Seeking ADHD evaluation — but therapist thinks it's unnecessary

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This topic contains 9 replies, has 5 voices, and was last updated by  Bloom 1 day, 21 hours ago.

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  • #135620

    miral
    Participant

    Hello everyone,

    I’ve been reading on ADDitude for weeks (if not months?), but only now moved over to the forums and thought I might as well ask for input/thoughts/comments.

    Disclaimer: at this point, I am not diagnosed with AD(H)D. But I have decided that I want to get evaluated.

    It never occurred to me that I could be AD(H)D. As a girl, growing up in the 90s and early 2000s and outside the US, ADHD was this hype diagnosis for rampant boys and parents who were just too lazy to parent. Yeah, lots of stigma – which obviously stuck.

    I never (really) struggled in school. I certainly didn’t show any of the really obvious signs that would warrant a ADHD evaluation as a kid. I wasn’t the “problem child”. I had good and excellent grades. I was able to pay attention – because I freaking love learning. I am now 32 and a PhD student in the Sciences.

    Earlier this year I finally started therapy (after years of struggling) for various reasons including exhaustion, difficulties with motivation/focus, and sleep issues. I was diagnosed with GAD, PTSD and depression. While I have no doubt about GAD and PTSD (because, I live it, daily), I highly doubt the depression diagnosis – it just doesn’t fit from where I stand (but who am I to question the expert).

    Either way, while getting more informed on these and joining a different forum, ADHD came up from someone who has it herself and mentioned it as causing her perfectionism – something I relate to a lot. And while perfectionism is common for people with anxiety, all the descriptions just don’t quite fit.

    So I started reading and researching ADHD. And with every article I read on it, I was like having epiphanies. One after another. I was feeling like someone was writing about me. I couldn’t stop going “yes, Yes, YES!”. To the point of actually crying because it felt so damn accurate.

    For years I’ve struggled with feeling misunderstood. With people just not quite getting me. Like my brain is just wired differently, somehow – because I kept bumping into the same bumps over and over.

    In retrospect? LOTS of signs that point toward a possibility of ADHD. Not in the obvious diagnostic criteria kind of way. But convoluted — yet still there if you know what you’re actually looking at.

    Talking non-stop and at warp speed.
    Also blurting out (inappropriate) comments. I always say I talk my mind. Which has caused a lot of embarrassment and emotional pain over the years.
    Always late. Always!
    Super messy.
    Constantly loosing/misplacing things.
    Careless mistakes. Over and over and over. Regardless of how much/hard I try.
    Distractibility.
    Perfectionism.
    Workaholism.
    Impatience. Why is everyone always so daaaaamn slow? And why does everything always take soooo long? And why do I need to wait half a year or a year for something that I clearly want NOW?
    Procrastination. (“I have a motivation problem until I have a time problem”)
    A gazillion unfinished projects.
    Rejection sensitivity. Big time.

    You name it.

    Each of those on its own? Probably fairly normal or at least within normal norms of most people, things everyone struggles with every now and then and to varying extends. However, taken together? And wile many of those can very well be part of GAD/PTSD/Depression, many of those predate the latter diagnoses by like forever. It’s my “normal”. (I guess that’s part of why it never occurred to me that it could actually be caused by a legit neurobiological disorder).

    And people who don’t really know me in-depth and for a long time? Wouldn’t know. Because I’ve become a master at hiding and compensating all those things I struggle with, daily. Like…my therapist things I’m a very organized person because during the first session I came in with three pages of bullet points of “issues” (well…yeah, because otherwise I would’ve forgotten to bring up half the things that were on my mind and I deemed important).

    I know how problematic self-diagnosis is. But, I have this strong gut feeling that it could be. But I’m also facing my own and society’s deeply engrained stigma combined with skepticism by my therapist (and my own tendency to doubt everything — I’m very susceptible to imposter syndrome). I’ve been carrying around the suspicion for quite a while, now, but didn’t mention it to my psychologist, because I didn’t want to bias her assessment of me. But since she repeatedly attributed what in my opinion are CLEAR signs of ADHD to pure anxiety, I finally mastered up all the courage I could get and asked her about it. She said I’m welcome to get assessed by my Psychiatrist and while she doesn’t think it’s completely ridiculous, she also said she fails to see how it would make a difference. Because she says even if I had ADHD, what difference would it make for me knowing, as the treatment would be medical (and I’m already reluctant towards medication for anxiety/depression) and behavioral, and the behavioral treatment is essentially the same for all of these (i.e. ADHD, anxiety, ….). She thinks it’s not worth the effort going through the complicated evaluation as an adult (because it’s more difficult and involves a lot of tracking down records, finding someone willing to fill out questionnaires on my behalf etc.) relative to the therapy I’m already having. Because at the end of the day, it wouldn’t change anything — I’m dealing with chemical imbalances in my brain either way and it doesn’t reeeaaally matter what they’re called.

