Seeing a psych for ADD/ADHD as an adult?
December 16, 2018 6:25 PM   Subscribe

I’ve never talked to a psychiatrist about possible ADD/ADHD, nor do I know much about it. I want to bring it up with a psychiatrist but I’m pretty paranoid!

My life since my teens has been plagued by difficulties concentrating, staying on task, etc. I wouldn’t study, wouldn’t do assignments on time, etc. I “saved” my grades for doing a really good job even when late, but felt like a failure all the time because I wasn’t learning as much as a person who actually studied. You nice I got my first office job I really languished— I would find it hard to do more than an hour or two of work a day without getting sidetracked or feeling overwhelmed. Once I got a job with flexible hours, I started staying way too late in the evening trying to make up for the wasted day.

I had a therapist in grad school who suggested I might see someone for ADD/ADHD (she probably specified but I don’t remember the difference). Unfortunately I was on student health insurance and while previously they had precisely one psychiatrist who could diagnose ADD/ADHD in students after 6 weeks of screening (for reasons of students abusing it), he had left and they officially had 0. So I accepted that I couldn’t do it then.

Now I have better insurance and am an adult with a job in technology. While I’m not a student anymore, this is another place in life where abuse of meds for focus & energy is rampant. I’m really afraid of talking to a psych about it, because I fully assume they will assume I’m faking so I can work 20 hour days.

Is it likely I will get something in my medical history akin to “med seeking behavior”? How should I approach this? Also, I currently see a psychiatrist periodically for anxiety meds through an online video chat service... is it even possible to get an ADD/ADHD diagnosis through this way in a California or am I definitely going to need to see someone in person? (I don’t mind going in person I’ll just have to figure it out for the first time.)
posted by stoneandstar to Health & Fitness (16 answers total) 11 users marked this as a favorite
You want to have "neuropsychological testing and evaluation" in order to have a proper diagnosis of ADHD, very few insurances cover this sort of testing, and so it is hard to get as an adult. I was diagnosed with ADHD as a child, but in order to be able to receive accommodations as an adult(for the state teacher test), I needed to have a new set of testing done. What I did was enroll in the flexible health spending account, in order to cover the cost of testing. Most primary care doctors, as well as psychopharmacologists will not prescribe ADHD medication without a diagnosis via neuropsychological testing at some point in your life. I did not start taking ADHD medication until my late thirties, and I can tell you that it has helped me significantly with staying on task. It doesn't help 100% of the time, more like 70%, but it has been a life changer for me.
posted by momochan at 6:35 PM on December 16, 2018 [3 favorites]

Yep, get tested. Testing doesn't have to be through a psychiatrist. Once you have a diagnosis (or not), you can decide on the next step.

The Find a Therapist tool from Psychology Today might be helpful. Once you choose your location, you can filter by specialty, including ADHD.
posted by SuperSquirrel at 6:47 PM on December 16, 2018 [2 favorites]

Possibly the answer varies depending on your location - I was diagnosed earlier this year (in my 40s) by a psychologist who specializes in ADHD. If I were a kid who needed an IEP or if I needed some other sort of official accommodation, I would have needed the full neurological battery of tests. But he did some preliminary testing and felt comfortable diagnosing me based on those results and my family and educational history. He coordinated with my PCP, who has no issue with prescribing based on his recommendations.

Based on r/adhd (which seems like not a bad forum) it seems like it is probably more common than not for adults not to do the full neuropsych thing. If you do, look into whether your local university may offer it more cheaply than a standard parctice.

I do think you need to see someone in person, though. But it has been so worth it to get that diagnosis - medication has been life changing for me. For the first time I don’t leave work every day in a stew of shame and panic.
posted by Kriesa at 6:51 PM on December 16, 2018 [5 favorites]

Is it likely I will get something in my medical history akin to “med seeking behavior”?

If you're imagining your doctor putting some kind of black mark on your record that will follow you forever, you should know that they can't actually do that. You need to grant permission for records from one doctor to be transferred to another. (And it's pretty common for people to just plain forget to transfer records, so it's not even like failing to grant permission is going to be a red flag.)

