How do I get an evaluation for things like ADD?
July 5, 2015 1:43 PM   Subscribe

I'm an American woman in my mid 30s. I think I might have ADD or something like it, but I don't understand what the procedure is for being evaluated (/diagnosed, if there's something to diagnose). Where do I start? Far too many details follow, sorry.

A few months ago, I talked to my GP about what I identified as anxiety. She agreed that it could be anxiety and referred me to the psych department of her medical group, which is a big system that includes lots of specialists. My insurance said no; I have to use someone from their list. Mostly due to anxiety, coupled with confusing and incomplete information from my insurance, I still haven't found someone from that list. If I get spousal help and persist, I can probably find somebody who will give me CBT for anxiety.

But what if that's not what I need?

In the meantime, several other female friends have gone to get psych help for things like anxiety or depression, and have received surprising diagnoses including ADD, autism, and PTSD. (Their gender is only relevant because most of these diagnoses are determined differently for women, and because that's why we're all looking into this stuff later in life than people usually do.) These diagnoses have proved immensely useful to them. I don't want to diagnose myself with anything, but in particular, ADD seems pretty likely. I have trouble staying on-task for the length of, like, carrying an envelope to the recycling. And my house is a disaster zone. I really think I need help, but I'm not sure what kind of help. So I would like to find out if I need help for anxiety, or for ADD, or what, and I would like a professional to do it.

Anyway, I only have experience with therapists and psychiatrists who do talk therapy for depression. There was no real intake process looking for any other issues (just, you know, screening for imminent self-harm or whatever).

So what all this boils down to is:

What kind of facility/doctor/office do I go to? What kind of appointment or service am I asking for/looking for?

Where do I start with my insurance? (It's Anthem-Blue Cross, like a lot of West Coasters who aren't on Kaiser, but it's also confusing because it's a government-employee, union-negotiated package that isn't exactly the same as anyone else's--and it does claim to offer mental health benefits, but I can't figure out how to access them and phone calls terrify me.)

If I have to pay out of pocket, I will. The most important thing is knowing what I'm actually looking for.

Specific doctor/clinic/etc. recs are certainly welcome too. I currently live in Northern California, but more like Livermore or Concord and less like SF/Oakland/SJ.
posted by kutsushita nyanko to Health & Fitness (14 answers total) 11 users marked this as a favorite
keywords that may be helpful in your search: psychological testing, psychological assessment. these types of things are usually done by people with PsyD's, or people in the neuropsych field. hope that helps get you a tiny bit further...
posted by carlypennylane at 2:12 PM on July 5, 2015

CHADD is probably your best source of local resources.

You'll go to a doctor, probably a psychiatrist, you'll take some tests (maybe on paper, maybe electronic, probably a final stage of testing will be a verbal conversation with the doctor but don't be surprised if you don't meet that person until after all the assessments), they tell you what to do next. They will lead the way for you.

It may be easier to identify available doctors in your area first (that they still exist, and then that they are taking new patients) and then ask THEM to figure out if they take your insurance. They are often better at it than the insurance company anyway, they have more motivation to be right.
posted by Lyn Never at 2:18 PM on July 5, 2015 [1 favorite]

You're making it more complicated than it needs to be. Those same therapists and psychiatrists who helped you deal with depression should also be able to help you determine if ADHD is a possible problem for you , they should also be able to help with anxiety.

There's no clear test for ADHD, it's primarily diagnosed through observation and survey, frequently it's a matter of saying "Yep, that's what it looks like", and seeing if the usual meds help. A good therapist can also help you deal with some of the other aspects of ADHD....
posted by HuronBob at 2:22 PM on July 5, 2015 [2 favorites]

You're making it more complicated than it needs to be. Those same therapists and psychiatrists who helped you deal with depression should also be able to help you determine if ADHD is a possible problem for you , they should also be able to help with anxiety.

