What to do next if you think you might have ADHD: diagnosis & treatment
Diagnosis
To get the diagnosis process underway, you’ll need to see your GP first to get a referral. You can use the below questions as a starting point, as they are often used as an initial screener for ADHD.
From there you have two options for assessment as an adult:
(1) a psychologist (including neuropsychologists)
(2) a psychiatrist.
(Please note, this is in Australia, may vary in other countries. Children have other options such as paediatricians).
I would strongly recommend the following at the outset:
(a) writing a list over the course of a few days of everything that you are experiencing regularly that you think might be related to ADHD before you see your GP. When you are in their office and they ask, you’ll likely forget most of it if you don’t. Or fill out the checkboxes above and take it with you.
(b) do your research about the psychologist or psychiatrist you would like a referral to - look online, check out reviews, google, join local ADHD facebook groups for recommendations. Your GP may know someone good, they may not, don’t leave it to chance. This is critical!
(c) self advocate every step of the way. My intial GP referral sat in triage for months at a clinic, this was just to see if they’d be prepared to take me on! Turns out despite my calls and emails it had just been sitting there in the pile and had not progressed for months. I know we often hate doing hassling but don’t be afraid to chase up. Referrals get lost or forgotten unfortunately.
Self-advocacy is also really important because things this below this happen (way more often than you would believe I’m afraid):
After a consult for ADHD with a psychiatrist back in 2014, I was dismissed after 20 mins, told to read a book on meditation and charged $350. The next 8 years were full of struggle (and addiction) that could have in all likelihood at least partially been alleviated had that psychiatrist done his job properly. He’s still practising as an ‘ADHD specialist’.
Do your homework, please!
You’ve been ignored and dismissed for long enough.
A key difference between a psychologist and psychiatrist is that the former cannot prescribe.
If you do receive a diagnosis from a psychologist you will then need to see a psychiatrist for medication if you decide to go down that path.
What does an assessment involve?
Your clinician will let you know before your first appointment if you need to bring anything. Your first appointment will usually involved discussing why you think you have ADHD, the impacts and some general questions.
You might need 1-3 sessions for the assessment process, depending on how that clinician operates.
Costs: Always check fees up front as they are mostly out of pocket, and can vary wildly between $500 and $3,000 to you.
Some psychologists may let you use mental health care plan sessions towards your assessment, others won’t. Some will use telehealth for assessments, others will want to see you in person.
During the assessment process you will likely be asked about:
your history
mental health/family history
presenting issues (e.g. where you’re struggling or noticing things are different for you than others)
concerns you have.
They may ask for school reports or for a parent or family member to complete questionnaire about you. It's essential to rule out other conditions that might have similar symptoms (there are quite a few).
There is no one, standardised way to test for ADHD yet and so this process can vary depending on who you see. It may involve things like the CONORS Test, TOVA, DASS and PTSD testing, depending on how you present.
Sometimes they will tell you at the end of the assessment whether you have an ADHD diagnosis but often they will write a report that you receive a copy of. This can take up to another month.
My thoughts on the assessment/diagnosis process
At this time, the whole process (in Australia at least) can be very ADHD unfriendly because it involves a number of different parties, quite a lot of out of pocket costs, loooonggggg waits (expect 3-12 months) and multiple assessment sessions before receiving a diagnosis.
There can also be long waiting lists and a lot of contradictory and confusing information. This may change in future - there is an inquiry underway as of writing in 2023 - but at the moment there’s a backlog due to the explosion of diagnoses of adults who were missed in their childhoods, and not enough professionals to manage.
Don’t let these challenges put you off! A diagnosis can be life-changing. But be prepared for some frustration in this regard.
Treatment
The good news is that ADHD can be managed (not cured) and the earlier it is picked up on, the better. There are a few common treatments:
1. Medication: Doctors can prescribe medications that can help increase attention and reduce hyperactivity. Some of these are stimulants like Ritalin and Vyvanse, others are non-stimulants (Intuiv, Catapres). These medications will be explained to you but do your own homework to decide what’s right for you. Choose reputatable sources for this information like ADDitude and CHADD.
Medication alone is unlikely to be a whole solution and for many it can take a bit of trial and error to find something that works well, as the medication’s effectiveness depends very much on the individual’s physiology (much like anti-depressants).
2. Behavioural therapy or coaching: Therapy or coaching can help individuals with ADHD learn new strategies for managing their symptoms. This might include learning to set goals, stay organised, and manage time better. The first ADHD Clinical Guidelines (2022) recommends the use of ADHD coaches to help manage symptoms. I’m a coach and therapist who is late dx ADHD and offers ADHD Coaching, if that’s an option you’d like to take.
3. Lifestyle changes: Simple changes in lifestyle can be a big help. Exercise cannot be overstated and can be as effective as medication some studies show. Other recommendations include maintaining a regular routine (lol), getting enough sleep, eating a balanced diet, and reducing distractions.
4. Support and understanding: Support from family and friends is invaluable. Understanding and patience go a long way in helping individuals with ADHD thrive. Don’t feel you need to share your diagnosis if you are not ready to. Some people might not understand or might be unwilling to accept it.
