How to Get An Adult ADHD Diagnosis — Assessment & Expectations

 

Just thinking about getting an Adult ADHD diagnosis can feel overwhelming.  Where do you start? Who can you trust? In this post, I’ll guide you through the process.

But first, many see the evaluation process as a mere formality — necessary only for obtaining prescription medication or accommodations.  But an accurate Adult ADHD diagnosis offers much more. It provides a “road map” for achieving lasting progress.

Many people don’t realize this—because no one tells them! By understanding the specific symptoms affecting you, you can set medication-sensitive goals. This means you’ll better distinguish how medication can help versus where you might need new habits and skills.

Here’s another big reason to self-educate: When you understand how the Adult ADHD diagnosis was made — how exactly ADHD resonates for you — you have more confidence in the diagnosis. That means you don’t backslide into self-sabotaging with skepticism (“Is this ADHD thing real?”).

Even if you were diagnosed with ADHD years ago, do you remember why? Did you ever understand it? You might be missing a key piece of the puzzle. But it’s not too late to do a deeper dive. Check my training at the end of this post.

Right now, how do we eliminate that sense of overwhelm and maybe fear, too? We get educated and empowered. We get very familiar with the evaluation process—before even thinking about booking an appointment. Read on!

Let's get started

 

Questions and Answers: Getting an Adult ADHD Evaluation

In this post, you’ll find these topics:

  • ADHD evaluation guidance from a leading expert
  • What are the DSM-5 Requirements for Adult ADHD diagnosis?
  • What should take place during the ADHD evaluation?
  • Adult ADHD in women: Are there different Considerations? (Bonus download)
  • Getting diagnosed with ADHD: the evaluation process made easy
  • Summary
Thomas E. Brown, PhD
Thomas E. Brown, PhD

ADHD Diagnosis Guidance from a Leading Expert

“You cannot measure suffering by clinical tests”

That’s a meaty quotation from psychologist Thomas E. Brown, PhD, a preeminent ADHD expert.

In fact, there is no single test to evaluate for ADHD. That means no

  • Computer test
  • Fill-in-the-blank test
  • Blood test
  • Genetic test

The anti-psychiatry peanut gallery lobs these claims as proof that ADHD does not exist. But, wait. Can you measure headaches or backaches with a quiz, a blood test, or a genetic test?

Dr Brown stresses the importance of the professional asking about functioning in real life

 

ADHD Happens On a Spectrum — A Matter of Degrees or Dimensions

Having ADHD doesn’t make a person fundamentally different from other humans. Millions of adults with ADHD have unique experiences. ADHD is a highly variable syndrome, and it’s just one part of personality.

Experts refer to ADHD as a dimensional condition. This means the symptoms are actually intensified versions of typical human behaviors. When you are diagnosed with Adult ADHD, it simply indicates that you exhibit more common human traits or more intense versions of these traits.

For example, everyone procrastinates, prefers fun over hard work, and gets distracted. However, not everyone faces these challenges to the extent that it significantly affects their education, work, relationships, happiness, health, or even driving safety.

In this way, ADHD is similar to characteristics like intelligence, weight, or height, which exist on a spectrum. Thus, diagnosing ADHD is not always a straightforward “Yes or No” decision.

To determine if someone has ADHD, professionals assess the severity and impact of symptoms through detailed conversations, focusing on:

  • Identifying specific areas of significant difficulty
  • Ruling out other potential causes for the symptoms

Can You Have ADHD and Not Be Hyperactive?

“ADHD used to be considered a disruptive order of childhood, Dr. Brown explains. “The diagnosis was based on observing overt behavior.”   In other words, If it squirms, you. must confirm.

Today we know that many people, especially adults, have no obvious physical hyperactivity. Ever since the 1990s “Decade of the Brain,” revolutionary techniques for studying the brain have shed light on the more subtle nature of ADHD symptoms.

