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May 13, 2011

Speed Bumps on the Way to an A.D.H.D. Diagnosis


By LESLEY ALDERMAN
Ms. Goldberg said of her eventual diagnosis: “It was so
WHEN Liz Goldberg, 53, was growing up, she always felt freeing. I realized, ‘I’m not stupid — I have a mental
“a little off.” She received good grades and even disorder.’ ”
completed a master’s degree in health administration,
but it was always a struggle. Just getting the correct diagnosis can be costly. “Many
clinicians do not know how to spot the signs,” said Ari
In school, she would procrastinate and then pull Tuckman, a psychologist in West Chester, Pa., and
desperate all-nighters to study for an exam. She’d author of a book about A.D.H.D., “More Attention, Less
become hyperfocused on a project and let everything else Deficit” (Specialty Press, 2009).
fall by the wayside. Maintaining relationships was tricky.
“I would concentrate intensely on a friend and then Clinicians may arrive at the diagnosis with a snap
move on,” she said. She commuted to college one year judgment, or they may send patients for lengthy and
simply because she had missed the deadline to apply for expensive neuropsychological evaluations. Both
housing. approaches tend to miss the main symptoms — and
therefore waste the patient’s time and money.
“I managed to achieve a lot, but it was difficult,” said Ms.
Goldberg, a mother of three who lives near Philadelphia. If you think that you may have A.D.H.D., or that a friend
“I sensed something was wrong, but others would always or family member may, the first thing to do is get a
talk me out of it.” proper diagnosis. Here’s how to get tested and what to
avoid.
Finally, in her late 40s, Ms. Goldberg was given a
diagnosis of attention deficit hyperactivity disorder, a Step 1: Test yourself.
condition caused by signaling problems in the brain. The
primary symptoms are impulsiveness, inattention, Cost: Free.
restlessness and poor self-regulation. Children with the
condition tend to be hyperactive, but adults who have it If you’re not quite sure if you or a family member has the
often just seem distracted and disorganized. disorder, start by printing out the Adult A.D.H.D. Self-
Report Scale and answering the 18-question assessment.
Undiagnosed, A.D.H.D. can wreak havoc on It was developed by a team of psychiatrists in
relationships, finances and one’s self-esteem. Adults conjunction with the World Health Organization, and it
with the disorder are twice as likely as those without it to is used by many clinicians to diagnose A.D.H.D.
be divorced, for instance, and four times as likely to have
car accidents. It’s no surprise that they also tend to have The test is simple and has a straightforward scoring
poor credit ratings. system. Use the results only as a guide to gauge your
symptoms or a family member’s; it should not serve as a
“A.D.H.D. is a very debilitating mental disorder,” said final diagnosis.
Russell Barkley, a clinical professor of psychiatry at the
Medical University of South Carolina. “It can produce Bear in mind that A.D.H.D. is not something you
more severe impairment, and in more domains of life, suddenly develop as an adult; you are born with it. “If
than depression or anxiety.” you tell me, ‘My life was fine until I was 24,’ you don’t
have this disorder,” said Dr. Barkley.
More than 5 percent of adults have A.D.H.D., according
to a recent study by Dr. Barkley. But just 10 percent of Avoid: Snap diagnoses.
those adults have a formal diagnosis.
Diagnosing this disorder takes time. A quick assessment,
It’s an expensive problem for many consumers. Adults even by your favorite doctor or therapist, can miss
with the condition, particularly women, are frequently important signs.
given a diagnosis of depression, anxiety or bipolar
disorder instead — or their symptoms are dismissed, as “I can’t guess how many clients I have had who have
Ms. Goldberg’s were. seen other psychologists, psychiatrists and primary care
physicians who missed their A.D.H.D., even though it
Speed Bumps on the Way to an A.D.H.D. Diagnosis – NY Times –May 13 2011 – Page 2
was burning like a bonfire,” said Dr. Tuckman. “It’s Avoid: An expensive neuropsychological evaluation.
possible to make a diagnosis by using a rating scale and a
10-minute discussion, but it’s also far too easy to make You don’t need a costly and time-consuming
an inaccurate diagnosis or miss a diagnosis.” neuropsychological evaluation — a series of tests that
evaluate cognitive, behavioral and executive functioning
Step 2: Find an experienced clinician. and language skills.

Cost: $200 to $500. “These tests were not designed to pick up A.D.H.D.
deficits and are not sensitive enough,” said Dr. Tuckman.
Make an appointment, or more than one, with a “It’s also overkill. It takes far longer and costs far more,
psychiatrist, psychologist or neurologist who has $2,000 to $5,000, than is necessary.”
expertise in diagnosing A.D.H.D. Ask your doctor or a
psychotherapist for a recommendation, or contact a local “Overtesting is a real problem” for patients seeking
chapter of the organization Children and Adults With A.D.H.D. diagnoses, added Dr. Barkley. Not only are so-
Attention Deficit/Hyperactivity Disorder (informally called neuropsychological tests inaccurate when it comes
known as Chadd) and inquire about local professionals. to A.D.H.D., but some unscrupulous providers may push
them to reap bigger reimbursements from insurers.
Dr. Barkley also suggests calling a nearby medical school
or university psychiatry program and asking whether A neuropsychological evaluation is useful, however, if
there is a doctor on staff who specializes in adult you suspect you have learning disabilities or need
A.D.H.D. accommodations in school or on tests.

An experienced clinician will typically schedule a two- to Step 3: Understand your diagnosis.
three-hour interview in one long visit, or two or three
shorter ones. The clinician will ask about your history — Cost: $50 or so for some helpful books.
how you performed in school as a child, how you got
along with family members and friends. If you are given a diagnosis of A.D.H.D., study up on the
disorder. Several helpful books are available, including
The clinician also will ask about your present life — your Dr. Barkley’s “Taking Charge of Adult A.D.H.D.”
job, your relationships, your driving record and your (Guilford, 2010) and “Understanding Girls with AD/HD”
finances. He or she will also want to know if other (Advantage, 1999), by Kathleen Nadeau, Ellen Littman
members of your immediate family have an A.D.H.D. and Patricia Quinn, which Ms. Goldberg recommends.
diagnosis.
Cognitive behavioral therapy often is helpful for people
To be found to have A.D.H.D., you must have specific with A.D.H.D. A new book, “Cognitive-Behavioral
symptoms that interfere with a significant part of your Therapy for Adult A.D.H.D.” (Guilford, 2011), by Mary V.
life, like your job or your marriage. Solanto, just came out on this topic, and it describes
strategies that may help people with the condition
“Everyone has some of these symptoms,” said Dr. become more effective at everyday tasks.
Tuckman. “But the person with A.D.H.D. has had them
his entire life, and they are chronic and pervasive.” You Your clinician will probably suggest that you try
can find the detailed diagnostic criteria on the Chadd medication as well as behavior therapy.
Web site.
Avoid: Feeling stigmatized.
The clinician will most likely want to corroborate what
you say with a family member. Some clinicians ask that a Many new patients with A.D.H.D. benefit from joining a
family member come to the interview, or fill out a support group. You can find one on the Chadd Web site.
questionnaire about your behavior and habits. “People
with A.D.H.D. tend to underreport their symptoms,” said “Most people feel a tremendous sense of relief when they
Dr. Barkley. are diagnosed,” said Dr. Tuckman. “They realize, ‘My
future doesn’t have to look like my past.’ ”

http://www.nytimes.com/2011/05/14/health/14consumer.html?_r=3&pagewanted=print

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