If one doctor suspects you of med seeking behavior, it will screw up your relationship with that doctor — and if they're part of a larger practice, the information can spread to the other providers at that practice. But it's not like a doctor you see years later in a totally different location will still be seeing "Stoneandstar asked too many questions about Adderall, you shouldn't ever trust them."
posted by nebulawindphone at 6:53 PM on December 16, 2018 [5 favorites]

Honesty, my child was diagnosed, I started reading up, learned it may be hereditary. A light clicked on. I told my symptoms to my GP and walked out with a starter script.
posted by rudd135 at 6:54 PM on December 16, 2018 [3 favorites]

IME dealing with adult adhd diagnosis, health insurance issues, medication, etc, is all 100% easier if the doctor you see for it is a neurologist and no one else, especially not a general therapist or some other adult-adhd-inexperienced doctor prone to biases against stimulant medication, if that's what turns out to be the right thing for you.

Ironically the right doctor for me turned out to be a pediatric neurologist but he's one of my best doctors; he is completely open to discussing in depth every medication I've ever asked about, totally without judgment, has never made me feel like a drug seeker or drug addict, and has been more knowledgeable about medication side effects than any other doctor I've seen in my life. This is the precise opposite of every other doctor I had in the past discussed a potential ADHD diagnosis with, from GPs to therapists to psychiatrists.
posted by poffin boffin at 7:07 PM on December 16, 2018 [4 favorites]

Not all add or adhd meds are stimulants or addictive so unless you go into this specifically asking for stimulants (and I wouldn't as they have a lot of side effects with long term use including weakened blood vessels and increased stroke risk) you need not even worry about being seen as drug seeking. Strattera is a very popular ADHD drug and it has worked well for me. I was diagnosed last year at the age of 42.
posted by TestamentToGrace at 7:25 PM on December 16, 2018

I see a Dr. who is board-certified in both neurology and psychiatric medicine. If I could only pick one, I’d go with a neurologist. ADHD is brain chemistry, not neurosis. My kids and I were part of an early study at UCLA dept of genetics.
posted by Ideefixe at 7:35 PM on December 16, 2018 [2 favorites]

You want to have "neuropsychological testing and evaluation" in order to have a proper diagnosis of ADHD

This might be a good idea but (for clarity) it is not a requirement, and it's expensive. Many psychiatrists are happy to diagnose ADHD and prescribe medication on the basis of a history. Although access to many ADHD medications is tightly controlled, the ADHD diagnosis is not really a legal concept and there isn't a fixed thing you have to do to get diagnosed.

Sometimes you will meet professionals who will shame and degrade you for doing ADHD wrong, or faking it, etc. Unfortunately, it's a feature of our system that you have to put yourself somewhat at the mercy of these people. But the good news is (as others have said) if you see a doctor who doesn't help you, just don't see them again and you generally don't have to worry about what they think following you around.

Since you already see a psychiatrist, you should try asking them about this -- if it turns out they can't help you, they may be able to help you find someone who can. I think it is likely your online psychiatrist can prescribe you ADHD meds but I don't know.
posted by grobstein at 10:37 PM on December 16, 2018 [7 favorites]

Do it. Do it. You sound like me 5 years ago when I was reading every ADHD AskMe, complete with not wanting to appear drug-seeking. Just describe the symptoms you think are ADHD and see what they say, you don't need to speculate what you might need for what you're describing in order to force a certain diagnosis or prescription. It might not actually be ADHD, or it might be mixed up with the other things you're seeing a psych for, and so not readily distinguishable. They might just give you a questionnaire for testing. tl;dr: let them be the smart one.

If you don't like how your Dr. reacts to all this, pick another one.

My path was to pick a therapist from the above-linked Psychology Today site, then ask them for references to prescribing doctors. I've had mixed results with therapists and my first Dr. was good and nice and smart, but not particularlyl aggressive. I'm doing much better with a new Dr. and new prescription. And a new therapist, but that was unrelated. Consider switching things up if not enough is getting better after a year or so.
posted by rhizome at 1:46 AM on December 17, 2018 [4 favorites]

I've dealt with similar situations by telling my primary doc (or a psych doc) the truth which boils down to:

* I am experiencing symptoms x/y/z
* These symptoms are affecting my life to in the following ways...
* I understand that these can be related to condition A and I would like to explore that
* I am open to non-drug strategies such as therapy (somewhat more relevant with depression/anxiety)
* (if relevant) - I have tried non-Rx strategies (exercise, meditation, etc) and this is what I have noticed...
* If condition A is not the problem/drug B is not the answer then I still need to figure out what is causing these symptoms and how to address them

Things that will raise concerns that you might be a drug-seeker include insistence on a specific diagnosis/drug, anger if not provided or if testing is needed to confirm the diagnosis, lack of willingness to try anything besides a specific drug.

