Adult ADHD assessment

[LoloBubbaMom]

I went to my therapist to be evaluated for ADHD and she wants to take care of the issues I’m dealing with right now. That’s great but it’s making, what I perceive as ADHD symptoms worse. I feel like Stratera would help me, at least, deal with the frustration and issues that make my depression and anxiety worse. My main question is my therapist said they would need my grades and teacher evaluations from Elementary School, I’m 48 years old. Is this normal?

[Hidden]

Yes. I was in my late thirties when I was diagnosed, and I took my mom with me to the appointment to tell my psychiatrist how I was as a child. Hope this helps. The book Driven To Distraction by Ned Hallowell talks about the school grade/ teacher evaluation thing.

[Loribird52]

I will be brutally honest by saying it does not sound normal to me and it also sounds like your therapist wants to make some money off of your long-term therapy which she will no doubt provide.

[DefinitionReclaimed]

Hi LoloBubbaMom ,

Yes, it's normal for your therapist to want to look at your grades and teacher evaluations. The reason is that ADHD is a neurodevelopmental disorder, meaning that they usually manifest early in your development. The DSM-5 says (source: qandadhd.com/diagnostic-cri... ) :

"DSM-5® DIAGNOSTIC CRITERIA FOR ADHD IN ADULTS1

All criteria must be met for a diagnosis of ADHD in adults1:

1. Five or more symptoms of inattention and/or ≥5 symptoms of hyperactivity/impulsivity must have persisted for ≥6 months to a degree that is inconsistent with the developmental level and negatively impacts social and academic/occupational activities.

2. Several symptoms (inattentive or hyperactive/impulsive) were present before the age of 12 years.

3. Several symptoms (inattentive or hyperactive/impulsive) must be present in ≥2 settings (eg, at home, school, or work; with friends or relatives; in other activities)."

So your therapist is probably just trying to see if there is evidence of impairment at school before the age of 12 to help establish an ADHD diagnosis according to DSM criteria.

[tiredofstruggling]

I think it sounds like you have an honest therapist, but while it’s important to know if you’ve always had these issues, school grades aren’t the only way to determine that. Not every clinician has equal experience in adult adhd. They aren’t disregarding your concerns about adhd, which is good as it seems fairly common to be outright misdiagnosed with depression and/or anxiety (though of course you can have them in addition to and sometimes because of adhd). To be fair though, it sounds like sometimes anxiety/depression can produce similar symptoms to adhd - they just probably wouldn’t be lifelong (is my limited understanding).

[jdelmonaco19]

Morning LoloBubbaMom!I’m a fellow ADDer…and I’m 56 years young! I “believe” the medical community is doing it wrong. I “think” just like you do…we ADDers tend to have an innate sense for what’s right and/or just. Try to talk to your therapist and/or psychiatrist about a good Treatment Plan! If you’re taking any medications, question what they’re for and how much “you” need. It’s important that everyone does their part…you can make the necessary adjustments to your behavior! It’s not going to be easy, but if everyone works together your Treatment Plan will be successful!

Good luck and God bless! 🙏

[lodopo]

She wants to insure you are having impairment in several areas of your life, and not just at work, or with your family. I would think your therapist would take your word for it and not need to see your grades but understand ing how you did in school will give a therapist a good idea of how you are being impaired and for how long.

Inevitably you want to learn how to manage your symptoms with medication and self-soothing and self-talk.

[wtfadhd]

