How to encourage someone to get tested for ADHD?
April 22, 2015 3:25 PM Subscribe
I strongly believe my younger sister would benefit from an ADHD screening. She hasn't been receptive to the idea. In the meantime, her life is often chaotic and there are real consequences to her disorganization. I know she might not have ADHD, but then again she may. Is there anything I can say or do to convince her to at least consider screening?
My sister is in her late 30s. As a child, she was diagnosed with ADD but was never treated for it, as far as I know. She is married and has several children. She works full-time for low pay, and her husband has several health problems. This means she is the number one decision-maker in the home and in charge of pretty much everything -- cooking, cleaning, parenting, paying bills. Life is extremely stressful.
As far as I've known her, she has been very hyper and very disorganized. She tries really, really hard to stay organized, but can't find systems that work for her. She constantly loses things (she has lost her Social Security card nine times, for example; you can only lose it 10 times before the government stops issuing new cards to you). She has been in more fender benders than anyone I know. She constantly misses or forgets deadlines. She is a night owl and has trouble sleeping. She is really hard to have conversations with because she jumps from topic to topic and frequently interrupts.
The family receives multiple sources of Social Security income and other assistance, like food stamps. There is a ton of paperwork to keep up with -- most people would find it challenging. My sister frequently forgets to fill out a form or turn something in, so every couple months some emergency happens. Right now, her husband isn't on any of his high-blood pressure and depression medications because of paperwork issues with Medicaid and the food stamps have been cut because of another deadline issue. In the 2-3 years she's been on food stamps, I've lost count of the number of times it has been cut because of paperwork (I know some of this is the bureaucracy of the system, but oftentimes it's something she's forgotten to do). This causes stress in her own household and in her extended family as we all scramble to help her financially or emotionally through these situations.
I don't want to pathologize her and I don't want to cling to the idea of an ADHD diagnosis as some magic solution. At the same time, it seems fairly clear to me that she could benefit from, at the very least, the types of services an ADHD specialist could provide in terms of organization skills or medication suggestions. Whenever I bring up the idea of getting screened, she says she tried Adderall once (someone gave it to her) and she didn't like it, so she's never going to try it again. She distrusts doctors in general.
I've been told that people who experienced early trauma often have behaviors that mimic ADHD (she is an older adoptee and absolutely experienced trauma). So I'm aware that she might not have ADHD at all, and I am also aware that she also has a very busy, stressful life, made more difficult by a low income, that would overwhelm anyone.
But I want to help. I love her and like her as a person and there are many things she does well, but she is exhausting to be around most of the time. Our relationship is definitely one where I nag and she ignores me, and where this nagging makes her feel like crap about herself. I've been trying in the last year to give less advice and be more of a sister who just listens, but it's hard when someone's life seems to feature a crisis of the week that was caused by paperwork.
I've tried in the past to help fill out forms and suggest organization systems. Nothing provides a long-term fix. Since she does not have health insurance, I am willing to foot the bill of any testing and have told her this.
If you have ADHD, what finally made you get tested? Is there anything I can say or do to push her in that direction?
My sister is in her late 30s. As a child, she was diagnosed with ADD but was never treated for it, as far as I know. She is married and has several children. She works full-time for low pay, and her husband has several health problems. This means she is the number one decision-maker in the home and in charge of pretty much everything -- cooking, cleaning, parenting, paying bills. Life is extremely stressful.
As far as I've known her, she has been very hyper and very disorganized. She tries really, really hard to stay organized, but can't find systems that work for her. She constantly loses things (she has lost her Social Security card nine times, for example; you can only lose it 10 times before the government stops issuing new cards to you). She has been in more fender benders than anyone I know. She constantly misses or forgets deadlines. She is a night owl and has trouble sleeping. She is really hard to have conversations with because she jumps from topic to topic and frequently interrupts.
The family receives multiple sources of Social Security income and other assistance, like food stamps. There is a ton of paperwork to keep up with -- most people would find it challenging. My sister frequently forgets to fill out a form or turn something in, so every couple months some emergency happens. Right now, her husband isn't on any of his high-blood pressure and depression medications because of paperwork issues with Medicaid and the food stamps have been cut because of another deadline issue. In the 2-3 years she's been on food stamps, I've lost count of the number of times it has been cut because of paperwork (I know some of this is the bureaucracy of the system, but oftentimes it's something she's forgotten to do). This causes stress in her own household and in her extended family as we all scramble to help her financially or emotionally through these situations.
