How Do I Know Whether I Have ADHD?

Disclaimer: The information contained in this article is for informational purposes only and is not a replacement for professional medical advice. Every case is unique, and this article may not apply to your specific situation. Should you require medical advice, it is crucial to consult with a trained healthcare professional such as a psychiatrist, who can provide you with tailored recommendations.

If you're reading this article, then you're probably a teenager or adult who is struggling with attention-related challenges. You may have read a Diagnostic and Statistical Manual (DSM) list of ADHD criteria, and perhaps you're finding yourself identifying with some or all of those items. Does this mean that you have ADHD? Unfortunately, it's not that simple.

ADHD is a Neurodevelopmental Disorder

First, it's important to realize that ADHD is an issue with brain development. This means that, by definition, it is present during childhood. There has never been strong scientific evidence that adults or teens over the age of 12 can develop ADHD that wasn't there before. There are also many mimics of ADHD, such as anxiety disorders, post-traumatic stress disorder, cannabis use, traumatic brain injuries, and many more.

However, it's not uncommon for true ADHD to be missed for years before it becomes a sufficiently significant problem to motivate someone to seek out help. This can happen in people with high intelligence who are able to maintain good grades despite challenges with attention, concentration, and organization but are later unable to keep up with the increasing demands of high school, college, graduate or professional school, or detail-oriented jobs.

Also, consider that the ADHD criteria were originally established from studies mainly of young Caucasian boys. This, along with other factors, has historically resulted in missed diagnoses of ADHD in women and people of color. In other cases, people may lack access to a trained professional who can diagnose ADHD during childhood, resulting in a missed diagnosis.

Diagnosis of ADHD

Diagnosing ADHD later in life is more complicated than diagnosing it in the young. This is because we have more scientifically validated diagnostic tools, such as Conners and Vanderbilt questionnaires, that help us figure out whether young people have ADHD or not. The age cutoff for the Conners is 18, so if you are an older teen, you may wish to consider seeking an evaluation before you turn 19. Similar tools do exist for diagnosing adult ADHD, but studies show they aren't very reliable.

For those over 18 who are seeking an evaluation for ADHD, two options are to see a psychiatrist with experience working with adults with ADHD or a neuropsychologist. As a psychiatrist specialized in ADHD, my process involves first meeting with a patient for a complete evaluation. This is important because it can reveal imitators of ADHD and helps me to build an understanding of the paradigm in which the patient exists. I invite patients to bring a parent, sibling, or partner to the appointment as observers who know someone well can provide invaluable information for the process of diagnosing ADHD. Sometimes, it is obvious after the first meeting that a patient does not have ADHD, and no further workup is necessary.

Other times, I think there may be ADHD, but there are also other problems that could be masquerading as ADHD. In those cases, I often help patients with those other mental health challenges, which frequently leads to the improvement of ADHD-like problems. Often, the initial evaluation reveals evidence of ADHD without significant imitators that require treatment first, and then I meet with the patient a second time for a structured ADHD interview, which takes 60-90 minutes. After the interview is over, I can usually determine whether someone has ADHD or not.

Neuropsychologists have a different process that can involve observing the patient doing specific tasks and rating their performance on those tasks. This process typically takes several hours and can be very helpful in understanding how a patient functions. However, it can also be expensive and often isn't necessary to diagnose ADHD. It's also worth noting that, unfortunately, there is no test that can determine whether someone has ADHD if they also have other significant mental health challenges that can imitate ADHD.

Avoid Easy Answers From Bad Actors

Over the last few years, regulations regarding telehealth prescribing of ADHD medications have relaxed. As a result, large companies have sprung up to offer easy access to ADHD medications. Some of them are making the diagnosis of adult ADHD without a thoughtful diagnostic process. This can be harmful to patients as they can experience unnecessary medication side effects, develop addictions, and continue to suffer because their real diagnosis is missed. Note that this does not mean that all telehealth is low quality. Personally, I conduct telehealth evaluations frequently and believe that for most patients, it is just as effective as in-person evaluations.

Conclusion

In summary, ADHD is a common brain development problem that starts in childhood and does not develop during adulthood. Many teens and adults may have missed diagnoses of ADHD that were there all along. Those wishing for answers about ADHD are best served by seeking an evaluation by a psychiatrist or a neuropsychologist. It's important to resist the temptation of easy answers offered by profit-driven companies who are not acting in the best interests of patients. Treatment for ADHD can be life-changing, but it’s important to seek professional help to make sure ADHD is actually the problem.

Read part 2 of this series to learn about common imitators of ADHD.