    It makes ALL the difference to me. How she cannot get that is beyond me.

    I guess my question is…has anyone struggled with this? Feeling like they actually have it but facing opposition from the very people who would be able to diagnose them? Any tips?

    I guess I’m also curious what to actually expect when going in for evaluation?

    And what are things I could proactively prepare already before going in to talk to my Psychiatrist at the end of the month (for an actual different appointment – current medication (that I’m not taking) evaluation. It’s only a normal 20 minutes appointment, unfortunately).

    Thank you!

    • This topic was modified 5 days, 13 hours ago by  miral.
    • This topic was modified 5 days, 13 hours ago by  miral.
  • #135637

    I can relate to much of your post – did not have typical symptoms as a kid and even as an adult – i would have never thought about it until – my daughter was diagnosed and sending endless hours reading about ADHD and listening to webinars. In fact the added “burden” of trying how to manage my daughter’s ADHD really through me into feeling overwhelmed like never before. All the reading i was doing – i often had epiphanies as you did – realizing – oh my, this is me, and when I think back to my childhood- I see it now even though i did not have the typical inattention – I did well in school and was not a problem child, but i was exhausting to be around and was a bit awkward socially – but managed to make a small circle of friends who accepted me for who i am and are still very much in my life – thought I know being my friend hasn’t always been easy- and I understand that more now than ever.

    I have many of the same symptions
    Talking ALOT and quickly – bouncing from one topic to the another non-stop
    Also blurting out (inappropriate) comments. I always say I talk my mind. Which has caused a lot of embarrassment and emotional pain over the years.
    Used to be on time, but last couple of years with added stress of kids – i am always late..and being late stressing my out but always underestimate the time it will take the get our the door.
    Constantly losing/misplacing things.
    Getting easily distracted from one thing to another
    Perfectionism.
    Workaholism – and feeling guilty when I can’t work as much as i think i need to
    Impatience
    Procrastination for things that are not super interesting to me
    A ton of unfinished projects and books
    Rejection sensitivity!!!!

    I actually am curious to hear others opinion on the benefits of getting diagnosed – I am having trouble making sense of it for myself – i sort of feel – it doesn’t change how i feel and not sure i would do meds – there is no “cure” so it is just something i have to deal with.

  • #135648

    quietlylost
    Participant

    Short answer yes. I’ve had some very similar experiences and thoughts that you have shared, and for a long time wondered if there might be attention issues as part of the presentation. I initially sought help most recently about 1.5 years ago for those and over time we got to the ADHD diagnosis which has been super helpful.

    It took me a while to believe it, but the more research I’ve done since the more it makes sense. I find that it helps clarify a lot of things and gives me a new perspective. I still receive support including therapy and medication, and those have been critical.

    I’d say if you’re wondering, let your provider know. Ask if they’re willing to discuss it or explore it further. Cognitive testing may be ordered though it’s not really diagnostic. You can ask if they have preferred ways to assess, or if they’d like you to do some screening tools like the ASRS. It’s okay to keep asking questions and advocating for yourself. The info you shared here is a good way to introduce the topic to them as well.

    Whatever happens, diagnosis or not, the idea that you may have it is still helpful. A diagnosis is important when getting medication, but without the diagnosis we can still “know” what we have and seek help for it. I hope you get the support and clarity you need.

  • #135661

    Penny Williams
    Keymaster

    This guide explains the diagnosis process:

    ADHD in Adults: Your Guide to Symptoms, Diagnosis and Treatment

    Penny
    ADDitude Community Moderator, Parenting ADHD Trainer & Author, Mom to teen w/ ADHD, LDs, and autism

  • #135695

    miral
    Participant

    @penny Williams: Thank you for the link! I’ve actually already read it a while ago, but helpful to go over it, again.