“We know that impairments related to Executive Function are largely cognitive, covert, and not easily observed,” Dr. Brown adds. “They are also complex and interactive and not easily measured.” Furthermore, the longer the patient goes with untreated ADHD, the higher the chances of developing a coexisting condition such as anxiety or depression.

Treating ADHD, Missing the Depression—and Vice-Versa

“Too often, the ADHD is treated and the coexisting condition is ignored, or vice-versa,” Dr. Brown continues. “The Diagnostic and Statistical Manual (DSM), used by professionals to diagnose psychiatric conditions, separately lists more than 200 disorders. But these are not all different trees bearing different fruit.”

Among the DSM’s most common disorders: Major Depression, Anxiety, Bipolar. Then there is a long list of other diagnosable conditions, including Autism Spectrum disorder, schizophrenia, avoidant/restrictive food intake disorders, and the personality disorders (e.g. Narcissistic Personality Disorder).

In fact, many DSM disorders may be linked biochemically. In other words, having one disorder increases the chances that you’ll have another. For example, research has shown that the longer Adult ADHD goes poorly managed, the greater the risk of developing bipolar disorder. We finally have a clearer understanding of sleep disorders—and eating disorders as well— related to ADHD. 

Yet, it is very easy to mistake ADHD for the fallout it creates: looking like “depression” or “anxiety.”   But guess what?  Sometimes those apparent conditions resolve once the ADHD is treated.  Mistaking ADHD for these other conditions—and treating them—risks intensifying ADHD symptoms. Yet, it happens all the time.

This is no minor thing, as we see with the woman in Misdiagnosed Until 39: “Best Week of My Life”

For all these reasons and more, it’s wise to self-educate on the complexity of ADHD before seeking an evaluation.

 

What Are the DSM-5 Requirements for Adult ADHD Diagnosis?

The previous DSM’s official criteria (DSM-IV-TR) were empirically based and rigorously tested. Yet, there were limitations. For example, the guidelines:

  • Were developed with children in mind, not adults. Therefore, ADHD experts considered it problematic in diagnosing adults.
  • Didn’t reflect current thinking about when the signs of ADHD first appear.

Previous guidelines for ADHD diagnosis required that impairing symptoms manifest before age seven. Yet, as Dr. Brown points out, signs can fly under the radar until middle school or junior high, college, and even later adulthood. Consider two common possibilities:

  1. Parents sometimes provide so much support that it obscures impairments.
  2. A highly intelligent child can compensate for many years before “hitting the wall” of unaddressed symptoms. As life grows more complex and demanding, they cannot keep up.

With the new DSM-5, the criteria moved the age up from 7 to 12.  Yet, that higher number is still not hard and fast. Rather, it is a suggestion, to be factored in along with all the other data in establishing an ADHD diagnosis.

For the nitty-gritty on other changes in the diagnostic criteria, read Changes in the Definition of ADHD in DSM-5: Subtle But Important

[You’ll find the list of proposed criteria by Barkley and colleagues in my groundbreaking book, Is It You Me, or Adult A.D.D.? Many experts consider these criteria superior even though unofficial. In particular, they can help you to better understand the ADHD diagnosis for adults.]

Gina Pera Adult ADHD course

 

What Should Take Place During the ADHD Evaluation?

First, the evaluating professional gathers data from multiple sources. Ideally, you receive these forms weeks prior to the appointment date, so you have time to complete them and ponder the questions. 

These forms might include:

  • Behavior rating scales (more information: Clinical Practice Tools)
  • Symptom checklists
  • Questionnaires completed by the client and, if possible, also by a partner, close friend, or family member (ADHD symptoms can impair memory and objectivity)
  • A detailed life history, including any head injuries (even “minor” ones) or physical illnesses

Next, the clinician also compares client symptoms to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  Click here to view DSM-5 criteria for ADHD.

Throughout the process, the professional will ask questions. They want to gain clarity as to how your answers best indicate ADHD instead of another condition, such as depression or anxiety disorders.

