A guide to diagnosis of adult ADHD

Very often, parents of children with ADHD start to recognise, at some point during their child’s journey, that perhaps they might possess similar traits themselves. I was in that group.

My son and I moved between boroughs and, in order to be accepted for support from our new local CAMHS service, we had to start from scratch with the diagnostic questionnaires, which as you can imagine was a bit of a bind. However, life moves in mysterious ways and, as I completed the parental parts of the information collation, I began to recognise that many of these traits I felt I had too, and to see that I had actually developed quite a few methods of checking myself professionally during my varied career to make sure that I did not overlook things - methods which my peers did not need to use.

In the days before widespread mobile phone use or email, if I remembered a detail which I had overlooked at home whilst I was at work I would call the house phone and leave a message on the answerphone. Likewise, at 4am when I woke with a start because I had missed a vital bit of detail in the workplace, I would disturb our night security guard by ringing my own telephone extension at work in order to leave a message at work at my own desk. I never did badly in any job I pursued, but didn’t have a lot of direction early on, and envied those who did.

What is the process for ADHD diagnosis?

I thought it might be useful to describe the adult ADHD diagnostic process for those of you considering pursuing the same thing.

Firstly, if you are not going to want to be medicated to help with your symptoms, read no further. Ritalin-based medication would help a neurotypical child to perform better, helping them to focus for longer in order to achieve tasks. You are not going to be given training or development as an adult, merely a diagnosis and the choice to medicate or not.

Medication simply gives you a window in which you can start to apply different coping techniques and adapt them to your own specific situation; it is not going to 'cure' you. ADHD is caused by low levels of neurotransmitters between nerve cells, so information is not processed in the same way as in the rest of the population. You are going to have to research coping methods yourself and arm yourself with tips and hints which you can then start to try out once you have medication in place.

So, if you have decided that you would like to try to pursue an explanation of why you are as you are, what do you do next?

1. Google 'Adult ADHD test', have a look at one of the self-diagnostic quizzes, and answer the questions there. You will probably identify with many, if not most of, the scenarios they have listed, and your score will give you an indication of whether or not you might be helped with further tests.

2. If this is the case, then secondly you will need to book an appointment with your own GP to arrange for a referral to adult mental health teams in your area. Take your quiz score with you and explain to them that you would like to be tested for adult ADHD. They may question why you want this, as obviously you have got this far in life without this information about yourself and will probably tell you that the process 'takes years'. There is a long wait.

3. After the doctor's referral letter, you will be given a screening telephone call with a mental health nurse who will ask you many questions about your life in general, to weed out those who are unlikely to get a diagnosis and thus should not take up the psychiatric resources of the next stage. See how you go. If you are then put on a waiting list, you know that you have shown signs to them, and there may be a diagnosis of some sort missing from your childhood.

4. Remember that one of the things the psychiatrist will be looking for is evidence that you have had challenges from an early age and in a variety of situations i.e not just at school or simply at home, but that these issues follow you around between settings with different social expectations and were there from when you were a child.

So, speak to your family about their recollections of your childhood and wrack your brain for those memories you have of times when you were 'away with the fairies', or the sorts of trouble you have got into but may have forgotten about - or actively blocked from your memory. Make a list of these - it can be useful to you during the examinations. Think of the mechanisms which you have devised to keep yourself on track; when you have managed to do this. Remember that many adults with ADHD have a constant feeling of not living up to their family’s expectations or of fulfilling their own potential. Make a list of examples.

5. You will eventually be invited for an appointment with a psychiatrist who will take a case history from you about your life to date. Many of the things you have written on your list will completely vanish from your mind as you are asked these questions, so make sure you have them with you! You will be asked about impulsive behaviours, your ability to judge risk, your early relationships, the history of your sex life (yes, compulsive sexual behaviours, addiction, and risk-taking are factors which are often present), drug use, and lifestyle. Your doctor will be sent a thorough report on your history.

What's next?

The psychiatrist has seen many people with ADHD and can often recognise just from your body language if something is amiss. If the diagnosis is a 'positive' one, you may be placed initially on lower doses of medication and work up towards the full adult dosage. It is important to consider the facts that unmedicated ADHD-ers can often start to self-medicate with alcohol or become addicted substance abusers.

A study done by the UK Adult ADHD network showed a disproportionately high percentage of undiagnosed and, therefore, untreated adults turn up in the criminal justice system. Roughly 20% of the adult prison population is considered to fall into this group, and around 30% of the adult prison population in total have ADHD, with 32% of these sufferers vulnerable to reoffending. A further paper published by this group showed a figure of 10% of drug and alcohol addicts have ADHD, compared with a percentage within the general population of just 2.5%.

Do not get the picture that all ADHD is doom and gloom! People with ADHD are rarely boring and have a fantastic ability to work outside the box. They will spot details that neurotypicals will not, and if they can devise ways of managing their conditions can go on to be incredibly creative and fantastically successful.

One of the seemingly contradictory features of ADHD is an ability to hyperfocus, or become so interested in and consumed by a project that all sense of time is lost. Once they have overcome the accompanying procrastination associated with so many tasks, ADHD-ers might go completely the opposite way and may not notice your presence at all once a subject holds their attention.

If you are still reading this article, then speak to people, join a group, find a knowledgeable coach, mentor or counsellor, and go and do some research. What works for one person may not be suited to you, but a healthy curiosity and interest will bring you in touch with little gems of wisdom which will have you shaking your head with their simplicity. Just be sure to communicate what works for you with somebody else along the way who you see struggling in the future.