Adult ADD

It generally takes me one, but sometimes two, fifty minute sessions to evaluate someone for ADD and begin treatment.  I usually start the session by helping the patient feel comfortable talking with me about his/her problem.  I then find out what exactly prompted him/her to make an appointment to be evaluated and, more specifically, why the patient came to see me at this time.

I usually have my patients fill out an ADD Questionnaire before they come to the office.  During the evaluation session, I explore any psychological or medical issues raised by their responses.  If they have not filled out the questionnaire, I ask them the questions during the session.   Since this involves asking over 50 questions about their symptoms, medical history, life history, and ADD history, I find it a more efficient use of our time if they have filled out the questionnaire beforehand

I have found that people sometimes interpret questions on the questionnaire differently from the way I 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 I ask them the questions aloud are different from the responses they gave on the written questionnaire.  For these reasons, I am skeptical of diagnosis by questionnaire, which is often unreliable.  A clinical discussion with the patient with or without a questionnaire always provides much more reliable information.

From the information I gather, I 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.

I then 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 (depression, anxiety, obsessive compulsive disorder, and others), stress, a sleep disorder, 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 I find the person suffers from one of these disorders, we discuss how they can be further evaluated.  If I am not expert in the disorder, I refer the patient to a specialist.

I make the diagnosis of ADD if…

• I can find no other cause for the patient’s 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

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