Adult AD(H)D diagnosis and treatment for dummies
December 13, 2019 7:40 AM Subscribe
I think that treatment for ADD/ADHD might help with some of the symptoms I've discussed in my previous questions. In particular, I want to know if medication is the right solution for me. Can someone walk me through the process of getting the appropriate diagnosis or diagnoses to try medication? Specific questions below the fold.
1. I'm female and I don't have "classic" executive function symptoms. Are there specific types of doctors or practices I should look for who will understand how ADD/ADHD presents differently in women than in men, and who will not treat me rudely or dismissively?
2. Is this diagnostic process something my insurance will likely cover? I have a PPO plan. If not, what costs can I expect? Is this in the realm of $1,000 or $10,000 out of pocket?
3. What will the diagnostic process look like? Will my parents be required to participate? I have reason to believe that if my parents were involved, their responses would make it more challenging for me to get an appropriate diagnosis.
4. I have heard that ADD/ADHD medication causes weight gain and loss of libido. Are these side effects universal, or do they vary from one prescription to another? Can they be mitigated?
5. The only reason I am interested in seeking a diagnosis is to get treatment. Is it easier to get treated for my types of symptoms (memory and attention issues, impulsive behaviors, repetitive behaviors, sensory sensitivity) without a formal diagnosis and if so, how?
I am in the Washington, DC area, if anyone has any locally-specific advice.
1. I'm female and I don't have "classic" executive function symptoms. Are there specific types of doctors or practices I should look for who will understand how ADD/ADHD presents differently in women than in men, and who will not treat me rudely or dismissively?
2. Is this diagnostic process something my insurance will likely cover? I have a PPO plan. If not, what costs can I expect? Is this in the realm of $1,000 or $10,000 out of pocket?
3. What will the diagnostic process look like? Will my parents be required to participate? I have reason to believe that if my parents were involved, their responses would make it more challenging for me to get an appropriate diagnosis.
4. I have heard that ADD/ADHD medication causes weight gain and loss of libido. Are these side effects universal, or do they vary from one prescription to another? Can they be mitigated?
5. The only reason I am interested in seeking a diagnosis is to get treatment. Is it easier to get treated for my types of symptoms (memory and attention issues, impulsive behaviors, repetitive behaviors, sensory sensitivity) without a formal diagnosis and if so, how?
I am in the Washington, DC area, if anyone has any locally-specific advice.
As an adult, I started by going to a therapist with an ADHD specialization to discuss my symptoms, who connected me with a psychiatrist for medication. I found my therapist through the Psychiatry Today Therapist Finder. The psychiatrist took my insurance, and it was a standard specialist co-pay. My therapist did not take my insurance, but worked on a sliding scale, so I paid him the same specialist co-pay for each session.
As for the side-effects of ADHD medication, as most of it is stimulant based, it's not likely to cost weight gain. It often has appetite suppressant effects. Loss of libido isn't something I've heard about as an issue either, but it deepends on what you're on. Bring these issues up with your psychiatrist when discussing medication.
posted by SansPoint at 8:10 AM on December 13, 2019
As for the side-effects of ADHD medication, as most of it is stimulant based, it's not likely to cost weight gain. It often has appetite suppressant effects. Loss of libido isn't something I've heard about as an issue either, but it deepends on what you're on. Bring these issues up with your psychiatrist when discussing medication.
posted by SansPoint at 8:10 AM on December 13, 2019
Im not an MD or in any way qualified to diagnose anything so feel free to ignore, but I'm not sure you will be diagnosed with or treated for ADHD based on your self-described symptoms from your other posts given that you have no EF issues AND are performing well at work AND are super organized, and capable of focusing under the conditions you describe. I'm a woman with diagnosed ADHD and can't relate to much in your post. Definitely sounds more like you're on the spectrum to me, as someone who has a lot of nonNeurotypicals of various stripes in her family. But I definitely agree a stimulant might be helpful for a few of your issues (constant interruption for eg). My cousin who is autistic benefits from stimulant meds.
Forgive me if I missed this in your posts, but have you ever been evaluated for autism or any other disorder related to socialization? Many adhd specialists can also evaluate you for autism I believe. I have a fantastic psych recommendation that I will MeMail you (he's in Boston unfortunately, but he does have many clients who travel to him monthly). I think he would be very helpful in teasing out whatever is going on -- he's the most thorough psychiatrist of 5+ I've worked with and tested me for everything
posted by shaademaan at 8:15 AM on December 13, 2019 [1 favorite]
Forgive me if I missed this in your posts, but have you ever been evaluated for autism or any other disorder related to socialization? Many adhd specialists can also evaluate you for autism I believe. I have a fantastic psych recommendation that I will MeMail you (he's in Boston unfortunately, but he does have many clients who travel to him monthly). I think he would be very helpful in teasing out whatever is going on -- he's the most thorough psychiatrist of 5+ I've worked with and tested me for everything
posted by shaademaan at 8:15 AM on December 13, 2019 [1 favorite]
I have ADHD and I take Ritalin for it. This medication is well known to suppress appetite, so I've only ever lost weight while on it. (Usually though I don't lose, I just eat a lot in the evenings when I find I'm ravenous because the medication wore off, lol.)