There's more to addressing ADD than getting drugs. They do help but you also need strategies. As a mefite once said on the green, the drugs give you focus but you have to learn how to manage that focus.
posted by bunderful at 7:59 AM on December 17, 2018 [3 favorites]

A previously that may be helpful.
posted by emkelley at 10:30 AM on December 17, 2018

Oh! Bunderful's comment reminds me that another thing that might happen is you might be prescribed a nonstimulant ADHD med, like Strattera. Like any psych med (including Adderall, Ritalin, etc), these work for some people and not others. Some psychiatrists like to try Strattera first out of the belief that it's less scary/harmful/abusable than the stimulants.

"I will try you on this med before trying you on a stimulant" is a reasonable approach, and shouldn't be a red flag. "I won't put you on a stimulant ever, so it's this med or nothing" is less reasonable, and if that happens to you it's a good reason to switch doctors.
posted by nebulawindphone at 10:39 AM on December 17, 2018 [2 favorites]

It really depends on who you get. When I was a student, I was diagnosed with ADHD as part of a clinical trial in diagnostic methods that was run by my school, so I got the whole battery of tests. But for a long time, I had shitty insurance or no insurance, and at one point went through the extreme rigamarole of getting an appointment with a county psychiatrist only to be told that if I had ADHD, I would have been diagnosed as a child and maybe I should try just exercising more. Because I was worried about looking like I was med seeking, I hadn't even brought up the stimulants thing, and eventually managed to cajole my parents' doctor into prescribing bupropion, which is an anti-depressant with off-label use for managing ADHD. It's OK, it helped a little (mostly because it turns out that major depression also makes it harder to handle ADHD), but when I got my current insurance, I went to see the doc and she just asked if I had ever tried stimulants and said that basically, the diagnostic criteria they use is that if you give a qualitative account of the symptoms and history, and respond to stimulants, you've got ADHD and they just prescribe 'em then work to dial in the dosage. It's been a goddamned godsend.

So while neither the county doc nor my current doc cared about the battery of ADHD diagnostic tests, I still found them useful, and I know that universities near me are still running trials of new diagnostic batteries that they'll pay adults who suspect they have ADHD to take part in. (The only caveat that I'll give is that they were LONG — it was like three hours of intense testing on three different days.) They gave me a pretty good framework to talk about my ADHD in a way that did help when talking to a good doc — I could answer pretty specific questions about the way it manifested. And if I had known then what I know now, I would have worried a lot less about coming across as drug seeking and just gone for it, because a good doc will know the literature well enough to discern your needs.
posted by klangklangston at 10:41 AM on December 17, 2018 [2 favorites]

One other note. You might have already picked up on this by reading these answers, but no one has come out and said it afaict: a lot of adults have this diagnosis; a lot of adults are taking these medications. It's pretty damn normal. Good luck.
posted by grobstein at 7:22 PM on December 17, 2018 [1 favorite]

Best answer: This varies a lot.

I paid $1200 out of my HSA to have the full battery of tests done and walked out with a 12-page assessment report signed by two psychologists with my diagnosis and test results, which I took to my GP for meds. The GP accepted the report with no issues and has been very hassle-free with my medication.

I have a friend who went to her regular doctor, talked about her focus and attention issues, and was prescribed directly based on her history and symptoms.

For me, doing the testing was worth it because a) it gave me invaluable backup data if anyone questions my diagnosis in the future b) when I start to get down on myself for being a terrible person who can't X properly I can go read the report and remind myself that I have a legit medical condition. So for me... a lot of the benefit was peace of mind that I'd started solid? It also helped me assuage my worries about being labelled as "drug seeking" - which, based on many conversations I've had with others, nearly every newly diagnosed adult worries about and it's totally normal.

Also: if you are what they call "twice-exceptional" ie you are gifted as well as ADHD, it might help to do the tests. Many gifted ADHD-ers don't ping all the expected boxes due to being able to sort of brute-force tasks with intelligence (like doing your homework in a rush in between classes but still getting a good grade.) I was valedictorian of my high school class, graduated with honors from a tough school... then flamed out of grad school spectacularly because I'm ADHD as hell and finally reached the point where I could no longer compensate for procrastination with intelligence. When I did testing they started with IQ tests and then they looked at the focus and attention tests not just for "how well did she score" but "how well did she score, as compared to how well someone with this IQ would be expected to score if they were neurotypical" which helps to get rid of that confounding effect.

(So many things I thought were a sign I was uniquely terrible in some way were Totally Normal for ADHD, it was relevatory.)
posted by oblique red at 11:09 AM on December 19, 2018 [2 favorites]

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