Finally, Dr. Brown stresses the importance of the professional asking about the adult client’s abilities in these areas that require executive functioning:

  • Holding a job and working productively
  • Managing household and finances
  • Maintaining stable relationships
  • Parenting effectively and consistently
  • Sequencing tasks and completing chores
  • Driving safely
  • Managing one’s health, including getting good sleep, eating well, and avoiding excesses

 

Adult ADHD in Women: Are There Special Considerations?

When it comes to women, ADHD often goes unrecognized, often misdiagnosed as depression or anxiety.

One reason: ADHD symptoms can manifest differently between the genders. For example, boys with ADHD might be physically hyperactive. Hyperactivity for girls with ADHD might be verbally hyperactive.

Anecdotally, we often see girls and teens with ADHD as more driven to achieve, to please. In fact, they might be stellar students all the way through high school graduation. But they might have pulled it off  by recruiting anxiety and putting in long hours. It’s not sustainable. And when they can no longer drive themselves, they might feel “depressed”—but that doesn’t mean they have clinical depression.

Moreover, the cyclical nature of female hormones can create a monthly “roller coaster” easily mistaken for other conditions. That means that ADHD is assessed a little differently for women.

Bonus: Download This Helpful Self-Assessment Tool

The Women’s ADHD Self-Assessment Symptoms Inventory  (SASI) was developed by psychologist Kathleen Nadeau, PhD, and developmental pediatrician Patricia Quinn, MD. They recommend using it as part of a structured interview in conjunction with other diagnostic tools.

It covers traditional ADHD symptoms. But it also goes beyond by measuring difficulties in time management, organization, parenting, life-maintenance activities, hormonal issues, and problem eating patterns.

Gina Pera Adult ADHD course

 

How to Choose a Professional to Perform the Adult ADHD Evaluation?

Overall, the highly variable nature of ADHD requires that the clinician:

  1. Has deep familiarity with ADHD symptoms in adults — and the myriad ways they can manifest throughout the lifespan
  2. Uses informed data collection, including a thorough history from birth on— noting physical, psychological, and learning issues, among others
  3. Where possible, solicits third-party feedback, such as from a spouse or other family members
  4. Has an ability to listen closely, ask perceptive questions, and make connections

(A physical exam beforehand should rule out other physical conditions that can affect brain function or limit medication choices.)

Who Can Make the Adult ADHD Diagnosis?

Now that we know a bit about how Adult ADHD is diagnosed, let’s consider the types of professionals who might perform the evaluation:

  • Physicians (MD), most often psychiatrists
  • Psychologists (Ph.D. or Psy.D)
  • Therapists who hold masters degrees (MCSW, LCSW, MFT, and others)

Finding a Professional to Perform the ADHD Evaluation:

  • If your family physician cannot make a confident referral, contact the closest university teaching hospital.
  • When searching online, note carefully the website’s text. Does the professional list their educational background and specialties? Can you see how those relate to expertise in ADHD?
  • Is there a local chapter of CHADD? (Check the CHADD chapter locator.) Attend and talk to members about their experiences with local professionals. Look for names mentioned repeatedly. But also note that some people deem a professional good simply because they “believe” in ADHD—or they have ADHD themselves. Neither necessarily means they have expertise.
  • By the way, when seeking an evaluating or prescribing psychiatrist, particularly look for appropriate state licensing and “board certified.”

Questions To Ask Professionals Before Making the Appointment

It’s tempting to believe you can just farm all this out to licensed professionals.  That is a very dangerous temptation—and one best avoided.

If all you can ask are close-ended questions (“Do you specialize in ADHD?” with a simple answer of yes or no), then you have no assurances. If you don’t know how the process should go, you remain at a disadvantage. This is too important!

