Adult ADHD Assessment - Confused!

[ShoobyDoos]

I'll try to keep it short - I'm late 30s and think I've got ADHD (lots of executive dysfunction and honestly, it all just fits. Big a-ha moment when I connected the dots.). Anyway, I finally had a formal assessment today, and the result came back that I do NOT qualify, as there is not enough evidence to suggest it manifested before the age of 12! (I was very chatty, daydreamy, and impulsive, but I also did well academically.) I also suffered a lot of trauma between the ages of 12 - 25, which I think the psychiatrist leaned into as alternative potential reasons for my 'symptoms'. I'm not sure what to do from here! I just have this gut feeling that this is an incorrect conclusion. Has anyone else had similar? what did you do next? Is it worth fighting for medication? It's so isolating and confusing.

It’s worth checking out how C-PTSD for childhood trauma presents in adults.

I have C-PTSD, my friend has ADHD. We both have similar presenting symptoms but although they present similar, the way they come about is very different.

This with bells on. DS1 was found not to have ADHD a few years ago, but was placed on the waiting list for ASD assessment. He was finally diagnosed with autism a couple of months ago after 4 years on the list. We went down the ADHD route because several of DP’s family members are diagnosed and if DP doesn’t have it, I honestly don’t know who does! I still believe DS1 has ADHD but am leaving things as they are as he’s 17 and doesn’t want to revisit it. He is adamant that he will never go on medication and he can still follow any strategies for management that he finds helpful.

Yup, known as a ‘drive-thru’ diagnosis. The same with Autism.

I suspected I might have it so went to see a private psychiatrist.. they gave me a written test to fill out - - you had to tick boxes if symptoms were present. On the left it had a column for adulthood and on the right childhood. I ticked many of the boxes in the adulthood section but none in childhood.. the psychiatrist said it's unlikely I have it then as most people who have ADHD it's something they have throughout childhood - not something they develop later.

He said the medication for ADHD is Ritalin.. he said we could do a trial for a few days - (it only takes a couple of days to start working) / he said I would soon know if I had it or not as I would either feel better on it...or worse..

OP I would sit with it for a little while to give yourself time to process what was said. Then I would investigate ASD and trauma. If that doesn't give you satisfactory answers then perhaps revisit ADHD.

As has been pointed out already, trauma can manifest in a similar way to ADHD.

Try not to pin too much hope on medication. It definitely helps my DD but it certainly hasn't fixed everything. Although it is more complex with autism as well due to the way autism and ADHD affect each other.

Fwiw for the doubters on this thread, my DD was diagnosed with autism as a child (NHS) and ADHD as an adult. She initially had a private assessment for ADHD but it was confirmed later by the NHS.

This is the most disgusting thing I’ve read on MN today. My ADHD has led to severe Anxiety and suicidal thoughts at times, despite being highly intelligent it has destroyed my career and makes life extreme difficult. I can’t express how disgusted I. Am by your, at best, uneducated, comment.

I would suggest looking at treatment for the trauma first. If you aren’t meeting the diagnostic criteria for ADHD then it’s less likely that treating that will be effective. You may benefit more from approaches like trauma focused CBT or EMDR. Those therapists might also be able to advise on whether they think your symptoms are more trauma related or whether it’s worth revisiting an ADHD diagnosis and/or an autism assessment once the trauma has been explored.

I had a similar experience OP, my mum filled in the form and ticked no for all of them but I clearly remember not being able to sit still, daydreaming / hyperfocusing, being very bright but struggling to do school work I wasn't engaged in to the point of actually vomiting, all well before age 12. It just went under the radar.

This was private by the way so you can't just "buy" yourself a diagnosis 🙄

I have come to the conclusion that I have ADHD traits but I don't qualify for a diagnosis, and that's OK. It could also be caused by trauma (although both my DC are neurodivergent...)

I have found some supplements really helpful with focus.

It's a weak area of the assesment that hasn't really been considered for adults who may no longer have school reports or parents/relatives able to complete the informant part on their childhood.

It's not even that accurate given many Parents have their own hang ups so will deny their was anything different or can't recall after so many years so their report doesn't match their adult child's memories. Given it's often genetic there's a good chance the families view of what 'normal behaviour' also doesn't match with neuro typical it's being compared to.

Did you have an informant who knew you as a child? If not did you complete the Wender Utah form?

DD was diagnosed with ADHD by the NHS, ten years ago as an adult. She did an autism screening this year, and scored highly, but she decided not to pursue it, as another label would just put her travel insurance premiums up!

She finds it annoying that so often, people seem to think ADHD and trauma are mutually exclusive. She says why can’t some people be born with ADHD (it clearly runs through 3 generations in our family), but then suffer trauma later? As happened to her!

Medication helped her not to make silly mistakes at work; she wasn’t so fidgety and impulsive; and we could see how she became more volatile emotionally, as the meds wore off in the evenings. It didn’t help with everything though - she still needed to read in peace, to learn anything.

Honestly can't comment in the way i want to as I'd be banned - such an ignorant, nasty comment. And yes, I do have "the label"

Can you please stick your ableist BS up yours?

I'm not convinced it is actually any different.