your therapist does not understand adult ADHD. Because he/ she is still functionung under DSM and stigma that ADHD is about being a hyper kid - which we all know is complete misinformation. That misconception is exactly why soo many of us struggle until late 30’s, 40’s n 80’s to get proper support n treatment. Your therapist might be great working with other common DSM diagnosis like depression, etc but ADHD isnt one of them. ADHD is complex n misunderstood n has a nasty stigma because lets face it- our unmanaged symptoms can make us insufferable!!! In our generation( im 46) society, to include medical professionals were just figuring out that girls can even be smart 🤪so how 30’s yrs later do they expect people to remember grade school- i cant remember anything unless i personally found it to be profound!!! having grade school teachers weigh in on ADHD eval is helpful for diagnosis children for sure- but an adult?!?! feeling alone, not fitting in, trying to watch others to mimick normal behavior without sucess n then falling into depression n anxiety n exhaustion bc of it is something all of us late diagnosed adults cope with. and then add that whole super sensitive symptom!!! but those symptoms dont even make it to the DSM. Im a social worker n counselor- i am forced to use the DSM. its antiquated. us ADHD’ers are so used to having to defend ouselves that when a dr/ therapist tells a 38yr old that in order to get help they need to invoke “ evidence” from 30 yrs ago?!?! the fact that you are even considering trying to do it is alot of evidence that you are struggling with ADHD. a non ADHD person would tell that dr to F off!!! lol lol lolgood luck!

[DingoDoug]

Your therapist is using the textbook method, which is the idealized version of treatment. Obviously not many people have school work from over 3 decades ago. The typical method is simply bring a lifelong friend or relative such as a parent, sibling, or a friend you had for many years to back up your claim as opposed to the stuff from elementary school that you probably don't have.

[jilllewis84]

Just echoing what others have said condemning the DSM-IV criteria that a lot of doctors use for evaluation. If your doctor is telling you *have* to do a specific thing to get an eval/diagnosis (especially if it requires memory or a lot of executive function, like finding decades old documents that are possibly at someone else's house and bringing them in), that's a sign they don't really know ADHD. And no, early evaluations are not required to diagnose ADHD. They can provide insight, but they can also be misleading as grade school structure really helped performance for a lot of us, hiding our symptoms.

Ideally you want a doctor who's thorough but collaborative. Who you feel really gets the experiences you're describing. Not someone who's bent on proving to you that you don't have a severely under-diagnosed disorder. Doing your own research on ADHD can be really, really helpful for describing your struggles and for confidence with self advocacy.

I was treated for general anxiety for years with little improvement. But once I started treating my ADHD like ADHD (even before meds), my anxiety lifted like a fog. Best of luck!

[LifeIsLearning]

Do you see ADHD symptoms in your childhood? Consider telling the therapist all the stories you can remember that you may now think were ADHD related. I was very good at most parts of school, but I talked through most of lunch till my classmates all went outside for recess, then I sat and daydreamed or talked to the teacher and often never finished my lunch. I lost several really important things as a kid and I have absolutely no idea where they went. Both of these point to Inattentive Type. I also started a ton of different craft projects and they were all over every table, chair, counter in my house so much that my older brother yelled at me about it. That "messiness" and love of starting things but not finishing also points to ADHD. . . . sooooo many ideas!!!!! these stories demonstrate my symptoms negatively affecting multiple areas of life as Definition Reclaimed highlighted in the DSM-5 earlier.

By the way I'm 39 year old female working on officially getting diagnosed. I had no idea I might have ADHD when I was a kid.

My neuropsychologist actually surprised me by NOT asking many questions about my childhood. I was told I may need to have my husband or one of my parents also call the neuropsychologist, but he did not ask for them. I hope/assume he's just following more updated ideas than the DSM-5.

My regular doctor (and my husband's therapist) is also keen on making sure my symptoms are not actually depression. . . . but they could also be concurrent with depression . . . or my ADHD could be causing the depression. I'm glad my doctor asked which one I'd like to treat first (she offered to try anti-depressants, or get evaluated for ADHD).

I'm not 100% sure what you mean by "take care of the issues I'm dealing with right now." I assume you mean the depression and anxiety. . . but if there is more to it, then I agree with what I think you are saying that treating the ADHD will make dealing with the other things more possible. I

The bottom line is that most therapists, counselors, and even psychologists really don't know much about ADHD, especially not ADHD in adults, and reallllllly not ADHD in women adults. Not unless they've chosen to take it on as a specialty and done additional research on it. I have read so many times that "it's really important to find a professional who understands Adult ADHD" ugh, I've spent hours and hours and hours across months and years trying to find one to little avail. (I keep giving up and then coming back to it.) The best I've found is a therapist who used to be a Special Education teacher whose ADHD co-worker insisted on educating her on ADHD (and she's pretty good so far!) I don't mean to be discouraging but I want you to be ready to grit your teeth and set reminders on your phone to try again. ADDitude Magazine also had a webinar (replayable for free) on Womens ADHD that was awesome. Educating myself, here, on the CHAAD website, Dr. Russell Barkley's talks, and largely through ADDitude Magazine have been helpful too.