When you are solidly self-educated, you can ask open-ended questions and have a context for assessing the answers, such as:

  • What is your process, specifically, for conducting an evaluation?
  • Which forms do you use and why do you find them useful?
  • How important is third-party feedback (from a family member who knew you in childhood or from a spouse/partner)? Hint: It’s very important but many do not know this.
  • How did you develop ADHD expertise?
  • Ask  about conference attendance, workshops, continuing education, professional guides relied upon, etc..
  • You want to hear recognition of leading clinical experts who write and teach. These might include psychologists Russell Barkley, Thomas E. Brown, Russell Ramsay, Arthur L. Robin, and Kathleen Nadeau, along with physicians Patricia Quinn and Anthony Rostain. 

Getting Diagnosed for ADHD — The Evaluation Process Made Easy

Are you seeking reliable guidance on all things Adult ADHD, including step-by-step treatment strategies, understanding how poorly managed ADHD can affect couples (and how to heal dysfunctional cycles), and other important topics?  Look no further than my comprehensive online training: Solving Your Adult ADHD Puzzle: Foundations

In the training, you’re walked through Adult ADHD evaluation process in depth. You get:

  • The DSM-V official diagnostic criteria, presented in an engaging, visual format.
  • An interactive PDF of the full criteria— to guide you in identifying the symptoms that resonate most with you, along with examples from your youth to now.
  • Step by step instruction — how a proper evaluation should proceed.
  • Tips on finding the right professional to conduct your evaluation.
  • Plus a lot more – this is evidence-based therapy for Adult ADHD, at your pace and in your space
  • Learn more at Solving Your Adult ADHD Puzzle: Foundations

 

Consider One of Many Testimonials:

Alex M., Oklahoma, had this to say about Solving Your Adult ADHD Puzzle: Foundations

My husband and I just began Gina’s course. It’s much more approachable than asking him to read an ADHD book. He gets so distracted reading. 

These are short videos, super digestible and informative. My husband now reports feeling much more in control, less defensive, that he actually can learn to manage his ADHD. 

We are just doing a bit every evening after work and have learned something each time. It has been just as helpful for me as it has been for him so far. It feels very much like we are working as a team for the first time in a long time

 

Having an accurate adult adhd diagnosis also provides a road map for achieving lasting progress

Summary — Self-Education is Key

  • Equip yourself with knowledge and confidence — but remember to be humble!
  • Know what to look for in a qualified clinician. Sometimes choices are few, which is all the more reason to self-educate first so you can fill in any gaps.
  • Don’t hesitate to self-advocate during your ADHD evaluation process. For example, perhaps the professional misunderstands one of your answers on a form or draws an incorrect conclusion.  Clarify.
  • Take along a friend or loved one—to support you and be an extra set of  “eyes and ears”. This person might also support you in completing the forms beforehand.
  • Learn the specific steps involved in a proper ADHD evaluation.
  • Recognize the importance of collecting a thorough personal history and third-party feedback.
  • Understand that ADHD symptoms can manifest differently between genders and over time.
  • Be aware of the potential for coexisting conditions such as depression or anxiety, which can complicate the diagnosis.
  • Familiarize yourself with the DSM-5 criteria for ADHD to better understand your symptoms.
  • Use reliable resources to support your journey in getting evaluated and managing ADHD.
  • For a deeper dive into the evaluation process, check out my comprehensive online system. Your path to clarity, effective treatment, and support starts there.

I hope you found this helpful.

As always, I welcome your comments.

—Gina Pera

MORE FROM GINA

20 thoughts on “How to Get An Adult ADHD Diagnosis — Assessment & Expectations”

  1. Jerry Coltin

    Hi Gina,

    Thanks for providing the self test for women. Where do I find the key to the results. Jerry

    1. Hi Jerry,

      There is no key for the inventory; this is not a diagnostic instrument.

      As it states on the PDF:

      This scale should not be used for diagnostic purposes. Instead, results should be considered
      as part of a structured interview, and used in conjunction with diagnostic testing when
      evaluating women for possible ADHD.

      best,
      g

  2. OH my gosh, Gina! I’m so glad you wrote this.
    I’m always looking for a shorter explanation of the wheres/hows of getting the diagnosis. Usually I’m referring to Barkley’s books. This will be so much easier for people to read and digest than a whole book.

