ADD evaluation?
November 18, 2014 9:19 AM   Subscribe

So this is actually a 2 part question....

So I've suspected for a few years that i might be wrestling with some flavor of ADD. It was actually a post on the green that pointed me in that direction- up until then I had assumed that even though I had some of the classic symptoms, I didn't really fit the profile bc instead of being hyperactive and unable to focus I am usually one who hyperfocuses when I get into a tasks and can literally sit for hours going at the task not stopping for bio breaks or to walk around or anything bc I am so engaged. The post I read noted that hyperfocus IS actually a symptom of ADD (just not ADHD).

First question is how can one - if one can- self-evaluate properly to determine whether they are dealing with ADD or just a character defect that is better suited to resolution with some sort of therapy? My entire life i have wrestled with finishing projects I start after the initial excitement wears off and unless i am totally "feeling it" (in which case i can hyperfocus and work for hours or days on end and do a kick ass job) i fall into this task spiral of doom where I start to get a little behind and then thinking about how i am behind triggers anxiety about finishing on time which makes me want to avoid thinking of it and do some other soothing activity instead which puts me further behind which has me eventually waking up at 4am w a panic attack over how far behind i am and how i am playing with fire and could push past the point of no return which eventually propels me to attack the task at the last possible minute and work in a rushed pace to get it done just in the nick of time. STRESS. I'm gifted and so this usually works out ok in the end for most things in terms of meeting the deadline and my clients/friends/mgt never even notice but the internal stress I have dealt myself along the way is harmful and my finished product isn't my best (even though it seems to past muster) and I don't want to live like this anymore. More urgently, it DID NOT work out ok in the end for grad school but has really screwed me over bc grad school is just not something you can have success with if you push every assignment off till the last minute. Despite the fact I knew i was risking complete failure and really don't want to fail, i couldn't seem to make myself work on tasks on a consistent and organized basis. Net result for school is that I effectively dropped out this week, a year into it, and while all my stress and panic attacks have vanished i am still very disappointed I couldn't seem to accomplish this thing that was important to me. I don't want to ever have this happen again; i want to figure out what is behind this behavior and how to fix it before it wrecks something else.

Second question is if i do self-evaluate and determine it's probably ADD, where do i start with a medical resource? Do i ask my GP to evaluate me and prescribe ADD meds? Or do I get a referral straightaway to a psychiatrist? Or is this something an ordinary Master's degree'd therapist can help with even though it's a medical issue? And if so, what kind of therapist should i look for?
posted by TestamentToGrace to Health & Fitness (14 answers total) 7 users marked this as a favorite
I think especially if you walk in with, "I just had to drop out of graduate school because I could not keep myself on-task," then certainly a doctor's going to take this seriously. My eval was done by a psychologist and then my medication originally referred elsewhere; I now see a psychiatrist. Really kind of depends on what your GP is comfortable with, but talking to them would at least be a good first stop, as long as you make it clear that you don't just expect them to give you meds right off.

I think just therapy can be helpful, but has never been as helpful for me as supportive help plus medication. If you want to see if stimulant medication is going to help you generally--well, how much better do you do after a couple cups of strong coffee? Some people even with ADD can't take stimulants well but find help with other things like Strattera or Wellbutrin, but actually looking at how your body responds to OTC stimulants seems like an easy place to start.
posted by Sequence at 9:26 AM on November 18, 2014

The answer to the first question is: don't. The answer to the second question is: talk your GP about your symptoms, and ask what he/she thinks the next steps should be with regard to evaluation and treatment regardless of the results of the evaluation (because even if the results don't suggest ADD, there is an issue that would be improved by some sort of treatment, you just have to figure out which kind).
posted by brainmouse at 9:28 AM on November 18, 2014

If therapy is an option, why not start there? Any clinical psychologist, clinical social worker or psychiatrist should be able to assess you for ADD and then help you evaluate the findings. You can do a self-screening, but to be sure you should get an assessment by a professional. Then you can decide whether you need coaching, more therapy, drugs or whatever.

