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ADHD Diagnosis: Adults, Women & Children

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that can affect individuals of all ages differently. As a result, the diagnostic process may vary depending on age and other factors. Nevertheless, understanding the root causes and obtaining an accurate diagnosis is vital for effectively managing ADHD.

 

Understanding ADHD and Its Causes

 

ADHD is a multifaceted condition with various potential causes and contributing factors. Although the exact causes of ADHD are not entirely understood, several crucial aspects play a role in its development:

 

  • Genetic: One of the most well-established factors contributing to ADHD is genetics. In fact, according to a review on the heritability of ADHD, it is estimated to be around 70-80%, making it one of the most heritable psychiatric disorders.
  • Neurobiological Factors: People with ADHD have unique differences in brain structure and function, which cause various core symptoms, including hyperactivity, impulsivity, and inattention. MRI scans and other neuroimaging studies have shown that individuals with ADHD have distinct differences in brain structures responsible for attention, impulse control, and executive function regulation compared to those without the condition.
  • Environmental Influences: Prenatal exposure to substances like alcohol or tobacco, premature birth, low birth weight, and early exposure to lead can increase the risk of ADHD by disrupting brain development.
  • Role of Brain Chemistry: Imbalances in brain chemistry, particularly involving neurotransmitters like dopamine and norepinephrine, are closely associated with ADHD. These neurotransmitters play a crucial role in managing impulse control, focus, and attention regulation; imbalances in their functioning contribute to the symptoms of ADHD.

The Diagnostic Process for ADHD

ADHD diagnosis is a complex process that requires a comprehensive assessment with a psychiatrist, psychologist, or pediatrician. Here is an overview of the steps involved in the diagnostic process:

 

  1. Clinical Evaluation:
    The first step in diagnosing ADHD typically is gathering information about your signs and symptoms, medical history, and family history. The psychiatrist or psychologist will ask questions about your behaviour, daily functioning, and any challenges you face.
  2. DSM-5 Diagnostic Criteria:
    When diagnosing ADHD, psychologists use specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). They evaluate the severity of each symptom and its impact on your daily life to determine if you meet the criteria for an ADHD diagnosis.
  3. Observations and Reports:
    Your doctor may use questionnaires or rating scales from the people around you to assess your symptoms and gain a complete picture of your behaviour.
  4. Physical Examination:
    To ensure that your symptoms are not caused by any underlying medical condition, it is important to undergo a physical examination. This examination will help rule out other health issues contributing to your symptoms.
  5. Psychological Testing:
    You may need to undergo psychological testing to assess cognitive functioning and rule out other developmental or learning disorders. Doing this confirms the diagnosis and identifies if there are any coexisting conditions.
  6. Rule out other conditions:
    Other conditions, such as anxiety disorder, mimic ADHD symptoms. If you have these conditions, the mental health professional will thoroughly evaluate ADHD from these conditions.
  7. Duration and Severity:
    The duration and severity of your ADHD symptoms are one of the factors for you to receive an ADHD diagnosis. To be diagnosed with ADHD, you must have experienced symptoms of inattention and/or hyperactivity-impulsivity for at least six months. This duration requirement helps differentiate ADHD from temporary or situational issues and ensures that the symptoms have been present over a sustained period. Furthermore, the symptoms of ADHD should significantly impact your daily functioning in various settings, such as at home, school, or work, and in social interactions. This impairment should be noticeable and disruptive to normal activities and responsibilities.
  8. Subtype Determination:
    ADHD can be categorized into three main subtypes, and the mental health professional, typically a psychiatrist, psychologist, or pediatrician, will assess your symptoms and behaviour to determine what type of ADHD you exhibit.
    The three subtypes of ADHD are:

     

    • Predominantly Inattentive Presentation (ADHD-PI): People with this subtype primarily struggle with inattention symptoms. They find it hard to concentrate on details, follow through on tasks, and plan activities. They can also be forgetful, misplace things often, and have difficulty focusing on a task for a long time.
    • Predominantly Hyperactive-Impulsive Presentation (ADHD-PH): This subtype is characterized by hyperactivity and impulsivity symptoms. Individuals with this presentation may have trouble sitting still, frequently interrupt others, and act impulsively without considering the consequences. They may appear restless and have difficulty waiting for their turn.
    • Combined Presentation (ADHD-C): This is the most common subtype, which includes a combination of inattention, hyperactivity, and impulsivity symptoms. People with ADHD-C exhibit a broad range of symptoms across all domains of ADHD.
  9. Treatment Planning:
    After confirming a diagnosis, your doctor will collaborate with you and your family to create an all-encompassing treatment plan. It’s important to understand that the treatment plan is highly personalized and unique to every individual. Depending on your needs, this plan includes behavioural therapy, medication, educational interventions, and supportive services.
  10. Follow-Up and Monitoring:
    Monitoring your progress regularly and adjusting your treatment plan as needed is crucial. Your healthcare provider will monitor your response to therapy and modify the treatment approach based on changes in your symptoms.