I don't want to pathologize her and I don't want to cling to the idea of an ADHD diagnosis as some magic solution. At the same time, it seems fairly clear to me that she could benefit from, at the very least, the types of services an ADHD specialist could provide in terms of organization skills or medication suggestions. Whenever I bring up the idea of getting screened, she says she tried Adderall once (someone gave it to her) and she didn't like it, so she's never going to try it again. She distrusts doctors in general.
I've been told that people who experienced early trauma often have behaviors that mimic ADHD (she is an older adoptee and absolutely experienced trauma). So I'm aware that she might not have ADHD at all, and I am also aware that she also has a very busy, stressful life, made more difficult by a low income, that would overwhelm anyone.
But I want to help. I love her and like her as a person and there are many things she does well, but she is exhausting to be around most of the time. Our relationship is definitely one where I nag and she ignores me, and where this nagging makes her feel like crap about herself. I've been trying in the last year to give less advice and be more of a sister who just listens, but it's hard when someone's life seems to feature a crisis of the week that was caused by paperwork.
I've tried in the past to help fill out forms and suggest organization systems. Nothing provides a long-term fix. Since she does not have health insurance, I am willing to foot the bill of any testing and have told her this.
If you have ADHD, what finally made you get tested? Is there anything I can say or do to push her in that direction?
My sister is in her late 30s.
It's not appropriate to give late 30s siblings specific medical advice. You're phrasing your entire post on ADHD, which may or may not apply to your sister. You should be looking based on issues that you think could be helped (which you have listed) rather than attempt to diagnose your sister when you neither a doctor nor her doctor.
you can only lose it 10 times before the government stops issuing new cards to you
This is false. The actual requirement only applies to cards issued after December 17, 2005. Even then, the cardholder can provide a reason for the replacement and have the replacement be issued.
she also has a very busy, stressful life, made more difficult by a low income, that would overwhelm anyone.
If she's this stressed, then a doctor is even more stress, for no apparent gain (from her perspective). Is there something you can do to help out her life so that she has time to go to a doctor? As I read your post, I can just imagine thinking (in her shoes), "I have all of these problems, and my sister thinks I have one more - why should I listen?".
After that, stop mentioning ADHD - at all. Phrase your request as just a discussion with a therapist or psychologist. That discussion may end up rapidly veering toward ADHD, but then the diagnosis starts with a professional and not you.
posted by saeculorum at 3:47 PM on April 22, 2015 [4 favorites]
It's not appropriate to give late 30s siblings specific medical advice. You're phrasing your entire post on ADHD, which may or may not apply to your sister. You should be looking based on issues that you think could be helped (which you have listed) rather than attempt to diagnose your sister when you neither a doctor nor her doctor.
you can only lose it 10 times before the government stops issuing new cards to you
This is false. The actual requirement only applies to cards issued after December 17, 2005. Even then, the cardholder can provide a reason for the replacement and have the replacement be issued.
she also has a very busy, stressful life, made more difficult by a low income, that would overwhelm anyone.
If she's this stressed, then a doctor is even more stress, for no apparent gain (from her perspective). Is there something you can do to help out her life so that she has time to go to a doctor? As I read your post, I can just imagine thinking (in her shoes), "I have all of these problems, and my sister thinks I have one more - why should I listen?".
After that, stop mentioning ADHD - at all. Phrase your request as just a discussion with a therapist or psychologist. That discussion may end up rapidly veering toward ADHD, but then the diagnosis starts with a professional and not you.
posted by saeculorum at 3:47 PM on April 22, 2015 [4 favorites]
The sort of mental health care you are likely to get when you are low-income and on Medicaid varies, but I don't think anywhere in the US is it going to involve the sort of "specialists" who perform things like personal organizing services. If she had the money for services like that, she could pay for them now, without a diagnosis. The sort of thing you get from going to the doctor for an official screening and diagnosis are pills. I like my pills. Stimulants are a mixed blessing but they've done a lot of good in my life. However, all of the good they've done, they've done because I was already motivated to be working on things when I got them.
Other than this, what is there? You can do the same work on stress management with a therapist whether you have AD(H)D or not. If her husband's been on medication for depression at any point, even if he's not taking it right now, then I would assume that she is in fact aware that mental health care is available and how to get it if she wanted it.
So it boils down to: Do you have some reason to think she'd be a better sister or a better human being on amphetamines or similar? Probably not. She's already said she doesn't like how Adderall makes her feel. A lot of people don't. If she's disinterested in medication, then screening is probably pointless, since medication is the only thing you need the screening for. As a sister, none of this is your job to fix. She might be better off with a comprehensive treatment plan for ADD, including coaching and therapy and meds, but she might also be better off with a doubled income and a helpful husband, and you can't fix those, either. Fixing isn't your job. Let it go.
posted by Sequence at 4:44 PM on April 22, 2015 [2 favorites]
Other than this, what is there? You can do the same work on stress management with a therapist whether you have AD(H)D or not. If her husband's been on medication for depression at any point, even if he's not taking it right now, then I would assume that she is in fact aware that mental health care is available and how to get it if she wanted it.