The diagnostic process varies WILDLY from case to case, depending on the idiosyncrasies of your prescribing doctor. I have a friend who did an exhaustive 5-hour battery of computerized tests measuring response speed, memory, etc. to diagnose ADD separately from their Bipolar disorder. I have another friend who described symptoms to their regular doctor and walked away with both a diagnosis and a prescription after a 30 minute appointment (some questions were asked to diagnose, but nothing too deep). I myself had to go to three one-hour interviews with a psychologist who gave me several assessment questionnaires (which seemed super subjective to me, tbh) and asked me a lot of questions about my life. At the end of the three appointments, he gave me a diagnosis and then my doctor wrote me a prescription + recommended therapy.
I don't think your parents will ever need to be interviewed, however, unless you're a child/minor or otherwise require guardianship.
posted by MiraK at 8:49 AM on December 13, 2019 [1 favorite]
The diagnostic process varies WILDLY from case to case, depending on the idiosyncrasies of your prescribing doctor. I have a friend who did an exhaustive 5-hour battery of computerized tests measuring response speed, memory, etc. to diagnose ADD separately from their Bipolar disorder. I have another friend who described symptoms to their regular doctor and walked away with both a diagnosis and a prescription after a 30 minute appointment (some questions were asked to diagnose, but nothing too deep). I myself had to go to three one-hour interviews with a psychologist who gave me several assessment questionnaires (which seemed super subjective to me, tbh) and asked me a lot of questions about my life. At the end of the three appointments, he gave me a diagnosis and then my doctor wrote me a prescription + recommended therapy.
I don't think your parents will ever need to be interviewed, however, unless you're a child/minor or otherwise require guardianship.
posted by MiraK at 8:49 AM on December 13, 2019 [1 favorite]
As for learning more about ADHD in women, I highly recommend Sari Solden's book WOMEN WITH ATTENTION DEFICIT DISORDER. A couple of other books were helpful too but none so much as this one, which really is substantial, not dumbed down.
The battery of computerized tests cost about $1000 but insurance covered most of that for my friend, who ended up paying about $120. My three therapy appointments for assessment were also covered but would otherwise have cost me about $500 total.
You can easily get psychotherapy for your symptoms without a diagnosis. It could easily be effective for you! But if you need medication, you will need a diagnosis. For me, though therapy has been great as a supplement to my medications, I saw a huge difference from meds alone and would never go without them.
posted by MiraK at 9:01 AM on December 13, 2019 [1 favorite]
The battery of computerized tests cost about $1000 but insurance covered most of that for my friend, who ended up paying about $120. My three therapy appointments for assessment were also covered but would otherwise have cost me about $500 total.
You can easily get psychotherapy for your symptoms without a diagnosis. It could easily be effective for you! But if you need medication, you will need a diagnosis. For me, though therapy has been great as a supplement to my medications, I saw a huge difference from meds alone and would never go without them.
posted by MiraK at 9:01 AM on December 13, 2019 [1 favorite]
1. I'm female and I don't have "classic" executive function symptoms. Are there specific types of doctors or practices I should look for who will understand how ADD/ADHD presents differently in women than in men, and who will not treat me rudely or dismissively?
Are you sure you don't have classic executive function symptoms? Completing work quickly can be a sign of hyperfocus. Does your work have typos or other mistakes in it? Do you proofread it before turning it in? How many books are piled beside your bed right now? Any laundry not folded? How's your time management? Are you late to things, or excessively early? Do you have trouble finishing books, or boring work documents, or focusing during power point presentations? Do you zone out when people are talking to you, and then miss the important parts of the conversation? Do you fidget? Do you doodle? Do you find it hard to focus on work if there is music or the TV on, or do you NEED music or television to stay focused on your work? How many tabs do you have open right now?
As for doctors, I'd talk to local friends. Be open that you're trying to find someone to diagnose you with ADHD. Once I put it out in my online social networks that I was looking for a diagnosis, I received several messages that local friends--who I hadn't known were diagnosed--all saw the same doctor in my area.
2. Is this diagnostic process something my insurance will likely cover? I have a PPO plan. If not, what costs can I expect? Is this in the realm of $1,000 or $10,000 out of pocket?
If you see a GP, it will likely be covered though there may be incidental costs; I have a heart murmur and had to spend several months and a few thousand dollars getting my heart checked out before I was diagnosed. Unless you see a neuropsych for an evaluation, you are likely to be handed a questionnaire to fill out, and then you'll have an in-office conversation about it.
3. What will the diagnostic process look like? Will my parents be required to participate? I have reason to believe that if my parents were involved, their responses would make it more challenging for me to get an appropriate diagnosis.
The online ADHD evaluations I filled out and brought with me were more thorough than the questionnaire my doctor handed me. I came in prepared with anecdotes from work, my personal life, and my childhood. I'm no contact with my mother. However, I did tell my doctor how my parents were frequently exasperated by my general inability to keep a tidy room or desk despite being labeled gifted, and how I saw myself as "lazy" as a result.