Surround yourself by people who do understand - whether that’s online, face-to-face, informal (peers) or formal (therapy, professionals etc) so as not to minimise yourself and the things that have been challenging to you.
Myths and Misconceptions
Let's clear up a few common myths about ADHD:
Myth 1: ADHD is not real: ADHD is a scientifically recognised condition - it’s one of the most researched conditions in mental health out there. There is a huge body of work that verifies the impact of ADHD on addiction, relationships, educational attainment, work performance etc. Absolutely huge.
Brain imaging studies have shown that the brains of people with ADHD not only work differently, but they look different. So, no, everyone isn’t ‘a little bit ADHD’ anymore than ‘everyone’s a bit socially awkward’ is like autism. It is often impairing in some ways for people who have it.
Myth 2: Only kids have ADHD: While it's often diagnosed in childhood, many adults have ADHD (and many were missed in their childhoods). For the vast majority of us it’s a lifelong condition.
Myth 3: Everyone with ADHD is hyperactive: Nope, again. They can be the quiet, shy type at the back of the class who actually performs quite well academically.
That’s because there are three types of ADHD: inattentive, hyperactive-impulsive, and combined type. Some people only have inattentive symptoms, especially adults, which can present quite differently. To make things even more confusing, females present differently to males as we are socialised very differently and are often more adept at masking our symptoms.
Myth 4: ADHD is caused by bad parenting: ADHD is not caused by bad parenting. This myth stops people actually getting help as they feel it’s their issue to deal with as a parent.
It's a complex condition that involves genetic, environmental, and neurological factors - and it’s 80% heritable meaning that one of your parents or your kids are likely to have it.
Neurodiversity runs strongly in families (alongside autism, dyslexia, dyspraxia, dyscalcula, ODD, OCD, Tourettes). Often one person gets a diagnosis within the family and then everyone else realises they’re neurodiverse in one way, shape or form. This can often span generations.
Myth 5: Medication is the Only Solution: While medication can be very helpful, it's not the only solution, and often not a quick fix. Usually treatment requires a combination of coaching, lifestyle changes, support and education.
Living well with ADHD
People with ADHD can lead happy and successful lives.
It's important to remember that ADHD doesn't define who you are; it's just a part of you. Many successful, entrepreneurial and creative individuals have ADHD.
Our world is neurotypical, that’s really the only reason you have struggled. You’re expected to sit down for 8 hours a day from a young age and manage in a way that does not work for your brain and certainly not in today’s modern world with so many competing demands for our attention bombarding us.
Here are some tips for living well with ADHD:
Acceptance: Accept that you have ADHD, and that's perfectly okay. It's just one of the many things that make you unique.
Learn your strengths: People with ADHD often have unique strengths like creativity, high energy, and out-of-the-box thinking. Embrace these strengths.
Support: Surround yourself with supportive friends and family who understand your challenges and celebrate your successes.
Self-care: Take care of your physical and mental health. Get enough sleep, eat well, exercise, and practice relaxation techniques.
Time management: Use tools like calendars, timers, and to-do lists to help you stay organised and on top of your tasks.
Define your own version of success: ADHD people can often be quite non-conformist and think outside the box types, especially when we’re not masking. So use it! Work out what success means to you, not someone else’s version that you’re always comparing yourself to and falling short of.
Seek help: Don't be afraid to seek professional help if you're struggling. Therapists, doctors, coaches and support groups can provide valuable guidance and encouragement. Especially important is lived experience. Other people who have ADHD get it, regardless of whether they are your psychologist or your friends. It helps a great deal when you can share with these people and they understand.
Post diagnosis can be an unexpected rollercoaster period because there are often so many conflicting emotions at play - relief, grief, sadness, acceptance, understanding, joy, hope - and I will write about that in a future blog.
ADHD is a real condition that affects how a person pays attention, controls impulses, and manages time, emotions and energy.
With the right support, understanding, self-acceptance and a combination of treatments - and acknolwedgement of the struggles too - people with ADHD can lead fulfilling and successful lives, embracing their unique strengths along the way.
And go gently with yourself. It can be confusing, overwhelming and very frustrating at times. There’s nothing wrong with you and this is not your fault! ❤️
If you’d like to book a session to talk about your ADHD, your symptoms, ways you can better manage life - you don’t need to be diagnosed.
Check out my info on ADHD coaching or how to work with me.
Sources:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC; 2013.
Chen Q, Brikell I, Lichtenstein P, Serlachius E, Kuja-Halkola R, Sandin S, et al. Familial aggregation of attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry. 2017;58:231–9
Del Campo N, Chamberlain SR, Sahakian BJ, Robbins TW. The Roles of Dopamine and Noradrenaline in the Pathophysiology and Treatment of Attention-Deficit/Hyperactivity Disorder. Biol Psychiatry. 2011;69(12):e145-157. doi:10.1016/j.biopsych.2011.02.036
Hoogman M, Bralten J, Hibar DP, et al. Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. Lancet Psychiatry. 2017;4(4):310-319. doi:10.1016/S2215-0366(17)30049-4