Most GPs will not feel comfortable prescribing ADD drugs based on a self-assessment, and many will not feel comfortable prescribing them at all. ADD drugs tend to be stimulants with high street value and potential for abuse, so you will want to get them from someone who specializes in mental issues, such as a psychiatrist or a psychologist working with a psychiatrist.
posted by ubiquity at 9:29 AM on November 18, 2014 [1 favorite]

A proper ADHD evaluation would be performed by a licensed (PhD level) psychologist. It would involve cognitive testing as well as a full history dating back to childhood. Whether you have ADHD or not, it sounds like there's some issues that you're struggling with like time management, motivation, and moving from task to task. Check out this book. It may help you address some of the problems that you're facing. There are ADHD coaches that can help, as well. A diagnosis is not needed...just some clarity about the things that you want to work on. Meds do work for some, but they can be a mixed bag. The clinic where I work generally recommends trying non-medical interventions first. Best of luck.
posted by batbat at 9:30 AM on November 18, 2014 [2 favorites]

FYI, the psychologist may want to talk to a parent - not because they need permission, they just want to know what you were like as a kid. If you are uncomfortable with this, it isn't strictly necessary, but it can help with diagnosis.
posted by maryr at 9:39 AM on November 18, 2014

Oh, yeah, when I had my eval they needed a family member--but because of my strained relationship with my parents, I was able to substitute another relation. But someone who's known you about that long, anyway.
posted by Sequence at 10:02 AM on November 18, 2014

My father is dead, I am estranged from my siblings and my mother is near death and not coherent. Is a family member really necessary? There isn't anyone from my childhood in my life now that could speak to my history. That seems unnecessary anyway as a medical diagnosis should be able to be made based on current symptoms, no?
posted by TestamentToGrace at 10:04 AM on November 18, 2014 [1 favorite]

I have been diagnosed twice with ADD, and the process for me was something like this:

1. In college, I was seeing a therapist (of the MSW/LSC type) who suggested to me, based on some of the frustration I was describing to her re: not finishing assignments, etc., that I should be evaluated for ADD. At this time, I had never even considered that I might be ADD, I just thought I was kind of lazy and slothful. She referred me to a psychiatrist, who met with me several times, had me complete an assessment, and eventually prescribed ADD medication to me.

2. After moving out of the state I went to college in and losing health insurance, maintaining my prescription for ADD medication became impossible, and I wasn't in school anymore so it didn't seem to matter that much. When I moved to where I live now, I briefly got health insurance again through my family (thanks Obama!), and once again started seeing a psychiatrist. She agreed with the previous psychiatrist's ADD diagnosis, but wanted me to complete some medical tests (EKG, physical, etc) prior to prescribing me any medication. Predictably, without the medication I was too disorganized to ever make the appointments, and by the time my family-covered health insurance lapsed, I still hadn't done it.

3. Finally, I got a job that offered health insurance, and thanks to the very organized system at Kaiser, my GP made me an appointment for a therapist (of the MSW/LSC type). I discussed my symptoms with her, and based on that session, she then referred me to a psychiatrist. This psychiatrist performed another assessment, and had me get the bloodwork/EKG done that my previous psychiatrist had requested (made much easier by the fact that it was all done in-house). She then prescribed me ADD medication.

I think if you are interested in being evaluated for ADD, you should ask your GP to refer you to a psychiatrist who can make the diagnosis, or even a therapist who can then refer you to a psychiatrist. Your GP will not be willing to just prescribe ADD drugs right off the bat, as they are highly controlled nowadays.

As a data point, none of my psychiatrists ever requested a family member or longtime relation to discuss my childhood symptoms (or lack thereof) with, although they did ask me many questions pertaining to whether I had had the same difficulties in childhood. There was also never any cognitive testing, except the first psychiatrist had me fill out a self-assessment (of the strongly agree/strongly disagree type).
posted by Aubergine at 10:04 AM on November 18, 2014 [1 favorite]

I would choose someone who will evaluate you more generally, not just "ADD y/n?" but a holistic view of what's going on psychologically. Sometimes it's not just one clear-cut thing that a pill can singlehandedly fix.

I don't say this to discourage you from going the GP and/or psychiatrist route. Just to encourage you to consider a therapist as well. If it turns out to be as simple as ADD only, then you can get some good support to help you establish new time management habits that your new meds will make you capable of following through on. And if it turns out to be something else instead of, or in addition to ADD, you can get support with that as well.

Inability to concentrate is a symptom of a lot of different stuff, including anxiety and depression, which are really common.
posted by Bentobox Humperdinck at 10:18 AM on November 18, 2014

That seems unnecessary anyway as a medical diagnosis should be able to be made based on current symptoms, no?