Not really, since that was years ago, in a different city, and part of my graduate school.
posted by kutsushita nyanko at 2:30 PM on July 5, 2015 [2 favorites]

When I got diagnosed with ADHD, I got referred to a psychologist for that purpose by my PCP (but I belong to an HMO so all their psychologists were covered.) Once there, he and I talked for two hours; he had some very specific but not leading questions. I did my best to be as honest as possible and not "point" my responses in one direction or another. At the end of those two hours, he felt confident that my initial hunch that I had ADHD was well-supported by my answers to his questions, and he recommended some books and referred me to a psychiatrist for a discussion of medication. That psychiatrist did his own 1-hour talk evaluation to rule out things like bipolar disorder or a history of psychosis, and prescribed me a very low dose of Adderall to see if I would tolerate it well. I did, they brought it up into a therapeutic range, and that is where I remain. It has in fact been incredibly helpful for managing both my anxiety and my depression. I am a 40 year old woman, I was diagnosed in November of 2014, and if you want to know more about my experiences, feel free to memail me.
posted by KathrynT at 2:33 PM on July 5, 2015 [6 favorites]

I would definitely try to seek out someone who specializes in ADD/ADHD specifically. It's unfortunate but there are still a lot of docs out there who think ADD doesn't exist, and it's incredibly frustrating to essentially be told you're making things up, especially since women can have slightly different symptoms than the stereotypical hyperactive young boy.

CHADD is a great place to start and will definitely have links to resources in your area. I should note that I was diagnosed by a Psych nurse practitioner prior to seeing a specialist doc, which insurance companies tend to be happier about covering (and the nurse practitioner was more thorough than any of the docs I've seen, to be honest).
posted by AaronRaphael at 2:39 PM on July 5, 2015 [2 favorites]

A couple years ago I provided a detailed description of the ADHD screening process in response to another, somewhat different question--perhaps it would help answer yours. I think a rigorous screening process is really helpful, because it helps prevent you from second-guessing yourself about whether you really do have ADHD or not--it's pretty damn hard to fake.

It is possible for ADHD to present along with anxiety and/or depression (I am being treated for both, after having been treated for depression only for more than a decade). In many cases (probably mine) the ADHD contributes to the depression and/or can create a vicious sort of catch-22.
posted by tully_monster at 2:54 PM on July 5, 2015 [3 favorites]

For my SO, it was a just a matter of finding an in-network psychiatrist from the list on her insurer's website and scheduling an appointment. After some discussion, she was referred to a CBT psychologist for her anxiety and prescribed appropriate meds. Some time later it became clear she also had ADD, so in one of her occasional visits with her prescribing psychiatrist, she brought it up as a possibility, he "tested" her, and she left with a low dose of Ritalin. After finding that didn't work as well as would be expected, she was switched to Adderall, which worked wonders.

That was in Oklahoma, though, where there are apparently fewer rules on prescribing Adderall. Having moved to Florida, it is proving to be a longer process to get ADD meds, but again it is just a matter of making an appointment with a psychiatrist that was accepting patients and going through the process. (Easier said than done when one has ADD and anxiety, I know!)
posted by wierdo at 3:03 PM on July 5, 2015 [1 favorite]

I'd find a neurologist. Mine is board-certified in psychiatric medicine as well as neurology and is located in Pasadena. MeMail me if you'd like his contact info.
posted by Ideefixe at 4:14 PM on July 5, 2015

Trying not to threadsit, but Ideefixe, could you expand on the neurologist suggestion? That's not a direction I had considered. (I actually have a neurologist because of a peripheral nervous system thing I had a couple years ago, though I don't know if he does psych stuff at all.)

