Adult ADD

The guidelines below may help you find a competent ADD specialist to evaluate and treat you.  They may also help you get the most of the treatment you receive. Following the guidelines is no guarantee that your evaluation and treatment will be successful or that the specialist you see will be competent.  But they will increase your chances of success.   Here are the steps.

Table of Contents

Get the names of a few ADD specialists in your area
Check out the reputation of the clinicians on your list
Call the “finalists” on your list and ask a few questions
Once you have made an appointment…
To prepare for the evaluation session, write down the following information
Get to the appointment at least fifteen minutes early
At the end of the evaluation, make sure you know what the plans are for the next step
Be sure you are comfortable with the plans suggested by the doctor
How to keep ADD from interfering with your treatment sessions

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Get the names of a few ADD specialists in your area
Try to get at least a few names to start with.  If possible, get the names of ADD specialists from more than one source.

• Ask your doctor or another a health care professional you trust for names.
• Phone your local hospital’s department of psychiatry or pediatrics and ask the secretary of the head of the department for names of ADD specialists who see adults.
• Call your local mental health center and ask for the names of Adult ADD specialists in your area.

Less reliable methods include…

• Checking ADD sites on the internet for names.
• Looking in the yellow pages of your phone book under physicians, social workers, psychologists, or coaches.  See if any advertise that they specialize in ADD.

You can use the Google to find ADD specialists.  After “Adult Attention Deficit Disorder…” enter the name of a city near you.  For example, Adult Attention Deficit Disorder Cleveland Ohio.

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Check out the Reputation of the Clinicians on Your List
As best you can, check out the reputation and qualifications of the people on your list, then select one or two who seems best suited to evaluate ADD. As in any field, some people are smarter, more responsible, more patient-oriented, or more knowledgeable than others.  Get as much information about the specialists on your list as you can.  Ask your doctor if he or she is familiar with any of the people on your list personally, professionally or by reputation.

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Call the “finalists” on your list and ask a few questions

• Are they accepting new patients?
• If you will be relying on insurance to help pay for the evaluation or treatment, check to be sure that visits to the professional you have called will be covered.  If your insurance is through a managed care plan, and you are willing to see only a doctor who is in your plan, the first question to ask is whether the doctor is in your plan’s “provider network”.  Don’t rely on the insurance company for this information as these companies sometimes add unaffiliated physicians’ names to their lists to attract more customers.
• If the provider you want to see is not on your insurance network list, try to find out if you have benefits that will pay for a provider who is “out-of-network”.
  Keep in mind that some excellent doctors do not participate in some (or any) managed care plans.  While you may have to pay a deductible and a larger co-payment for an out-of-network provider than you would if you saw someone in your plan, there may not be a good ADD specialist in your insurance plan.
• Ask the secretary (or the provider) if the provider specializes in the diagnosis and treatment of adult ADD.  In some smaller communities, you may not be able to find a specialist and may have to see someone with less experience and knowledge, but if you can find a specialist, you will probably be better off.
• If the person you are speaking to does specialize in ADD, you might ask some more questions.   For example, how many times do they see someone in order to decide whether the person has ADD.  No more than two visits are usually required.  However, many other disorder such as hyperthyroidism, anxiety, sleep apnea, or hypomania, may mimic ADD, and in more complicated cases, medical or other tests may be needed.
• Will the clinician want to talk to your significant other.  If information can be obtained from a patient’s family or a friend or co-worker, it helps a great deal in making the diagnosis since people with ADD are often unaware of the full extent of their symptoms. The situation is similar to that of a person who is hard of hearing who may not fully appreciate how severe his hearing disorder is, while those around him can judge it more accurately.
• Will you have to take special tests to make the diagnosis. The diagnosis of ADD is most often made solely by taking a history and making observations.  Psychological tests, neuropsychological tests, or computerized tests rarely need to make the diagnosis of ADD.  They should be done only if there are specific questions that need to be answered.  Some psychological tests, like the subtests of the IQ test or certain neuropsychological tests, may be useful for answering questions like whether there are learning problems present, what kind of memory problems the patient is having, how severe they are, etc.  Continuous performance tests use computers to measure certain psychological capabilities. It is unlikely that they will be of great value in making the diagnosis. However, repeated over time, they may be helpful in measuring the effectiveness of the treatment.
• Find out  how much it will cost to do the evaluation. It’s OK to ask.  The cost will depend on a number of factors: if you are seen within a managed care network, you will usually have to pay only a small co-payment (from $5 to $25).  If seen outside a network, your fee for the evaluation may run from $100 to $500 or more depending on where you live, who you see, how long the evaluation takes, etc.  You can usually get reimbursed for some part of out-of-network costs if the provider is not in your insurance network.
• Will the person who is doing the diagnostic interview will also carry out treatment for ADD if it is indicated.  It will probably save you time and money to have your evaluation done by someone who can carry out your treatment, if it is indicated.
• Does the clinician usually use stimulant medication to treat ADD.  Research strongly suggests that the most effective treatment for ADD is psychostimulant medication.  In the largest study done to date, involving hundreds of children with ADD, medication accounted for 90% of the improvement that occurred with treatment, while extensive behavior therapy, counseling, and coaching together accounted for only 10% of the improvement.  So medication should always be seriously considered as a component of the treatment of ADD. Still, there may be good reasons not to take medication.  It is not helpful to everyone; it may be contraindicated because of some medical problem;  there are some risks to taking any medication.  Nevertheless, it is generally useful to see a specialist who is familiar with the effects of medications and who can either prescribe them him or herself or has a medical colleague with whom he can collaborate if you need medication.
• Will the ADD professionals do psychotherapy if it is indicated.  Psychotherapy can help a person deal with some of the interpersonal problems that are often caused by ADD.    It can also be useful in dealing with depression or anxiety or other psychological problems that coexist with the ADD.  It can also help people and their families adapt better to the limitations that ADD imposes on them.  However, psychotherapy alone is only rarely an effective treatment for ADD.