So it boils down to: Do you have some reason to think she'd be a better sister or a better human being on amphetamines or similar? Probably not. She's already said she doesn't like how Adderall makes her feel. A lot of people don't. If she's disinterested in medication, then screening is probably pointless, since medication is the only thing you need the screening for. As a sister, none of this is your job to fix. She might be better off with a comprehensive treatment plan for ADD, including coaching and therapy and meds, but she might also be better off with a doubled income and a helpful husband, and you can't fix those, either. Fixing isn't your job. Let it go.
posted by Sequence at 4:44 PM on April 22, 2015 [2 favorites]
Since she dislikes doctors and isn't currently interested in trying medication, how about suggesting that she meet with someone who can help her figure out an organizational system / organizational techniques that work better for her? This might be a therapist who specializes in ADHD (and presumably is familiar with non-medication coping techniques) or some other professional - perhaps Metafilter has suggestions on what kind of person.
If you're going to suggest something like that, I'd make it as easy as possible for her, and also be clear that it's not because there's something wrong with her, it's because she's dealing with a lot. (For what it's worth, I don't have ADHD and I'd have trouble keeping up with that kind of paperwork while working full time and caring for multiple kids and a husband with health issues!) I'd tell her a) she's juggling an incredible amount of work and you want to help her if you can, b) you found a professional who specializes in helping people figure out systems to cope with this kind of situation c) you'll pay for a couple session with the professional, plus d) you'll arrange and pay for childcare (if needed) while she meets with them. If she says no thanks, tell her that the offer stands and she can take you up on it anytime, and then don't mention it again.
posted by insectosaurus at 4:49 PM on April 22, 2015 [1 favorite]
If you're going to suggest something like that, I'd make it as easy as possible for her, and also be clear that it's not because there's something wrong with her, it's because she's dealing with a lot. (For what it's worth, I don't have ADHD and I'd have trouble keeping up with that kind of paperwork while working full time and caring for multiple kids and a husband with health issues!) I'd tell her a) she's juggling an incredible amount of work and you want to help her if you can, b) you found a professional who specializes in helping people figure out systems to cope with this kind of situation c) you'll pay for a couple session with the professional, plus d) you'll arrange and pay for childcare (if needed) while she meets with them. If she says no thanks, tell her that the offer stands and she can take you up on it anytime, and then don't mention it again.
posted by insectosaurus at 4:49 PM on April 22, 2015 [1 favorite]
I'm on ADHD medication and it's bee super helpful for me and even so it is no magic wand. So I do things like work trades with people that make it easier for me to get help with things I'm terrible at (paperwork, organising, etc.) and doesn't feel like I'm a charity case because I help in return (oddly, other people's paperwork, other people's organising, cleaning, etc.). If your sister can help you with something, propose a work trade. Either way, you kind of just have to love her even though her life is a mess and it's stressing you to observe that. It is stressful to watch the people we love suffer.
posted by Bella Donna at 6:18 PM on April 22, 2015 [2 favorites]
posted by Bella Donna at 6:18 PM on April 22, 2015 [2 favorites]
You could look at this in two ways: my sister might have ADHD, can I help her with that? Or, my sister has a hard time with paperwork, can I help her with *that*? I have several family members medicated and having been through therapy/life coaching for ADHD. You know what? They still don't do paperwork very well, and rely on other family members to manage bills and other similar things. That's ok! They do other awesome stuff. But ADHD meds were not a magical paperwork pill.
So. Can you help her with paperwork? If so, does she want you to? You could ask and find out.
1. Automate what you can. Set up automatic payments for utilities, etc.
2. Set routines for everything else. "Put bills in this shoebox when you check the mail. Every other Sunday, we can fill them out when I come over for family dinner. I'll drop them in the mail for you on my way home." Or whatever works for you both. Routines help my ADHD family members when meds aren't enough. Also, the routines really help with the stress and anxiety.
posted by instamatic at 5:42 AM on April 23, 2015
So. Can you help her with paperwork? If so, does she want you to? You could ask and find out.
