.

March 6, 2008 10:13 AM

I think I have ADD. I'm seeing a doctor tomorrow. How can I best take advantage of the visit?

I'm 37. Ever since I was a camp counselor in college, I've suspected that I have (and have always had) ADD. I didn't get into any trouble in school, but I also got by mostly on my wits. I learned fast, did well on tests, and did as little homework as possible (often none). The kids at my camp taking Ritalin were the ones just like I had been, except I had gotten away with it. I haven't since learned anything about either myself or ADD to make me think my approximate self-diagnosis is incorrect, but I've also mostly been able to get things done in spite of it.

In addition to the suspected ADD, I have had sleep problems all my life. I finally saw a doctor (a neurologist, as it happens) about that and have gotten my sleep issues somewhat managed mostly with a combination of light therapy and melatonin, and a fallback prescription for Ambien (although I prefer to reserve that for when my sleep patterns get very out of whack).

Recently I have found, however, that even though I'm sleeping better and more regular hours, I am still often unable to concentrate on work. Since I'm basically self-employed, this is bad, because hours I don't work I can't bill for, and that adds up. So after a really bad brain week I called my sleep doctor's office for a referral to somebody to ask about ADD, and it turns out my sleep doctor does the screening, and then refers patients internally to neurology or psychiatry depending on what's appropriate. So I'm seeing a doctor I already have a relationship with, and I'm armed with a general understanding of how I've probably had ADD all my life and mostly managed to get by in spite of it. I've talked to a few friends who said, "um, YEAH" when I asked if they thought I had ADD, and I talked to my mom, who said she didn't think that ADD was it, but who also said she was glad I was seeing somebody about it (she also recounted a few things I didn't remember, but that will probably help a doctor with his diagnosis).

What questions do I need to ask my doctor? What answers do I need to beware? I plan on going in with an open mind, since he's the doctor and I'm just a geek with internet access, but I'd like to come in as well-informed as possible on how I can best use his time.

posted by fedward to health & fitness (10 comments total)

My doctor put me on a low dose (5mg) of Ambien and it had the opposite effect.

Since you are an Internet-savvy geek forearm yourself by reading up on webmd.com. Also look for a national organization or support group.

Ask your doctor about alternatives. Keep asking "what are the alternatives?" until (s)he runs out of them.

Check out the CD series "Ultimate Brain" by Tom Kenyon ($100 list, $60-70 off the net). It is a series of background audio to promote relaxation, concentration, etc. Centerpointe research also has a series of CDs but their's are more expensive ($150-$250).

(My free advice, and worth every penny!) Good luck!!
posted by swarkentien at 10:36 AM on March 6, 2008

Conventional medicine offers very little in the way of treating much less curing ADD other than trying out various drugs on you to see which one *does the trick* of reducing symptoms. In order to effectively treat this condition is imperative to take full stock of your lifestyle - from the food you eat, the place you live in, your genetics, your water system and intake and other factors such as relationships, memory and motivation to name a few. So aside from perhaps doing some testing, all the doctor basically will be doing for you is prescribing medication. If he or she is top notch maybe they will offer bio-feedback and/or EMDR. I would suggest you get yourself educated on how to separate the hype from the facts and empower yourself with knowledge with books, videos and a top notch forum that offers encouragement, positivity and excellent resources for healing. Good luck.
posted by watercarrier at 10:41 AM on March 6, 2008

What kind of doctor are you seeing? Just your regular primary care physician or a psychiatrist/specialist?

In my experience, PCPs don't diagnose ADD and will probably not prescribe you ritalin or any other ADD medication without documentation of diagnosis by a qualified mental health professional.

I really wouldn't bother to even talk to your PCP about this, unless your insurance requires referral to a specialist by your PCP. If this is required, I'd just tell your PCP the barebones -- basically that you wonder about whether you have undiagnosed ADD and that you want to talk to a psychiatrist about it. If you have health insurance with a separate mental-health program, just cancel the appointment with your PCP and find a psychiatrist/psychologist that specializes in ADD/Learning disabilities (with a focus on adults) in the database of providers covered by your insurance.