4. I have heard that ADD/ADHD medication causes weight gain and loss of libido. Are these side effects universal, or do they vary from one prescription to another? Can they be mitigated?
I'm on a relatively low dose of Adderall and I've lost 15 pounds in 6 months. If anything, my libido is stronger.
5. The only reason I am interested in seeking a diagnosis is to get treatment. Is it easier to get treated for my types of symptoms (memory and attention issues, impulsive behaviors, repetitive behaviors, sensory sensitivity) without a formal diagnosis and if so, how?
I had been trying to treat my symptoms (disorganization, irritability/depression, anxiety) with CBT or general life hacks for years and it was exhausting and didn't work. Getting an Adderall prescription has been lifechanging. I can now see that I was struggling to function all the time. All the time.
posted by PhoBWanKenobi at 10:24 AM on December 13, 2019 [3 favorites]
Are you sure you don't have classic executive function symptoms? Completing work quickly can be a sign of hyperfocus. Does your work have typos or other mistakes in it? Do you proofread it before turning it in? How many books are piled beside your bed right now? Any laundry not folded? How's your time management? Are you late to things, or excessively early? Do you have trouble finishing books, or boring work documents, or focusing during power point presentations? Do you zone out when people are talking to you, and then miss the important parts of the conversation? Do you fidget? Do you doodle? Do you find it hard to focus on work if there is music or the TV on, or do you NEED music or television to stay focused on your work? How many tabs do you have open right now?
As for doctors, I'd talk to local friends. Be open that you're trying to find someone to diagnose you with ADHD. Once I put it out in my online social networks that I was looking for a diagnosis, I received several messages that local friends--who I hadn't known were diagnosed--all saw the same doctor in my area.
2. Is this diagnostic process something my insurance will likely cover? I have a PPO plan. If not, what costs can I expect? Is this in the realm of $1,000 or $10,000 out of pocket?
If you see a GP, it will likely be covered though there may be incidental costs; I have a heart murmur and had to spend several months and a few thousand dollars getting my heart checked out before I was diagnosed. Unless you see a neuropsych for an evaluation, you are likely to be handed a questionnaire to fill out, and then you'll have an in-office conversation about it.
3. What will the diagnostic process look like? Will my parents be required to participate? I have reason to believe that if my parents were involved, their responses would make it more challenging for me to get an appropriate diagnosis.
The online ADHD evaluations I filled out and brought with me were more thorough than the questionnaire my doctor handed me. I came in prepared with anecdotes from work, my personal life, and my childhood. I'm no contact with my mother. However, I did tell my doctor how my parents were frequently exasperated by my general inability to keep a tidy room or desk despite being labeled gifted, and how I saw myself as "lazy" as a result.
4. I have heard that ADD/ADHD medication causes weight gain and loss of libido. Are these side effects universal, or do they vary from one prescription to another? Can they be mitigated?
I'm on a relatively low dose of Adderall and I've lost 15 pounds in 6 months. If anything, my libido is stronger.
5. The only reason I am interested in seeking a diagnosis is to get treatment. Is it easier to get treated for my types of symptoms (memory and attention issues, impulsive behaviors, repetitive behaviors, sensory sensitivity) without a formal diagnosis and if so, how?
I had been trying to treat my symptoms (disorganization, irritability/depression, anxiety) with CBT or general life hacks for years and it was exhausting and didn't work. Getting an Adderall prescription has been lifechanging. I can now see that I was struggling to function all the time. All the time.
posted by PhoBWanKenobi at 10:24 AM on December 13, 2019 [3 favorites]
I am in Australia. My psychologist referred me to a psychiatrist after I kept saying "I can't concentrate". I was in my early 40s. The psychiatrist gave me a very long questionaire that at points I struggled to answer honestly because while I may have experienced X in the past, it wasn't at that moment an issue, but I figured it was relevant and gave it a mid to high rating because X was a reasonably regular occurrence. He would have liked to have interviewed my parents (both deceased) but I did tell him my report cards frequently said: should pay more attention in class, not reaching potential etc. I told him how I got my degree in 15 minute increments (15 minutes study, 15 minutes housework etc) and after a couple of brain exams (one in a tube, one with stickers on my head) to rule out other conditions, I was prescribed dexamphetamine sulphate (previously used to assist with weight loss), and told to keep increasing the drug until I noticed a difference. I started on 15mg and my life changed. The shrink told me that unlike recreational users I would be able to keep at the same level (though, for a period when I was very active 10k a day) we bumped up the dosage because my metabolism was faster. My GP now prescribes it for me.
posted by b33j at 4:09 PM on December 13, 2019 [1 favorite]
posted by b33j at 4:09 PM on December 13, 2019 [1 favorite]
This thread is closed to new comments.
I feel like I'm going to doctors with a broken ankle and people are telling me "oh no RC, you're so wonderful and lovely, you should stop using words like 'broken' to describe yourself". You know?
posted by robot cat at 7:47 AM on December 13, 2019 [1 favorite]