    1. Hey Liz!

      Thanks for letting me know!

      I was working most of the day on the online training video for that topic (diagnostic criteria and what an evaluation should look like). I kept moaning and groaning…”why is this taking me so long? why am I so slow? why do I take 100 times longer with more effort than I need to?”

      My usual patter while writing books, etc. And my husband says, “Because you do it right.”

      I do try. Thanks!

      g

    2. Liz,
      It would be beneficial if EACH individual member of an ADHD group READ THE WHOLE BOOK written by Gina Pera.
      ** Both of her books. Then read them again.

      Internet groups and others who meet to discuss this diverse disorder do not provide her knowledge, understanding and 20+ years of research. ( IMO)
      Such is the wealth of information Ms Pera has gathered.

  3. My story: I’m 59. A bit over a year ago I was reading a list of ADHD symptoms and said that’s me.

    I asked my primary care physician if he knew of anyone that had a lot of experience with adult ADHD (after having read the book this post came from) and he said sure. That got me an appointment with the mental health gatekeeper that was only interested in whether I was addicted to drugs or alcohol and also hyperactive. Since I have neither of those traits she literally laughed at me. This did not help.

    Jump forward a year and a change of insurance. I asked my primary care doc (different from last year) for help. He gave me a 1 page survey of symptoms, we talked for about 5 minutes, and he said “it looks like you’re not hyperactive but you certainly cover the inattentive side.” He gave me a prescription for Strattera. I was a bit surprised and a bit hesitant, but given my history of having doors slammed in my face I decided to just try it.

    It’s been 3 weeks and I’m on 60mg/day. At first it seemed like a wonder drug but I couldn’t tell if that was more placebo or not. But now I can tell there is a subtle change that is profound.

    I can talk myself into doing things I know I should do. I always thought that the idea of just having a positive attitude and magic will happen was just nonsense. I always felt we’re all lizards deep down inside and our emotions drive everything. What a surprise it was when I could just feel the negativity fall away just because I thought “I shouldn’t be angry about this. What would make me happier?”

    I can now sit and listen to my kids when they come over and not want to just run upstairs. I can also let things go now. I can change directions. Something falls apart and it’s a lot easier to just say okay, time for plan B. What sounds good? What used to absolutely freeze me in place is now a workable problem.

    What I’m going through now is figuring out where I’m at. Or maybe who I am. I’ve hung onto a few ideas of who I am for decades and now I’m thinking that maybe I can just change. Try something new and maybe it will be fun.

    I may never be good at names or learning a new language but the couple of times I’ve failed at something the past few weeks, and then easily tried again in a different manner, has just put a huge smile on my face.

    I can see walking away from an organization that I’ve spent 20 years with but has really not been that good for me lately. I have to believe that after nearly 60 years of fighting this there are scars and habits I need to learn to recognize. My 15-year-old dog pooped in the house and I got mad. Then I cleaned it up and asked myself why I got mad. That in itself is a big step forward but maybe I can learn to lead with compassion and not anger.

    And who knows, maybe Strattera is not the ideal drug for me (I know caffeine is important and a stimulant is part of what’s happening) but it seems to be a good place to start.

    1. Hi Matt,

      Thanks for sharing your story. I am delighted that you persevered and didn’t let the first abominable “evaluation” discourage you.

      It’s been only a few weeks, and you are noticing lots of progress. That’s fantastic.

      Unless you are independently wealthy or have plenty of other job options, you might want to hold off penning your resignation letter.

      Staying in the job, even if not ideal, a while longer provides one less “moving target”. If you continue to “tweak” your medication, avoiding new variables during that time will give you a better sense of what is the medication and what is the situation.

      Also, the stability can help you to gauge what in the job leaves you dissatisfied vs. an ADHD-fueled tendency toward being dissatisfied. 🙂

      If my first book is still sitting around, you might want to re-read, this time with an eye toward the success strategies. Including CBT-type approaches to revising reactions (as with the dog poop!) and to maximizing medication.