    @477sherlock@gmail.com and @quietlylost also thank you for your feedback!

    My therapist/psychologist said if I wanted an evaluation, I would have to approach my psychiatrist (which I’m planning to do on my next appointment). While she doesn’t think it’s completely ridiculous to want to be evaluated, she doesn’t seem to think I have it and also thinks it’s not worth the effort. She said for adults, the process is tedious and not straightforward, as it includes bringing in old school records and finding people who’ve known me since childhood and who are willing to fill out questionnaires (i.e. parents). And how a diagnosis wouldn’t change anything in terms of treatment etc.

    I have my school report cards. They say nothing — on the contrary, particularly in kindergarten they keep pointing out how I’m an ambitious student who’s paying attention, finishes tasks fast and on time etc. …. so…the exact opposite you’d expect from someone with ADHD.

    My parents….I’m very uneasy to approach them about that. They’re from the “pull yourself together and focus” tribe.

    So, essentially it’s my word. And while my gut feeling says “YES”, it’s hard to “proof”. I know how difficult ADHD diagnosis is, particularly since it’s so vastly overdiagnosed, and how critical differential diagnoses are. But I’ve rarely felt so certain about something…that is after having done a LOT of research on it over the past few months. Because my baseline is being skeptical. But this….just makes SO much sense!

    Like @477sherlock@gmail.com I’ve always been somewhat socially awkward, and while I get along with most people, I do have a hard time “really” fitting in in what is considered “normal” social contexts.

    I was lucky enough to go to a specialized school for highly intelligent/gifted people in the Sciences. It was extremely challenging and I think that’s what kept me afloat. I need challenge in my life and I love Science and learning. It made me thrive. Careless mistakes in Maths and Physics I compensated by taking on every single extra task to improve my grades. And generally, I was the one organizing every single class event, the teachers’ helper, and entertained at least two extra-curriclular courses and on average 3-4 regular hobbies. I just kept myself busy as hell. Also, all the folks in my class were neurologically atypical (i.e. IQ 130-140 people) and hence we got along perfectly because we all were “different” and we understood each other and our struggles without explanation. It made ALL the difference from personal experience for a couple years in a normal middle school context.

    I’m also exhausting to be around and tend to overwhelm people. But my friends in highschool could take it – because they themselves were exhausting (ever discussed with someone about black holes and n-dimensional hyperspaces at age 14? :p )

    I guess why it matters to get diagnosed? First and foremost confirmation that I’m not just lazy or not trying hard enough. That it’s not just all in my head.

    But also, to get proper treatment (whatever that is because I’m reluctant re medication) and to be able to appropriately communicate my struggles with the people around me, family as well as health professionals. It makes all the difference if I say for example “I’m having a hard time focusing/motivating” as a symptom of ADHD or depression.

    • #135706

      quietlylost
      Participant

      A good provider who understands ADHD will see beyond the stereotypical assumptions about ADHD. ADHD people can be high achievers, functional, successful, and even organized and goal-oriented. That doesn’t highlight the struggles faced inside that impact making those things so hard.

      I was in gifted education in the past and also have multiple degrees. Despite my “success” eventually my providers were able to sort out the underlying issues that had tempered my struggles along the way. I hope you get that for yourself.

      If you don’t have good documentation of your past struggles, it may be useful to seek people in your life who know you currently. Maybe include performance evaluations at work, feedback from friends or peers, and even keep a log of current challenges and examples of the symptoms you see. It can be helpful to catalog some of these things for providers as they can’t often see us in our home environment. Usually our friends or partners don’t either. Hopefully there might be someone from your life currently that can help testify to your struggles if you’ve been open with them. It doesn’t sound like your therapist would be one of those people.

      Again, good luck. It can be a challenging process, and it can take a long time. It took me 1.5 years with my most recent providers to get to that point.

  • #135709

    miral
    Participant

    Thank you @quietlylost

    Yes, the more I read about ADHD, the more I think my ambitious personality and above-average intelligence simply helped mask most of my symptoms. I’ve just become excellent at “coping”/hiding from a very young age. I’m also not the typical girly day-dream type.

    I will have to discuss with my psychiatrist (it sucks I only have appointments every month or so — there is my impatience yet again 😉 ); I’m sure I can get my husband to provide a statement. He LIVES with me, so he experiences my non-existent time management and misplacing and forgetting things on a daily basis.

