Posted by: counselorcarmella | August 24, 2011

Diagnosing ADD/ADHD in Adults

Sometimes,  clients come to us seeking ADD testing because they’ve heard about it, or because someone in their family has been diagnosed, and they think they may have it.  Other times, their physician has referred them for an assessment. Some doctors will assess and medicate themselves and then refer  the client for counseling, but usually it’s the other way around. Other times, clients will come in  with  anxiety or depression or anger issues, and as we’re talking, certain things they say will clue me in that ADD may be  the  real problem, or a big part of the problem.

 

Biopsychosocial Clinical interviews with the  client or patient and a family member should be conducted. Discussion of DSM criteria is crucial, but it is important to note that there is  not an actual diagnosis for  Adult ADD. The closest thing we currently have is a diagnosis of ADD/ADHD in partial remission if  a client doesn’t have enough  symptoms  for a more clear diagnosis.

 

We have to  be able to track it back to  early childhood. So, answering questions about some of the criteria are going to involve the  patient and observer  having to  do a lot of remembering. Since we have to trace symptoms back to childhood, we ask clients and their family members questions about school performance and teacher comments.  School records, when available, can help a lot with this obviously. So, I’ll say, “So, what was school like for you?” A lot of them will just start talking about how awful school was. I’ll ask about teacher comments   and   a lot of people with ADD talk about teachers saying they   just weren’t working up to their potential or that they could  do better if they would  apply themselves.

 

Some kids  got in trouble  at school a lot for being disruptive, but a  lot of them, especially girls,  would  just  space out.  They weren’t causeing problems, but they were in a whole different world.  A lot of girls write notes or whisper to friends.  Some people with ADD  simply fall asleep in class or meetings.

 

A lot of people with ADD  repeated grades,  were diagnosed with other learning problems, or dropped out of high school  or college due to  poor academic performance and frustration. Not everyone with ADD had  problems with grades, though  they might have always had to try a lot harder to focus and might have spent a lot  more time on homework than their friends did.  Really smart kids with ADD can cope through school sometimes, though this gets  more difficult as academic tasks become more structured.  I  diagnose a lot of kids once they’re in high school or early college because of this.  For some people, they can manage okay until they start dealing with  all the   adult pressures of work and family. Some people with ADD have a pattern of underachieving. Sometimes, they’ve gone from job to job and relationship to relationship and just can’t ever seem to settle down somewhere.

 

When you are interviewing someone with  ADD, you are likely to hear about

  • Chronic lateness and forgetfulness.
  • Anxiety.
  • Low self-esteem.
  • Employment problems.
  • Difficulty controlling anger.
  • Impulsiveness.
  • Substance abuse or addiction.
  • Poor organization skills.
  • Procrastination.
  • Low frustration tolerance.
  • Chronic boredom.
  • Difficulty concentrating when reading.
  • Mood swings.
  • Depression.
  • Relationship problems.

 

Assessment instruments can also be used. My favorite is

Jasper Goldberg ADD Assessment

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=974&cn=3

 

Others include

Adult ADHD Self Report Scale

Brown ADD Scale for Adults

Conners Adult ADHD Rating Scale

WHO Adult ADHD Self Report Rating Scale 

 

Our office also uses the Conner’s Continuous Performance Test (CPT) to measure attention span and aid in making the diagnosis of ADD. The Conner’s CPT is a computer-based fifteen-minute test of attention, vigilance, response time, and impulse control. On the screen, letters flash at one-second, two-second, and four-second intervals. Every time you see a letter, you hit the space bar, except when you see the letter X. Whenever you see the letter X you just let it go and do not hit the space bar. People with ADD often have erratic response times (good when the letters come fast at one second intervals, but slower when the letters come at two- or four-second intervals) and more impulsive responses, hitting an excessive number of X’s. This test frustrates many people with ADD.

 

Its important to note that other explanations for ADD, such as head trauma or other neurological issues, shold be ruled out before making a diagnosis.

 

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