Obviously there is no blood test or any easy way to evaluate whether you have ADD. It requires evaluation of symptoms as compared to the profile in the DSM. This can be done through simple conversation, or a number of different computerized tests. Since it's not an easy diagnosis to made, is over diagnosed in children, and *underdiagnosed* in adults, most general physicians avoid it all together.

If you are talking to a specialist tomorrow, I'd ask about possible alternatives to ADD. You may "pass" the "tests" for ADD, but in the long term figure out that ADD is not actually the issues. No matter what course of treatment you decide upon after your appointment tomororow, it's important to be able to understand the other possibilities and what the symptoms of those are (maybe it's depression, which is often confused with ADD, but has distinct symptoms). If they want to prescribe you medication, I would ask very upfront about all the options and their various side-effects, including how it effects mood and appetite. I don't know what gender you are, but if you're a man, there are possible sexual side-effects too.

Good luck with this.
posted by jk252b at 10:52 AM on March 6, 2008

Your doctor won't be able to tell you this, but you should see what your insurance will and won't pay for. Mine would pay for my original doctor visit, but it would not pay for testing by a psychologist. It would pay for the Rx without the testing though. I went to the first psychologist appointment and ended up paying a couple hundred dollars out of pocket. My doctor was willing to diagnose and prescribe based on that visit and his own evaluation without the formal testing. If/when the time comes, you can get Ritalin for $4 at Walmart but my co-pay for Concerta is $40. If cost is an issue make sure your doctor knows.

Think about your day to day life and the places ADD might be manifesting itself that might not be immediately evident. I didn't realize how it was interfering in non work/school activities until it stopped having such a huge effect. Whereas before I'd walk past a mess and just not see it, now I not only see it, I'm also likely spend a couple minutes picking it up. Having a serious discussion with my wife is significantly less stressful for both of us. My social interactions were often pretty strained as a lengthy conversation was "work;" keeping all of the details straight, remembering to ask questions to show I'm interested, forgetting the other party's name almost immediately, looking for a way to exit gracefully starting from "Hi, I'm X, how are you?"

As someone who was only recently diagnosed (as I approach 30), I can tell you that finding out why I am the way I am (and being able to articulate the ADD quirks and their source to my family) has been as helpful to my well being as the drugs. The drugs aren't magic but they have made a difference
posted by the christopher hundreds at 10:59 AM on March 6, 2008

To clarify: I'm seeing a neurologist whom I already see about my sleep issues, and he performs the screening that determines what, if anything, you may have (or which further testing would be needed, if appropriate), and whether you should continue seeing somebody in neurology about it or be referred to a specialist in the psychiatry department. My (male) gender is also in my profile. :-)
posted by fedward at 11:00 AM on March 6, 2008

When I was in a similar situation, it helped a lot for me to go ahead and recatalog some of the specific behavior patterns I had that correspond with what I knew about ADD. I knew there was a whole string of them, but whenever I was talking to someone about it, I could only remember 2 or 3, and it sounded kind of weak. So in the time leading up to my doctors appointment, I wrote down a list of repeated sorts of behaviors from my life that could be earmarked as ADD-related, both positive and negative ones, just so I didn't wind up clueless in front of the doc.
posted by redsparkler at 11:39 AM on March 6, 2008

Almost every psychiatrist will give you a form to fill out which will attempt to narrow the diagnosis. For ADD it's trickier because it's still a relatively new category, however what you may want to do is fill out something like a retrospective report (PDF). This one is publicly available from an organization called the Hallowell Center (ignore slightly cheesy website) which specializes in ADD diagnosis and treatment.

There's also a "lite" version here.

If you fill out a form like this and either send it to your doctor ahead of time or bring it with you, what you are essentially doing is self diagnosis. Most good doctors will take it into consideration but will likely want to give you their own tests.
posted by jeremias at 2:12 PM on March 6, 2008

I should clarify that the first link isn't as specific to your needs, it's just an example .. .
posted by jeremias at 2:17 PM on March 6, 2008

The weird thing I noticed in your question is that you compared yourself to the camp kids who were on Ritalin - you think that you, without treatment, are like they are under treatment? So how does that mean that you have their disease?
posted by jacalata at 11:34 PM on March 6, 2008

I'm unsure of how to interpret your question as you've written it. From here it looks like you're trolling. Care to rephrase?
posted by fedward at 11:14 AM on March 7, 2008