(If you know about diagnosing ADHD and the DSM, you might skip down to the good bonus links.)
To Diagnose ADHD:
- Sometimes I can talk to and observe a patient for just a few minutes and it’s obvious that they have ADHD. But not usually. In any event, patients need a real evaluation to discover or to confirm the diagnosis.
- A real evaluation would take at least an hour. It need to be done by someone who understands ADHD – usually a psychiatrist, psychologist, or ADHD coach. Other conditions that can mimic ADHD need to be ruled out. Many professionals don’t understand that they don’t understand ADHD.
- The evaluation should include an interview with questions about childhood and current symptoms, probably a pencil and paper test (which could be done before the appointment, or after), and ideally, talking with at least one other person who knows the patient. Records from childhood, report cards etc. are helpful.
- Then the diagnosis and options can be discussed.
DSM-V and ADHD:
Actually, this is what I meant this post to be about. But I needed to address evaluation first. I’ll start now and finish this the next post (or two).
The Diagnostic and Statistical Manual, fifth edition, is published by the American Psychiatric Association. It is the universal bible of how to officially make a psychiatric diagnosis. It originally (DSM I) was intended for researchers so that scientists in different places could be sure that when they studied one type of patient, schizophrenia, for example, they were all diagnosing the same way. Then all the patients would be comparable. It also had some clinical usefulness, for example, you were struggling to figure out what kind of problem a patient had.
The insurance companies soon got hold of it (as well as the lawyers) and wouldn’t pay unless the official code number for a diagnosis was given. It has been misused and abused since.
It is far from perfect. It’s produced by committees amidst a lot of controversy, politics and turf issues. And there is just too much we don’t know about psychiatric problems. But it’s been tested for some scientific validity and it’s the best thing we have for now.
So it is useful for diagnosing someone with ADHD, for example, using the DSM criteria instead of just saying, “Well, he looks like it.”
Too much already. Next time.
doug
Bonus Links:
good marriage tip from Melissa Orlov- mirror neurons
sentences that can change your life, from Brian Lee
n Lee
Maybe I’m just lazy?
ADDadultstrategies 
hey doug, i loved this post–particularly with how you explained the dsm.
“The insurance companies soon got hold of it (as well as the lawyers) and wouldn’t pay unless the official code number for a diagnosis was given. It has been misused and abused since.
It is far from perfect. It’s produced by committees amidst a lot of controversy, politics and turf issues. And there is just too much we don’t know about psychiatric problems. But it’s been tested for some scientific validity and it’s the best thing we have for now.”
too true. i used to volunteer in a psych. research lab & the leading researcher is regarded as one of the top psychologists in his field. he has had significant contributions to both previous and current editions of the dsm. he’s also an…
…ahem, ass. i had no idea just how political and egotistical it all was, until working for this dude.
anyway, sorry for the tangent. once again, you were spot on. great post.
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hold – glad to get your confirmation of some of my idiosyncratic ideas. its actually a mess but dont know if we know enough to do better yet. will post about science soon, i hope.
thank you for contributing
doug
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Hi Doug,
You bring up some good food for thought! I love your astute comment that “many professionals don’t understand that they don’t understand ADHD” – they got a few hours of training in it somewhere along the line and haven’t kept abreast of new research and developments, and I believe they do much more harm than good.
As a professional, well-trained, ADHD coach (who also has ADHD) I’d be remiss if I didn’t point out that it isn’t the domain of an ADHD coach to diagnose clients. For that, we refer them elsewhere – although I can support clients in deciding if an extensive assessment is necessary (more likely if they are looking for accommodations at school, college or work, or if it seems likely that the ADHD is paired with another condition) or if they want a diagnosis because they would like to try medication. In my experience, if a “real evaluation” is a full assessment it will take many, many hours.
As professionals who also happen to have ADHD I think we do tend to have better intuition about clients who have ADHD though – while everyone’s ADHD is different, there are always some patterns we can pick up on because of personal experience. For me, it feels like I’m talking to a member of my tribe. But as a coach, I’d be unethical if I told my client this meant they did or didn’t have ADHD.
I also want to point out that as an ADHD coach, a client doesn’t require an official assessment/diagnosis of ADHD in order for me to coach them – The coach/client relationship is a partnership, so as long as someone wants to address something that looks like an ADHD trait – ie. procrastination, lack of organization, impulsivity, etc, then I can work with them. Our role is to help clients understand what is getting in the way of what they want in life and move them forward, and to be able to come at it from an ADHD perspective when needed. If I come to believe that someone will be better served by getting a full assessment or diagnosis, or working with a different kind of professional, I let my client know that.
Sorry to be long – I do think as coaching is a relatively new profession getting out accurate information is important! I should also point out I’m in Canada so we may access and use our system a little differently here.
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Sue – thank you for your excellent note. i can correct that about a coach making a diagnosis, but i think a coach would be a reasonable place to start and could make good referrals. then someone wouldnt be seeing a psychiatrist or psychologist without knowing if they know ADHD.
i would like to post your comment if you dont object – i fear that many people dont read the comment
i like your idea that we are a tribe – it does feel that way
thank you for commenting
doug
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I am more than happy to have you post my comment.
And I agree, ADHD coaches are a good start point even if someone just suspects that they have ADHD, and not only can we make referrals, but we can partner with our clients to help them figure out what kind of additional help they really want.
My biggest concern is always that people need to seek support from professionals who specialize in ADHD regardless of whether that’s a coach, psychologist, or whomever. There is nothing more disheartening than hearing the professionals who are supposed to support us say “try harder” (and we hear them say it even if it’s not out loud).
The answer for ADDer’s isn’t “try harder”, it’s “let’s discover how you can try differently”.
Love the funny stuff you posted by the way!
Sue
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sue thanks
doug
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Hi Doug. I tried your Bonus Links, but they didn’t link to anything! I think it may because they didn’t contain full links there. Would you check into this? Thanks. Jeff
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jeff- thank you for letting me know. i keep saying i will check the links before i post, but, well,you know.
i think they are fixed now.
best wishes
doug
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I don’t know what to think of the long diagnostic test for ADHD. I certainly didn’t get one, and when I think of people who could be interviewed about my childhood…. well, there’s at least one who nagged me all the time because “you totally had ADHD when you were a kid!” and another one who is still upset about what she feels like is a misdiagnose, because she’s a scool teacher, so she knows ADHD and I’m TOTALLY not ADHD. All I know is: I might even have a co-morbidity, but the meds help a lot, and I learned to accept what I can’t change. So…
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anon- thank you. will follo soon with dsm and ADHD
thanks
doug
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Good post. Clear & informative!
Sent from my iPad
>
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martha – thank you too
love
doug
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Good post! Clear & informative!
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