Part of the diagnosis criteria for Adult ADD/ADHD is that the symptoms have been present since childhood. I'm sure there are ways around this or other ways of getting this information if you don't have anyone who can speak to you as a child, but it's helpful for this reason.
posted by brainmouse at 10:29 AM on November 18, 2014 [1 favorite]

Do not go to a GP unless you are searching for a reference for a mental health professional. Do not self-diagnose. If you suspect you have this, you need to know.

1) Are you "officially" dropped out? Do you still have any kind of health coverage or access to a health center at your school? Many schools have a mental health center which can help you with the access to the mental health professionals you need to be assessed with ADHD, some good, some not so good, but it's a very inexpensive first step worth trying if you are still able.

Don't be discouraged, however, by a non-ADHD diagnosis if you feel they didn't do a good job. Testing for ADHD is, and should be, rigorous. They will ask about your childhood, but that's to establish a history and help you figure out the kind of ADHD you have. Don't sweat it, and don't let it stop you.

2) You need to see a mental health professional, preferably a Ph.D level type (therapy and what not can come later). You need to see one for a few reasons:

a) Good ADHD management. Medication is just one part of ADHD management. Part of managing your ADHD is knowing the type you have, how it affects your life, what strategies you've already developed, and how to create and maintain other strategies.

I think of my ADHD management as a table with 4 legs: exercise, strategy, medication, and diet. I can knock one of those legs out, still have a tripod and be ok, but I need 3 to be effective. A mental health professional helps with all of those legs, and your "legs" may be different depending on your type.

b) Part of ADHD management is finding medication - if necessary - that works for you. Some types may work better than others, some may need changed in the future. You may need to experiment with different medications and dosage until you find one that works, and this takes time.

c) The mental and emotional disorder that often accompanies ADHD. Anxiety, stress, depression. . . there's a whole range of associated problems, and you need to discover if a) you have any; b) if they are mostly solved by being diagnosed correctly, and if not, what to do; and c) if you don't have ADHD at all but still have something else that presents with similar problems.

If you do have ADHD, with a late diagnoses you might have some emotional fall out: discovering what personal flaws and problems are actually a result of your ADHD; discovering strength and pride in the coping mechanisms you've already developed; and the "what-ifs". You'll swing from gratitude to anger to emotions about what the diagnosis means for your future. A mental health professional can help you deal with all that.

This may seem overwhelming, but it's a process, and will come in bits and pieces. For many people, the diagnosis alone is half the battle in determining solutions.
posted by barchan at 11:05 AM on November 18, 2014

For the history piece, do you have or can you find any old report cards? Even if comments aren't detailed (though if you had ADD or ADHD, I'd imagine there might be things like "TestamentToGrace seems preoccupied or is daydreaming in class" or "will not shut up" or "is fidgety" or "It would be great if TestamentToGrace would complete her/his homework now and then" [not to be rude at all -- some of these or similar may have appeared on my own report cards]), most schools (even back 20-30 years) will have had at least a column in there somehow logging organizational ability and/or behaviour (e.g. excellent/very good/good/satisfactory/poor).
posted by cotton dress sock at 3:03 PM on November 18, 2014

I hate to be the contrarian here. (not really).
My daughter showed very definite signs of ADHD in first grade. Out of control rolling on the floor under the tables during school (Montesorri). Gifted/not going to pass first grade sorts of stuff. We went to her pediatrician, the most holistic crunchy granola doctor I have ever met. I described what was going on. We walked out with a prescription. He (Doc) was visibly upset when I described the symptoms, I asked why, he said he had been trying to find a holistic solution for years and had failed. She is doing great these days.

I educated myself about the symptoms/meds/etc as any parent would. Then I noticed I was looking in a mirror.
Went to my GP, he agreed, walked out with a prescription for Ritalin. He wanted me to try it for a couple weeks and come see him again to discuss. It has been a godsend.
I've been getting my antidepressants from the GP for maybe 18 years now. I really think GP's are more willing to work with people on these issues than most give them credit for.
posted by rudd135 at 7:00 PM on November 18, 2014

The family member isn't necessary - just helpful and convincing. Nice to have the symptoms noted for a long time.

Good luck!
posted by maryr at 2:07 PM on November 19, 2014

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