Pasadena is the wrong end of the state, though.
posted by kutsushita nyanko at 4:40 PM on July 5, 2015

Since you're dealing possibly with both anxiety and ADHD (both things that can make things that seem simple to others really hard to do), make this as easy as possible on yourself and make an appointment with one of the doctors on your insurance's list. Just start at the top of the list and go down from there. Call each (or email if that's possible and easier for you) and ask them if they can screen you for ADHD, per your GP's suggestion (the last part is important so they don't think you're just trying to score some ritalin). Either a psychologist or a psychiatrist is fine (the former can't prescribe but your GP can, with a diagnosis).

Here's how it went when I was diagnosed with ADHD as a thirty-something woman: like you, I talked to my GP and she referred me to a psychologist (luckily in my case I was able to go with the clinic she recommended). I met with a psychologist for about 3 hours over 2 sessions. He asked me a bunch of questions and had me take a computer test that tested impulsivity and sustained attention (I think). Incidentally, he also screened me for depression and anxiety as well, since those are often comorbid with ADHD and/or can present with ADHD-like symptoms. He diagnosed me with ADHD and then I went back to my doctor, who prescribed me Concerta. I had had a lot of anxiety about the whole thing ahead of time, but it was extremely straightforward.

If you do get a diagnosis of ADHD, that can often be managed fairly effectively with medication only (ie, no talk therapy). Many people do find it helpful to work with an ADHD coach in addition to the meds, but that's usually not covered by insurance.

As for the anxiety, if you like the person who does your screening, you can continue to see him or her. If not, you can do what I did when I was looking for a GP: check out the online reviews for the docs your insurance will cover.

I do think getting the ADHD question answered first will probably be extremely helpful, because it is relatively simple to treat, and if you do have ADHD, you will probably find that the meds make an enormous difference (like RIGHT AWAY in my experience) in your ability to deal with complicated life stuff like finding the right therapist.
posted by lunasol at 6:27 PM on July 5, 2015 [2 favorites]

What kind of facility/doctor/office do I go to?

Start with your Primary Care Provider, ask for a complete physical. List your specific symptoms, explain that you suspect some mental health issues are at work here and that you want to rule out any medical problems that present as a mental health disorder or problems that can complicate a diagnosis. This will give your PCP an idea of what to screen for on the medical side.

Where do I start with my insurance?

Call and ask member services for an overview of your mental health care benefits and list of providers in your area that accept BXBS. Tell them you need an assessment and evaluation. They'll tell you about any in-network/out-of network options, co-pays/co-insurance. You might also be able to look this information up online.

Also ask around - friends, family, old therapists etc. - for recommendations.

It's really not necessary to see an ADHD specialist for an accurate diagnosis - just as one needn't see an ENT to diagnose a sinus infection. Any competent, credentialed therapist, psychiatrist or psychiatric nurse practitioner can diagnose depression, anxiety, ADHD etc. Again, explain your symptoms with as much specificity as you can, explain you suspect ADHD but want as thorough evaluation as possible to confirm/rule out other disorders.

Appropriate treatment follows a good evaluation - treatment is where an ADHD specialist comes in handy if that is in fact what's going on.
posted by space_cookie at 10:29 AM on July 6, 2015

Two relevant diagnostic instruments are:

1) Brown (Adult) ADD Scales
2) Barclay (Adult) ADHD Structured Interview

ADHD specialist or not, a psychiatrist, psychologist (maybe), or neuropsych MD person familiar with these as well as MMPI-2 can likely provide evaluation and diagnosis that will pass muster with your GP and insurance for meds (or whatever is indicated).

Tell them you have reason to believe this is your issue, and you want to investigate it (rule it in or out) so that you can keep sufficiently on task in your life and employment.
posted by lathrop at 3:46 PM on July 6, 2015 [1 favorite]

My diagnosis involved two diagnostic visits with various surveys or interviews, timed light / reaction tests to see how my internal sense of timing and focus worked, pattern recognition / "what's different between these images" tests almost out of Highlights magazine, and quite importantly, a questionnaire for a close relative or other relation to fill out for an additional perspective.
posted by aydeejones at 8:34 PM on January 3, 2016

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