[Hidden]

They don’t need your grades, that’s only because of your age. A lot of diagnoses are based on if this has been happening all of your life.

Try and create a time line of events that you recall throughout your young adolescent ages throughout college that you feel like ADHD affected your performance. Talk about your emotions behind it as well.

The anxiety, frustration, and depression feed off of ADHD.

[Hidden]

Message me privately if you’d like to talk more on how to explain your situation to your therapist or psychiatrist, it’s overwhelming at first and frustrating trying to figure out what meds work together. But rest assured, the results can give closure

[DesertAl]

Doesn't seem right. ADD has additional impacts that you cannot have as a child.

I read through a study in "JAMA" last week that was questioning the way we think about ADHD, there is always flux in the medical world.

May I suggest that some therapists do not have a strong understanding of the subtleties of ADD and ADHD. I have had therapist fail completely at understanding ADHD.

Seek out a therapist that specializes in ADD treatment; even better if they are certified in "EMDR."

I would forward that understanding your school impacts might present the basis for some of your traumas and impacts. The therapist could also obtain this info during a regular session.

ADD is composed of non-normative behaviors which cause impacts in the ADDer's life. The impacts are derivatives of the behaviors, including depression, anxiety, self-isolation, and low self-esteem. At the root of most impacts is the energy of shame.

A decent therapist will address your depression or anxiety first moving into cognitive therapy and ADD meds in that order. Meds are not one size fits all, you must commit to working with your doctor to find the right medication and then the right dosage. It is also helpful to research and expand your understanding of ADD.

Knowledge will help you understand your behaviors and see the impacts. At one point, you will actually experience what making a real decision feels like.

[Sleepygal]

School Report cards

[Sleepygal]

I don’t know if it’s normal but I suspect your therapist is looking (not just at grades) but comments too. If your teachers had comments that indicated you gazed out the window, couldn’t pay attention, or chatted with others during a lesson..that might indicate a case of ADD.

[brewedinhell]

I am 54 and only diagnosed recently although had my suspicions for a couple of years. I did menopause pretty young but didn't realise I was doing peri as none of the women I knew of same age were. Had a burnout then and bad depression. Was put on SNRIs and have been stuck on them for 12 years. Had then self diagnosed bipolar and took all sorts of anti psychotic anti depressants, benzos opiates and drank myself stupid... My symptoms were getting worse and worse. Sooo clumsy, forgetful losing stuff within seconds. Beating myself up and verbally abusing myself. Doing everything the hard way or just not. I live on a forest property and was injuring myself several times a day. Burns cuts two head injuries in 2 months tripping on cement slab...boiling the kettle dry, burning toast overflowing water... Had resigned myself to the couch with gallons of red wine. At least I had an excuse for the fumbling bumbling breaking spilling smashing. On and on till I really was thinking I had dementia... Went on mood stablisers for the bipolar 5 months ago and stopped drinking... easily!?! Got me out of the pit but made no difference to the other symptoms. I think they were worse cos I was doing more and knew what they were. My brain was over the other side of shed to get what I'd forgotten before my body and feet could turn around to race over there. Anyway... Got dexmfetamine a month ago and asked the psyche about adhd and menopause... He kinda shrugged. Time was up anyway... Knew my symptoms had been getting more unmanageable over last few years. I was becoming a danger to myself... So I did some research when I got home and it didn't take long to learn that estrogen has a huge influence on dopamine! An adhd brain is deficient but estrogen can drop by 65% over the meno years!!! Wow. Makes so much sense now. The switch prior to puberty. The wild angry/morbid pms, the bliss of pregnancy.My doctor is about to be bombarded by all I've sussed about women and adhd and especially older women. Anyway the meds were a huge relief. The dopamine surged into my brain and I was so focused while chainsawing I realised how blasé I'd become with the deadly machine. Stopped all the clutzing instantly. Was wary of feeling speedy but actually sleeping better than ever. I was put on a baby dose because they worry about the speed switching bipolar to manic/suicidal. I had double the dose. I am more likely to kill myself from an accident than from a possible hypomanic switch. If anything was gonna do that it would have happened in all the years of unnecessary fluctuation on antidepressants and grog. So will be good when I get my dose stable.