      Good luck and please keep me posted!

      g

    2. Gina, you made an assumption. The organization I’m backing off of is not my job. I’ve volunteered there for nearly 20 years. It was a rut I was in. Afraid to get out because once in a while it made me feel good. Now, maybe there are many things that might be fun.

      One thing I’ve realized is that since I was 17 and learned that if I poured my heart and soul into something I liked that there would be bits of bliss. The ADHD community calls it hyper focus. But the thing I just realized recently is that all wrapped up around the bits of bliss is anxiety, anger when things don’t go right and usually a desire for it to end. In just about anything I do “that I like doing,” camping, travel, designing things, work, cooking, volunteering, maybe even my family, it’s the same pattern. Bits of bliss woven into a big blanket of worry and being upset when things don’t go as expected. This is my roller coaster. And yet, I can’t let go.

      Over the past couple of weeks, when something has gone wrong, my response has been “oh well, what’s plan B?” Five minutes in it hits me. Hey, did I just not have a problem with that? So I’m starting to look at my activities and asking myself if it’s time to let it go or change things up. For my volunteer activity I’m still willing to volunteer, but I’m going to cut it way back and find the thing I enjoy and do well. I still don’t feel like I’ve very organized. I still need lists. I shouldn’t be the guy up front trying to organize 250 people. That’s not fun for me. I’d rather work one on one and do the creative work. The ADHD is not going away but maybe I can learn to enjoy it. That would be sweet.

    3. Yes, Matt. I made an assumption. You wrote “organization” and that to me connotes business. So sue me. 🙂

      g

  4. Pingback: Adult ADHD Diagnosis, "Sleep Issues," and Sex - ADHD Roller Coaster with Gina Pera

  5. This is great information about ADHD in fact. Let the public to drop the idea that ADHD is a “trouble-free” and note that nothing is so easy for a sort like that. It is sincerely clear that parents especially the female side to be so alert and careful about this. It is actually helping and I feel as though it has greatly of assistance for everyone needs to live a long and happy life. Thanks for your truthful and informative post about ADHD!

  6. Steve Malman

    Thanks for your honest and informative post about ADHD. I find that as an adult with ADHD there is a lot of confusion and ignorance about the topic. Great post.

    1. Thanks so much, Steve.

      It’s sometimes difficult to walk the line, between being open-minded about “alternative” explanations and strategies and being clear about the facts. I just try to do the best I can.

  7. This is great information and I’m sure glad I came across it.

    It drives me crazy how much we are into labels and tests and render labels, and then from those labels, someone with some letters behind their name poses treatment or sentence over you.

    Its good to know that its not so cut and dry to measure and understand which is what I have believed all along…but its still good to find someone in the know reinforce it.

    1. Hi Taylor,

      I’m glad you found this info helpful. Yes, the public often has the idea that ADHD is a “simple” diagnosis or that if you’re impulsive (or distractible or physically active), you have ADHD.

      The one tool I find most helpful when giving presentations on ADHD is …… a cookie cutter. 🙂

      There is nothing cookie-cutter about ADHD — its diagnosis or its treatment strategies. There are only individuals who fit into a syndrome that contains many criteria. Anyone who tells us they have all the answers for people with ADHD is, by definition, selling us a line. Caveat emptor!

      Gina

  8. Thanks for laying out the facts, Gina. I’ve referred quite a few friends to your blog. And your book.

    I just read the New York Times article today (the one that should have promoted your excellent book) and was disgusted that it didn’t.

    Even worse, Tara Parker Pope wrote that Hallowell is a RESEARCHER! Dang, if she got that wrong — and completely missed your book — what else does she get wrong.

    I used to t hink that the New York Times was a decent paper, but this gives me pause. In fact, I smell a rat.

    Hang in there. You’ve always taken the high road and well, nice gals finish last….lol! No, wait. I mean finish lunch. Well, you know I think you’re the best.

    jeff

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