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Once You Have Made an Appointment
After you have learned what you can about the providers you are considering seeing, select the one about whom you feel the most confident and comfortable and make an appointment,

• Write down the appointment date and time. Also write down the clinician’s address, directions to the office. and phone number.  Where will you park if you go there by car?
• Set your reminder system to remind you a day before the appointment.
• Write down the fee and the payment method.
• Write down how long the visit should be expected to take.

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Prepare for the evaluation session. Write down the following information:

• A list of all medications you are taking, including the doses and reasons for taking each.
• A list of all medications you have ever taken for ADD or other psychological problems. Include the dates taken, doses, effects, and side effects.
• A list of all doctors you have seen for evaluation and treatment of ADD or other psychological problems, with their addresses and phone numbers if possible.
• A description written by someone who knows you well of the symptoms of possible ADD you are having.  Sometimes ADD may prevent you from seeing your problem clearly.  A description of your symptoms written by a family member or co-worker can often help the specialist understand the nature of your problem more readily.
• If someone who knows your symptoms well can accompany you to the appointment, ask the professional whether it would be helpful if that person came with you to provide some observations about you.

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Get to the appointment at least fifteen minutes early
If you have ADD, there is a fair chance that you will arrive for your appointment late (unexpected traffic, parking difficulties, difficulties finding the office, poor directions from the computer or your global positioning device, you thought it would take much less time, got off the highway at the wrong exit, etc. etc.)   The best way to deal with these totally unexpected and surprising events is to include them in your plans.  Plan to be ten minutes early and bring a book or something else to keep you busy in the waiting room in case you actually arrive fifteen minutes early.  If it makes you uncomfortable to sit in the waiting room, wait outside the door and go inside when there are only two minutes left before your appointment.

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At the end of the evaluation, make sure you know what the plans are for the next step.
The biggest source of dissatisfaction with treatment is conflicting expectations of the patient and the provider. So get the following information: The overall plan for your treatment.

• What should you expect of the provider during the sessions and what will the provider expect of you
• The planned frequency of the sessions
• The length of each session
• The fee for the sessions and how you will be billed and pay for it
• The provider’s policy regarding charges for missed or canceled appointments
• When you might expect to see improvement

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Be sure you are comfortable with the plans suggested
If you are not, tell the doctor why and maybe the plans can be changed to suit you better.

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How to keep ADD from interfering with your treatment sessions
Once you begin treatment, you may find that the symptoms that brought you to treatment interfere with the treatment. Behaviors like lateness, interrupting, losing focus, have trouble persevering, memory problems, difficulty organizing, and others, can all make treatment sessions less efficient and less effective. For some ideas on how to minimize the effects of such behaviors on treatment (and other relationships), click here.

If you follow the steps above, you will be more likely to get the proper diagnosis and treatment for your ADD.  And that could make an enormous difference in your life.