Adult ADD

It generally takes one or sometimes two fifty minute sessions to evaluate someone for ADD and begin treatment.  Here are suggested steps for carrying out the assessment interview:

• start the session by helping the patient feel comfortable talking about his/her problem
• find out what exactly prompted him/her to make an appointment to be evaluated and, more specifically, why the patient came at this time.
• review the ADD Questionnaires.  If patients have not filled out the questionnaire, ask them the questions during the session.   Since this involves asking over 50 questions about their symptoms, medical history, life history, and ADD history, it is a more efficient use of time if they have filled out the questionnaire beforehand.  People sometimes interpret questions on the questionnaire differently from the way they were intended them. (Example: “do you pay your bills on time?”  Many patients answer yes when in fact they are so bad at it that they have had to turn over bill paying responsibilities to their significant other, who does pay them on time.  But now since their bills are being paid on time, they answer the question “yes”.)  I have also found that the answers some patients give when the questions are asked aloud are different from the responses they gave on the written questionnaire.  For these reasons, diagnosis by questionnaire is often unreliable.  A clinical discussion with the patient with or without a questionnaire always provides much more reliable information.
• review any information obtained from collateral sources.
• explore any psychological or medical issues raised by their questionnaire responses.
• from the information gathered, one can usually determine whether the person has the diagnostic symptoms of attention deficit disorder and whether they seriously interfere with their work, studies, interpersonal relationships, and/or feelings of self-esteem. Except in unusual circumstances, psychological tests, brain scans, PET scans, or computerized testing offer no useful additional diagnostic information.
• explore whether the person’s problems may be caused, or worsened, by some condition other than ADD, for example a medical problem, a psychiatric problem such as depression, anxiety, obsessive compulsive disorder, and others, stress, a sleep disorder, psychosis, or alcoholism.  Additional psychological assessment may be useful if the patient may have Asperger’s, autism, a learning, reading, or hearing disorder, an obsessive compulsive disorder, a developmental disorder, or a bipolar disorder.  If the person suffers from one of these disorders, consider and perhaps discuss how they can be further evaluated.  If you are not expert in the disorder, you may want to refer the patient to a specialist.
• make the diagnosis of ADD if…

• the patient has the requisite ADD symptoms to qualify for a DSM diagnosis.   (If the patients’ symptoms do not quite meet the criteria but cause enough distress or dysfunction the clinician should use professional judgment to decide whether to being a trial of treatment.)
• there is no other cause for the patient’s ADD symptoms
• the person has a life-long history of such symptoms
• the symptoms are severe enough to cause significant impairment in function and/or relationships

• discuss ADD’s causes, treatment, and prognosis of the disorder with the patient and answer any questions.
• discuss treatment options, including medication, coaching, couples therapy, and others.