1. Automate what you can. Set up automatic payments for utilities, etc.
2. Set routines for everything else. "Put bills in this shoebox when you check the mail. Every other Sunday, we can fill them out when I come over for family dinner. I'll drop them in the mail for you on my way home." Or whatever works for you both. Routines help my ADHD family members when meds aren't enough. Also, the routines really help with the stress and anxiety.
posted by instamatic at 5:42 AM on April 23, 2015
How to encourage someone to get tested for ADHD? Is there anything I can say or do to convince her to at least consider screening?
Step 1) "Hey, have you considered getting tested for ADHD? I think you would benefit from a diagnosis because [no more than two or three brief reasons]. I would happily pay for the test, if that is an issue."
Step 2) Never ever bring it up again.
That's how you encourage someone to do something. Anything beyond Step 2 is nagging someone and trying to control their behaviors and actions, which you cannot do. Which brings me to:
But I want to help. I love her and like her as a person and there are many things she does well, but she is exhausting to be around most of the time. Our relationship is definitely one where I nag and she ignores me, and where this nagging makes her feel like crap about herself. I've been trying in the last year to give less advice and be more of a sister who just listens, but it's hard when someone's life seems to feature a crisis of the week that was caused by paperwork.
All if this is about you. Getting her tested will not change anything about your nagging and your desire to fix her, and in fact I'm wondering how a formal diagnosis is going to change anything. What happens next? The diagnosis just gives this a name. It sounds like right now you're nagging her about changing her behaviors and she's not doing what you want her to do; if she is formally diagnosed are you going to stop nagging her and let her listen to the psychologist who evaluates her, or are you going to continue making suggestions - and ultimately nagging her - about how she can fix her life in light of her diagnosis?
What if the screening is negative? Are you just going to go back to nagging her?
You don't like seeing her life in crisis. I'm sorry, and that sucks, but that is about you.
Being around her is exhausting. I'm sorry, and that sucks, but that is about you.
She feels like shit when you nag her. I'm sorry, and that sucks, but thankfully that is something you can totally control.
I want to help. Awesome. That's really great. Thankfully, you can say to her: "I don't like seeing your life in crisis because it worries me. I also know that you feel like shit when I nag you, and I apologize for that because the last thing I want to do is hurt you. I want to help though, so if you have any specific way that you would like me to help you, please, ask me."
Then wait. Don't hover, don't nag, don't rescue her.
That is hard to do. Super hard. I would be sitting on my hands and biting my tongue. But her life is not your job, and making her life your job harms you and it harms her. Me? I got tested when my life finally got so unmanageable that I decided to take steps to change my behaviors.
Good luck to both of you, and again, I am sorry you are going through this because it does sound really painful.
posted by good lorneing at 7:19 AM on April 23, 2015 [3 favorites]
Step 1) "Hey, have you considered getting tested for ADHD? I think you would benefit from a diagnosis because [no more than two or three brief reasons]. I would happily pay for the test, if that is an issue."
Step 2) Never ever bring it up again.
That's how you encourage someone to do something. Anything beyond Step 2 is nagging someone and trying to control their behaviors and actions, which you cannot do. Which brings me to:
But I want to help. I love her and like her as a person and there are many things she does well, but she is exhausting to be around most of the time. Our relationship is definitely one where I nag and she ignores me, and where this nagging makes her feel like crap about herself. I've been trying in the last year to give less advice and be more of a sister who just listens, but it's hard when someone's life seems to feature a crisis of the week that was caused by paperwork.
All if this is about you. Getting her tested will not change anything about your nagging and your desire to fix her, and in fact I'm wondering how a formal diagnosis is going to change anything. What happens next? The diagnosis just gives this a name. It sounds like right now you're nagging her about changing her behaviors and she's not doing what you want her to do; if she is formally diagnosed are you going to stop nagging her and let her listen to the psychologist who evaluates her, or are you going to continue making suggestions - and ultimately nagging her - about how she can fix her life in light of her diagnosis?
What if the screening is negative? Are you just going to go back to nagging her?
You don't like seeing her life in crisis. I'm sorry, and that sucks, but that is about you.
Being around her is exhausting. I'm sorry, and that sucks, but that is about you.
She feels like shit when you nag her. I'm sorry, and that sucks, but thankfully that is something you can totally control.
I want to help. Awesome. That's really great. Thankfully, you can say to her: "I don't like seeing your life in crisis because it worries me. I also know that you feel like shit when I nag you, and I apologize for that because the last thing I want to do is hurt you. I want to help though, so if you have any specific way that you would like me to help you, please, ask me."
Then wait. Don't hover, don't nag, don't rescue her.
That is hard to do. Super hard. I would be sitting on my hands and biting my tongue. But her life is not your job, and making her life your job harms you and it harms her. Me? I got tested when my life finally got so unmanageable that I decided to take steps to change my behaviors.
