Despite the fact that at least 20 percent of the patients being seen in mental health practice will have ADHD (due to the high level of co-existing psychiatric disorders), most doctors and mental health professionals know virtually nothing about attention deficit disorder. Ninety-three percent of adult psychiatry residency programs do not mention ADHD once in four years of training. There are no questions about ADHD on the board-certification examination for adult psychiatry.
More often than not, it is the patient who suspects that he has ADHD and who makes an informal diagnosis. This happens because ADHD is genetic and runs in families. A person sees someone else in his family who has been diagnosed and treated for the condition. The more he talks with family members about the symptoms, the more he recognizes ADHD impairments in himself, his siblings, or his children.
Doctors, however, hold the key to treatment. Only a clinician can write a prescription for ADHD medication, which is the first-line treatment for ADHD. But before you can receive a trial of ADHD medication, you need a diagnosis. That can be the hardest part. Unless the doctor understands what is going on with you, he will make the wrong diagnosis. You cannot bypass the diagnosis step, ever.
Here are seven mistakes doctors make in diagnosing ADHD.
1. Your doctor doesn’t think that you might have ADHD.
Data from the National Comorbidity Survey Replication (NCS-R) shows that people with ADHD look for professional help, but don’t always find it. There are two reasons for this.
> Clinicians are given little or no training in recognizing ADHD. ADHD is the only medical condition for which there is no textbook. Even if a doctor wants to learn how to diagnose and treat ADHD, there are few places to get the information.
> Many doctors don’t consider the possibility that ADHD could be present. In a study examining which interactions between patient and psychiatrist led to the consideration that ADHD is present, not a single psychiatrist made the diagnosis. When the board-certified psychiatrists were told that they were participating in a study about adult ADHD, 60 percent of them refused to accept that attention deficit was a potential co-existing condition.
If you suspect that ADHD is not on your doctor’s radar screen, and he is not listening to you, find a new practitioner.
2. Your doctor assumes that a person who is successful can’t have ADHD.
Many of my patients who are successful professionals, spouses, and parents were not considered to have ADHD because they were successful. Doctors would say, “You graduated from college. You’ve got a good job. You couldn’t possibly have ADHD!”
This way of thinking dates back to the days when the condition was called Minimal Brain Damage, and children identified with symptoms were thought to be brain-damaged. These assumptions have continued due to the fact that children who are identified as having ADHD early in life are either severely hyperactive or have learning disabilities that prevent them from doing well in school and in life.
Most people with ADHD nervous systems compensate for their impairments. That’s why, in part, the average age of diagnosis for adults is 32. They have made it through school, established themselves in jobs, and started to raise families, but they can no longer meet the increasing demands brought about by their success. The doctor sees the “highlights reel” of a person’s life, not the hard work and sacrifice it took to get where the person is.