To answer your question though lol... I thought I would have to do the whole wenders scale stuff re childhood and everyone's observations etc. The psychiatrist just spoke to me for an hour on the phone and had it nailed. It was that obvious to him. He's on the ball. I was off the richta scale. You mention therapist... Is that a clinical psychologist? I suggest finding a psychiatrist who specialises in ADHD. Seriously. You are possibly starting perimenopause with dropping dopamine levels. No woman has to suffer as long as I did on ineffective meds through such a life altering time of change. Especially after the long years of frustration with undiagnosed adhd. If you learn about the symptoms you will know in hindsight how you flew under the radar as so many women have. Lots of research on girls and young adults being innatentive not hyper. But stuff all on hormonal midlife and older women. Most of us went to Dr around 40 with depression and anxiety. I wish you all the very best in your quest. Self advocacy is the best for us older women. Just having someone whos known you over 6 months/family/parteners/ co workers. Get a 2nd opinion. Or more if you think you aren't being taken seriously. It's not like we are begging to have adhd. Well what a spiel hey. This is my new hyper focus. Lol. Good luck Sista. Lx

[LifeIsLearning]

additudemag.com/webinar/com... was listening to this and thought of you.

Around 33 minutes into the lecture she says that the "old school" way was to treat the co-morbidities (like depression and anxiety) first in the hopes the ADHD would resolve.

[Credit]

The therapist is trying to be thorough but hopefully the treatment wouldn't be conditioned by the availability of the grades and evaluations. If the therapist refuses to treat without those documents, and if you don't have them, then change therapist. Mine did not require that information. He did ask how I did and when I explained, that was sufficient. For me it was easy, because the most frequent comments were "inattentive" and "could do better"... :))

[Hidden]

Here's the scoop, LoloBubbaMom,

First, yes that is how many practitioners who are by the book and not proactive in the latest research and accepted theories do it. It's "safe" for them. I suggest you specifically find a psychiatrist who specializes in diagnosing mature women, especially if they have knowledge as someone suggest above about the role of estrogen on the ADHD brain. Estrogen really messes with the ADHD brain. I did not start my periods until into my 14th year, and that's when I really thought something was "wrong with me" and it got worse in my latter teens. Birth control pills made me an emotional train wreck and I have never been able to take them. But perimenopause has really did a number on me. All the strategies that have allowed me to stay on top of managing my ADHD no longer are working. It's gotten really bad. I just got health insurance, with a mental health plan included, and they are also using the VSM-5 standard of having to be diagnosed by age 12, which is utterly laughable for me. I was 12 in 1982, when there had only been ONE single study done on ADD and girls. Believing girls could get it was a "fringe" idea at that time. So them using this standard is sexist and ageist.

But to your condition, I would start documenting all the ways you struggle on a day to day, week by week and month to month level. Create a journal and write in it daily. I was 48 when I really started to feel like I was unraveling and could not cope. I was also fired for the first time in my life, and I believe it was from my impulsivity. It's BS that Kaiser is saying I don't have it because I was not diagnosed as a child. The VSM is ignoring the fact that many girls don't even start their periods until past that point. This scientific review paper on the underrepresention of data for girls and women should give you all the ammo you need to make your point. Make sure to read/print the full text. Not only do the conclusions of this paper counter what your therapist is saying, but it cites oodles of peer reviewed research on the topic for further education:

acamh.onlinelibrary.wiley.c...

Good luck.