ADHD Diagnosis Criteria [DSM-5]

After analyzing all relevant information, your psychologist or psychiatrist will assess if you meet the DSM-5 criteria for an ADHD diagnosis. To be officially diagnosed with ADHD, you must exhibit at least six or more inattention, hyperactivity, and impulsivity symptoms for at least six months. This evaluation is typically performed to determine if you have enough symptoms significantly impacting your daily activities and overall functioning.

Inattention Symptoms:

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities.
  • Often has difficulty sustaining attention in tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions).
  • Often has difficulty organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
  • Often loses things necessary for tasks and activities (e.g., toys, school assignments, pencils, books, or tools).
  • Is often forgetful in daily activities.

Hyperactivity and Impulsivity Symptoms:

  • Often fidgets with or taps hands or feet or squirms in seat.
  • Often leaves the seat when remaining seated is expected (e.g., leaves the classroom).
  • Often runs about or climbs in situations where it is inappropriate (in adolescents or adults, it may be limited to subjective feelings of restlessness).
  • Often unable to play or engage in activities quietly.
  • Is often “on the go” or acts as if “driven by a motor.”
  • Often talks excessively.
  • Often blurts out the answer before the question has been completed.
  • Often, they have difficulty waiting their turn.
  • Often interrupts or intrudes on others’ conversations or games (e.g., butts into conversations or games).

Additional Criteria:

  • Several inattentive or hyperactive-impulsive symptoms were present before age 12.
  • Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
  • There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning.
  • The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder. They are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

Diagnosing ADHD in Adults

When you’re an adult with ADHD, it’s important to recognize that the condition doesn’t just disappear with age. Many adults continue to experience its symptoms. However, diagnosing ADHD in adults can be more challenging than in children because the way symptoms manifest may differ for you. Here are some key aspects to consider when you’re seeking an ADHD diagnosis as an adult:

  • Clinical Interview: A qualified mental health professional will conduct a clinical interview with you. This interview is designed to gather a comprehensive history of your symptoms and how they impact your life, including your work, relationships, and daily responsibilities.
  • Assessment Tools: Like children, you will likely undergo an ADHD diagnosis test using standardized assessment questionnaires. These include a self-report assessment for you and reports from close family members or your partner.
  • Developmental History: Examining your developmental history is crucial in adult ADHD diagnosis. This helps determine if your symptoms were present before you turned 12, a key requirement for an official diagnosis.
  • Differential Diagnosis: Diagnosing ADHD in adults can be tricky because the symptoms can resemble those of other mental health conditions like anxiety, depression, bipolar disorder, or substance abuse. Your psychiatrist will differentiate these conditions to avoid misdiagnosis and ensure you receive the right treatment.
  • Multimodal Assessment: To get a complete picture of your abilities and challenges, healthcare professionals conduct multimodal assessments. This involves cognitive testing, mood assessments, and a review of your academic or work history.
  • Consideration of Comorbidities: Many adults with ADHD also have other conditions like anxiety or depression. Addressing these coexisting conditions as part of your evaluation is crucial because managing them is essential for effective treatment.

Diagnosing ADHD in Women

ADHD in women is often underdiagnosed or misdiagnosed because the way symptoms manifest is subtler and distinct from that in men. Infact, the average age of ADHD diagnosis in females is said to be around the late 30s or early 40s.  The overall process is almost the same as in adults; however, some additional assessments are done when diagnosing ADHD in women. If you’re a woman trying to seek an ADHD diagnosis, here are some key aspects that happen:

  • Clinical Evaluation: You’ll begin with a clinical evaluation, discussing your current and past symptoms. Your developmental history, including any signs of ADHD during childhood, will be explored since symptoms should have been present before the age of 12 for an ADHD diagnosis.
  • ADHD Rating Scales and Questionnaires: Doctors may ask you to complete ADHD rating scales and questionnaires to assess symptom severity and their impact on your daily life. They may also seek insights from family members, partners, or friends to understand your condition and its effects on your relationships and activities.
  • Inattentive Symptoms Assessment: Women with ADHD often exhibit more inattentive symptoms than hyperactive-impulsive ones. Expect specific questions about difficulties with organization, time management, forgetfulness, and maintaining focus on tasks.
  • Women-Specific Assessment:
    • Emotional Dysregulation & Masking Behaviours: Emotional dysregulation and masking behaviours are common among women with ADHD. You’ll be asked about mood swings or intense emotions. Your healthcare provider may also inquire about your coping mechanisms, which may hide your symptoms, such as striving for perfection, overachieving, or concealing difficulties.
    • Hormonal Influences: Hormonal changes during your menstrual cycle, pregnancy, or menopause can affect ADHD symptoms. Your counsellor may inquire about whether these hormonal fluctuations impact your symptoms.
  • Screening Questions: Mental health clinicians may ask about your specific life experiences to gain deeper insights into how ADHD symptoms may worsen. They may focus on topics such as motherhood-related challenges or work-related stressors. Considering these factors helps clinicians provide more precise diagnoses and tailored treatment plans for women with ADHD.