    My therapist is convinced it’s basically all just plain anxiety and depression. A few sessions ago she made a test with me whether I could sit still for 5 minutes doing nothing (she pushed it to 15 total, I think?). Because I’m having a hard time relaxing…or rather, not a hard time, I’m unable. I’ve been so exhausted for years that the moment I’m not doing something, I just fall asleep. So…yeah….I was able to do those 15 minutes…because…well…at age 32 you’ve learned to behave. She also asked me about whether tags in clothes bothered me. And we had an entire session on how I can’t stand boredom and can’t get myself to do boring things. I thought all those were things she was kinda “testing” towards ADHD…. but turns out, not really.

    When I came in with a list of major struggles including procrastination, she glanced at it and right away said “anxiety”. When I say “I feel like most people plain misunderstand me” or when I don’t do the dishes or stack my clothes in a big pile instead of putting them away after laundry — it’s depression.

    It’s seriously no miracle that adults with ADHD who have not been diagnosed as kids are most commonly misdiagnosed with anxiety and depression.

    This entire being-my-own-advocate-thing is really hard for me because I know how much health professionals hate Dr. Google and as a scientist myself I feel like I can’t bias their assessment, they’re the experts on this, not me. If that makes sense.

    • This reply was modified 3 days, 17 hours ago by  miral.
  • #135746

    Bloom
    Participant

    dear @miral
    hopefully you have had a good rapport and work with this therapist in the past so there are positive take-aways from the experience. IMO it sounds like time to find another therapist who can help you explore this. Therapy is expensive and your time is valuable too.

    It’s not possible for healthcare providers to become experts in every field, so sometimes our health does need us to seek out a certain kind of expertise. (Here is a nice comprehensive article that describes some of the gaps between likely incidence, diagnosis, treatment and responses: https://healthengine.com.au/info/attention-deficit-hyperactivity-disorder-in-adults-adult-adhd )

    Spending your precious energy educating your provider and updating them to current research would be generous and might get you the diagnosis. (You could fill out the Jasper/Goldberg Screening and bring them a PDF copy, since it’s a robustly validated psychometric, even cross-culturally.) But that is actually just the start of the next chapter of your life – You need providers experienced at working with people in the next phase.

    Whether you are diagnosed with AD(H)D or even if you have lots of symptoms that don’t 100% fit (say a sub-clinical version of AD(H)D), many of the strategies an AD(H)D coach or clinician would teach you will help make your quality of life better. In most cases you would start to see benefits within a visit or two…
    bloom!

  • #135801

    miral
    Participant

    One thing I really keep wondering about is the “interfere with or reduce the quality of social, academic, or occupational functioning.” part of the diagnostic criteria.

    Because this feels so…subjective. Where does “interfere” begin? How does someone determine if the quality of life is “reduced enough” to warrant a diagnosis? Because what about people who are just really excellent at white-knuckling it? What is the baseline for comparison?

    Or in other words, most of what I recognize as symptoms either in the now or in retro-spect have never really “interfered” with my life as in I’ve just accepted them as part of me and my character traits, my idiosyncrasies, and as part of normal life challenges I have to overcome, and then find ways to overcome them.

    • #135803

      quietlylost
      Participant

      It can be a hard thing to sort out sometimes. Maybe think of it as, “What were some of the things I did have to white knuckle to get done?” Or, “What are some of the daily things I deal with that exhaust my brain or exhaust me physically?” Impairment doesn’t just mean that you fail, but it can mean making things more difficult, getting them done later, or even having to choose different paths to avoid having to do certain things.

      For example, maybe you still get the laundry done, but only after you’ve gone through your entire wardrobe and used Febreeze on dirty clothes for a few days. Or, maybe you are able to make it through the work day with meetings and job duties, but then when you get home in the evening your brain is so fried that you can’t focus, relax, or recuperate.

      Are there areas in your life where you feel you’re falling short of potential? Are there things that you avoid doing because you know that you won’t do them well or you’re afraid that others will judge your performance? Are there relationships that you’ve lost due to being forgetful, impulsive, or just uninterested?

      Most of us with ADHD find a way to make do, and we cope with what we have to do to survive. That doesn’t mean we’re not impaired. It means that we’re persistent, resilient, and creative. It’s important to identify what those areas are that are hard for us or where we fall short, as that can be a starting point for discussing that criteria.

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