Adult ADHD Assessment and Diagnosis
By Heidi Bernhardt, RN
The procedure of diagnosing adult ADHD is very similar to diagnosing ADHD in children. In fact it is quite common for adults to be diagnosed after their children are diagnosed.
The Assessment Process
The assessment and potential diagnosis of ADHD is not an easy 15-minute doctor visit. The process should be thorough and take more than one visit. An assessment can be done by a psychiatrist, psychologist, neurologist or a family doctor who is trained in ADHD. Since a thorough assessment requires a complete physical and psychiatric medical history and some type of screening to rule out any possible physical disorders, receiving an assessment by a physician at some point is recommended.
During a complete diagnostic procedure, screening for other conditions (such as anxiety and depression) that often coexist with ADHD should also be completed. Only 1 in 5 people have uncomplicated ADHD, or ADHD without any other coexisting conditions. All assessments should include an extensive interview with the patient, parents or significant other, and the administration of various symptom rating scales. Ideally, more than one scale is used to confirm the results.
A Thorough Assessment Should Include:
- A comprehensive physical history paying particular attention to disorders that may mimic the symptoms of ADHD – blood tests may be ordered to rule out any thyroid and kidney issues.
- A personal and family history of mental health disorders paying particular attention to disorders that may mimic the symptoms of ADHD –anxiety disorders, mood disorders, substance abuse issues and personality disorders.
- A personal and family history of cardiac issues.
- A review of childhood symptoms – for a diagnosis to occur symptoms must have been present by the age of 12. If possible, a review of old report cards or a discussion with parents can be helpful.
- Rating scales of symptoms completed by the adult being assessed and a significant other -those with ADHD are not always best at recognizing their own symptoms and areas where they have difficulties in functioning.
For a complete list of potential symptoms access Adult ADHD Red Flags
Some adults with ADHD will end up at their doctor’s office complaining of symptoms that differ from those that we normally associate with childhood ADHD. They may complain of feeling anxious or depressed, having trouble sleeping at night and waking up in the morning. Some adults with ADHD complain of feeling angry and irritable a great deal of the time. They may struggle with productivity, motivation, organization and procrastination. If impulsivity is a problem they may be experiencing some significant financial, social or legal consequences. Mood dysregulation can also be a symptom experienced by many with adult ADHD. Adults with ADHD have also had many years to perfect coping strategies, some helpful, others less so, which can mask the underlying ADHD symptoms making the diagnosis more difficult.
It may be their partner who demands that they go to see the doctor as many adults are unaware of their difficulties and how they impact others. If someone has lived with a condition all of their life, recognizing symptoms as those of a disorder may be a challenge. After all, this is the way their mind has always functioned.
Difficulties in Receiving an Assessment for Adult ADHD
Being able to find a physician to do an assessment in order to receive a diagnosis may be quite a challenge. Since the process of diagnosing ADHD is commonly done by physicians who specialize in childhood disorders such as paediatricians or child and adolescent psychiatrists, adult psychiatrists and family physicians may not be familiar with Adult ADHD. Some may even still be sceptical of the existence of the disorder. If you are an adult seeking an assessment for adult ADHD, it is important that prior to the referral you find out how knowledgeable the practitioner is about ADHD. Is this an area they specialize in and do they see many patients with ADHD in their practice? If your physician tells you that adult ADHD does not exist, find another doctor.
At this time, throughout most of Canada a severe shortage of physicians who diagnose and treat adult ADHD exists. There is such a significant shortage of physicians assessing for adult ADHD, that some paediatricians and child and adolescent psychiatrists have expanded their practice to include the assessment of the parents of their patients.
Psychologists who specialize in ADHD also assess and diagnose ADHD. And, often psychologists are the ones who adults turn to for psychosocial treatment modalities of ADHD, such as, cognitive behaviour therapy (CBT) or mindfulness. These therapies have been scientifically shown to be beneficial for adults with ADHD. Unfortunately, psychologists are not covered by provincial medical plans at this time. Private health care plans may be of some assistance with this.
If you are assessed by a psychologist and you chose medication as one of the forms of your treatment, you will need to find a physician to prescribe the medication. Thankfully, more family doctors are becoming educated in medications used for ADHD and some are willing to prescribe them for their patients.
Most physicians who assess for ADHD are specialists, so you will require your family physician to refer you. We strongly suggest that you call the offices of any professionals that you are considering before you ask your family physician to refer you.
Some key questions to ask when calling these offices:
- Are they accepting new patients?
- How long is their wait list?
- Do they charge over the provincial coverage, for what services, and how much do they charge?
- Does this physician do long term follow-up care? (Some physicians only assess and diagnose ADHD, start treatment and then refer you back to your family physician for long term care)
Once you have decided on an individual professional or clinic, ask your family doctor (or if necessary, a walk-in clinic) to fax them a referral to get the process started. We recommend calling the doctor’s office within a few weeks to make sure that the referral has been received. Wait lists tend to be long; therefore, we recommend a follow up call in a few months to see how things are moving. Sometimes they may have cancellations and can fit you in sooner than expected.
Please note that:
- Many psychiatrists are now charging additional fees over what your province will cover for an assessment. (Before going on a wait list to see a physician please clarify this with their office. Hospital clinics generally do not charge additional fees).
- Psychologists’ fees are not covered under provincial healthcare; however, they may be partially covered by a private health plan, usually about $500 per person per year.
- If you are still in school and struggling academically, your post-secondary institution may request a psycho-educational assessment from a certified psychologist before putting academic accommodations in place. This is comprehensive testing that looks at your learning strengths and impairments, and also tests for learning disabilities. The psychologist will write specific recommendations for accommodations in their report if Learning Disabilities and/or ADHD are diagnosed. Private psycho-educational assessments frequently cost at least $2500 to $3,000.
- Some post-secondary institutions accept a physician’s letter documenting the ADHD diagnosis and specific impairments that would impact you in a learning environment.
- Both the psychologist’s and physician’s documentation for post-secondary schools should include a list of specific accommodations that would be essential for you to receive at school (a list of potential accommodations can be accessed on the CADDAC website).
- Many adults also turn to an ADHD Coach for support. These coaches specialize in ADHD and fully understand the challenges of ADHD. They are trained on specific strategies for ADHD and how to implement them. Unfortunately, coaching is also not covered by provincial health plans. Coaches are not accredited in Canada so you will need to do your due diligence and request information about their training and references.