Good luck to both of you, and again, I am sorry you are going through this because it does sound really painful.
posted by good lorneing at 7:19 AM on April 23, 2015 [3 favorites]
I am 32 and, especially the past few years, have been incredibly disorganized and flaky. A few years back I wanted to be screened for ADD (no hyperactivity here) and I realized how very very subjective the testing process can be, especially when you're limited (as I am as well) to physicians covered by Medicaid.
I had a psychiatrist then I no longer see. I asked him to screen me, and he only asked me one question, which was what kind of grades I'd gotten in school. Since I'd performed well in school, he refused to explore further. I went to my gp next and she didn't ask many questions at all but agreed to start meds.
In my case, it shook out after a couple of years cracked out on Adderall that anxiety was the primary cause of my symptoms.
You've gotten a lot of good advice here about there being a limit to what you can and should do. You can no more force someone to get screened for this than for alcoholism. But also remember that testing for these things is incredibly difficult to even obtain, and even a thorough screening is just a snapshot. There aren't any genetic tests or markers.
posted by mermaidcafe at 7:31 AM on April 23, 2015
I had a psychiatrist then I no longer see. I asked him to screen me, and he only asked me one question, which was what kind of grades I'd gotten in school. Since I'd performed well in school, he refused to explore further. I went to my gp next and she didn't ask many questions at all but agreed to start meds.
In my case, it shook out after a couple of years cracked out on Adderall that anxiety was the primary cause of my symptoms.
You've gotten a lot of good advice here about there being a limit to what you can and should do. You can no more force someone to get screened for this than for alcoholism. But also remember that testing for these things is incredibly difficult to even obtain, and even a thorough screening is just a snapshot. There aren't any genetic tests or markers.
posted by mermaidcafe at 7:31 AM on April 23, 2015
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After a few sessions, the therapist pointed out that I was 'a bit hyper', noting that I talk fast and and have many thoughts to express. She did not mean it in a negative way, but was expressing an observation about my behavior.
I felt angry and spent a few weeks in denial. But I kept going to the same therapist, because I wanted to go to therapy for my depression (key word: wanted), and eventually learned enough about myself that I opened up to the idea that I did have ADHD, among other things, and took a strong interest in reading a lot of the literature on ADHD - especially as it applies to women.
As someone with ADHD, I can tell you that many of us get stressed out if we feel we're being forced or nagged by others to do something. That's not to say that you're forcing or nagging anything - but it may be interpreted that way, because oftentimes those of us with ADHD - undiagnosed or otherwise - don't want to deal with major, paradigm-shifting issues like this because it's overstimulating. And that's the thing - she's feeling overstimulated, which is deeply stressful and can reinforce unhealthy behaviors. ADHD types seek out stimulation because their brains are understimulated by nature (to put it very broadly and simplistically) but too much stimulation can have the same adverse affects. It's easy for stimulation seekers to overdose in their search for stimulation and the next exciting thing.
What I would recommend instead is to pick up a book like Women With Attention Deficit Disorder and Is it You, Me or Adult ADHD?: Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder. Spend time reading up on how you can better understand her and what she's going through.
Neither you nor I can diagnose your sister. But, your description suggests a strong likelihood of ADHD. There are other possibilities, yes - ADHD and Bipolar disorder are sometimes misdiagnosed as one another, for example. If she is resistant to the idea of seeing a therapist who can properly diagnose her, accept that and let it go for now. But read up on Adult ADHD, and read about how you, as a supporting and loving sister, can start to better understand what may be going on in her mind. It may help you to better communicate with her, which could lead to opening the door to real conversation about her at least seeing a therapist.
Also (and this is for your information, not for saying to her directly) - medication is not necessary to treat ADHD. In fact, I'd say cognitive behavioral therapy is more necessary. If you don't understand yourself and why your brain functions and responds to stimuli as it does, you will have a harder time on the path to finding a healthier, happier and more productive person. Drugs like Adderall are a tool. If you don't have the proper knowledge to use them, you'll just end up organizing your sock and underwear drawer for four hours straight. Furthermore, there are other drugs on the market that are excellent alternatives to Adderall and that she may potentially find more suitable. But, that's way down the road and dependent on her individual situation.
The main thing to remember here is that pushing, forcing, prodding, suggesting, hinting, whatever will rarely convince a person to do anything. You cannot make someone do something they don't want to do. Listening to her, however, and being supportive will build trust and a stronger bond. From there, things may start to fall in place. But let her come to you. No pushing. No hinting.
posted by nightrecordings at 3:47 PM on April 22, 2015 [1 favorite]