Diagnosing ADHD in Children

Typically, diagnosing ADHD in children begins during elementary school when symptoms become more noticeable. Here are some important points to keep in mind:

  • Developmental History: To diagnose ADHD in your child, healthcare professionals will consider their developmental history, noting that symptoms should have been present before they turned 12.
  • Teacher and Parent Reports: As a parent, you and teachers play a significant role in providing insights about your child’s symptoms through questionnaires and interviews at school and home.
  • Differential Diagnosis: Learning disabilities can sometimes mimic ADHD symptoms in children. A comprehensive evaluation is done to distinguish between these conditions accurately so your child will get the right treatment.
  • Educational Assessment: If your child’s academic performance is affected, an educational assessment may be conducted to determine whether they qualify for educational accommodations or need an Individualized Education Program (IEP).

Is it Worth Getting an ADHD Diagnosis?

Accurate diagnosis can be life-changing, allowing you to identify and commence an effective treatment plan. Consider your needs, goals, and how ADHD affects your life before deciding whether getting an ADHD diagnosis is worth it. While some people with ADHD may develop effective coping mechanisms independently, others may experience significant impairment from their symptoms. If you suspect that you have ADHD or are struggling with its symptoms, it’s recommended to see a healthcare professional specializing in ADHD for a comprehensive evaluation and guidance on the best course of action for your situation.

Is ADHD Self-Diagnosis Possible?

ADHD self-diagnosis is possible but has limitations. Even though you can research ADHD symptoms and compare them to your own experiences, it is a complex condition. Self-assessment may be biased and carries a risk of misdiagnosis. Therefore, please consult a qualified mental health counsellor for a formal diagnosis, as they can conduct comprehensive evaluations, rule out other causes, and provide access to appropriate treatment and support services. Self-awareness is an important first step, but a professional assessment is essential for a reliable diagnosis and proper care.

Where to Get ADHD Diagnosis?

When seeking an ADHD evaluation and diagnosis, there are various places where you can turn for assistance. Some of these include:

Psychiatrist: Psychiatrists are medical doctors with expertise in mental health conditions, including ADHD. They can conduct a thorough assessment, provide an official diagnosis, and prescribe necessary medication.

Psychologist: Psychologists are trained to assess and diagnose ADHD using standardized tests and assessments. They offer a detailed evaluation and can recommend treatment options, such as therapy and behavioural interventions.

Pediatrician: If you suspect your child has ADHD, consulting their pediatrician is a good starting point. Pediatricians are skilled in diagnosing and managing childhood ADHD and can make referrals to specialists if needed.

Mental Health Counselling Center: Mental health counselling centers often have professionals who can evaluate and diagnose ADHD. They offer a range of services to support individuals with ADHD.

What to Do After ADHD Diagnosis?

ADHD management is an ongoing process. Finding the most effective strategies and treatments for your situation may take time. To start, follow these steps after you get diagnosed with ADHD.

  • Learn About ADHD: Understand your condition and educate yourself on ADHD, its causes, and how to manage it. 
  • Discuss treatment: Consult with your mental healthcare provider if you want to proceed with medication, therapy, or alternative treatment options.
  • Implement Strategies: Use strategies and techniques such as organizers, breaking tasks into smaller ones, or setting a routine to manage ADHD symptoms in daily life.
  • Seek Support: Reach out to support groups, therapists, or counsellors specializing in ADHD. Connecting with others who have similar experiences can help you on an emotional level.
  • Accommodations: If you’re a student, discuss your diagnosis with your school or university’s disability services office. They can help you access educational accommodations, such as extended test-taking time or note-taking assistance. If you’re employed, consider talking to your employer or HR department about workplace accommodations. These may include flexible scheduling, noise-cancelling headphones, or task organization tools.
  • Healthy Lifestyle: Maintain a healthy lifestyle by exercising regularly, eating a balanced diet, and prioritizing sufficient sleep. These habits can help manage ADHD symptoms.
  • Regular Follow-Ups: Regularly follow up with the counsellor to assess your progress and make any necessary adjustments to your treatment plan.