I'm reading Scattered Minds by Gabor Mate (he's a Dr who has ADHD himself as do his children) and as far as I can tell the suggestion is that with ADHD it's simply that the trauma is likely pre verbal.

And trauma doesn't have to be violence, neglect or adoption. It could simply be adverse circumstances preventing parents from giving attuned enough care to an infant who is born with an inherent sensitivity (that's as hereditary as it has been proved to be. This sensitivity doesn't always result in ADHD). Circumstances such as: illness, depression, poverty, inadequate maternity support, poor housing, unsafe area, unsympathetic workplaces, too many care duties could all create an environment in which some children might be absolutely fine but others, with this sensitivity, might develop ADHD.

I'm also reading Cracked by James Davies which explains that many psychological diagnoses are almost arbitrary collections of symptoms (which are obviously very real to the individual) rather than medically provable in the way cancer or a virus is.

From these two books I really can't understand what the difference between PTSD and ADHD actually is, apart from the fact a PTSD sufferer might not have been born with an inherent sensitivity.

Not to discredit the experience of people with any of these things. I believe I have both ADHD and PTSD as did one of my parents.

I think it’s a bad idea to get parents involved (ie those that were parenting in the 80s). ADHD was not recognised then.

When I told my Mum DS had been diagnosed she said ‘no he hasn’t, he just needs to concentrate more’.

Can you imagine her filling in my questionnaire when I did well at school. She didn’t see the crippling shyness, how I’d cry at anything, I actually went mute at one point and didn’t speak to anyone. It was all internalised. None of this was thought of as ADHD. Because people even now (but more so back then) think ADHD is naughty boys bouncing off the wall and doing badly at school (bit like my Dad and brother!).

That doesn’t sound like a gold standard assessment. Was it private or NHS? Did you complete forms about yourself as you are now and another one about childhood? In addition to your mum completing your childhood form, did anyone complete a form about how you present now? Did you do a Qb test?

That said, it doesn’t sound like the psychiatrist dismissed your difficulties and it can be hard to pin down whether the challenges you face are due to trauma, AdHD, autism or another reason.

Can you do some more reading about both ADHD, Autism and particularly how they affect women? You don’t need a diagnosis to implement the suggested strategies and may find they help. If you find, you still want to be investigated properly, you could find a good, private provider. Despite Panorama, there are some good, supportive clinics out there.

The questionnaire for parents isn’t just about how the child felt. It’s also about how they behaved.

i’ve filled it in and it is fairly comprehensive.

obviously it’s possible for parents to completely misremember but some of this stuff you really wpild
notice.

Aren’t girls with ADHD generally well behaved as they internalise it? So it often comes out as anxiety later on. Don’t they overcompensate and mask trying to appear to be perfect? This leads to burnout and exhaustion but not necessarily bad behaviour.

I kind of think the assessment should be different for males and females due to how differently ADHD presents.

This 100% unfortunately medicine is still very androcentric esp in the world of neuro divergency.

This is especially true with AuADHD. Girls often do very well at school. But have jissues with friendships, social situations

Yes! And I don’t think mothers in the 80s would have sensed all that. Maybe now we are more involved and aware.

But you wouldn’t think - shy/socially awkward/anxious yet well behaved and good grades could mean either inattentive ADHD or autism or both. The parents would just say ‘oh she was a bit shy but did well and was never in trouble. Then they miss the diagnosis.

Things need to change. The questionnaires need to be completely different.

My initial ADHD assessor said I didn’t meet the evidential threshold for childhood ADHD but had strong inattentive ADHD presentation as an adult.
I went back to the Right to Choose provider and asked how my mother losing all my school reports due to a chaotic lifestyle (very likely she has ADHD too) should mean I can’t get a diagnosis even with strong current difficulties.
They did a review and got another assessor who was much better at drawing out my childhood memories, and that assessor took the time to find out I have been with DH since we were teenagers.
Using his testimony and my memories the second assessor was able to diagnose ADHD.
It can be worth challenging an inconclusive result as sometimes a different assessor will get better evidence from you.

Things need to change. The questionnaires need to be completely different.
A good professional, using a structured tool like DIVA during the clinical assessment, would draw out the information and circle back to it. The tools are evidence based and are definitely not focused on “naughty” boys. The trouble is that an hour long assessment isn’t going to do that and some of the cheaper online providers are just looking at tick-boxes.

Given that adhd is highly heritable, so likely raised by an undiagnosed parent you’d struggle to find an adult with adhd that didnt have childhood trauma.

You can self refer right to choose via the GP , you pick a provider in the uk you want to go with. Have a look at their wait times etc on ADHDuk they have a detailed table that shows all providers you can choose through the RTC. I went with CAREadhd, they were really good and thorough. I had to fill in a snapIV questionnaire initially when doing the referral ( this was given to the GP and sent to the provider with my referral information) I then got accepted for an assessment and got put onto a waitlist. Then I received a text with a portal to log into and had to fill in about 10-12 forms - I will list the titles of them here but happy to give you more details on the forms especially the ones relating to childhood if you would like more information? Just direct message me :

1. Patient Health Questionnaire (PHQ9) - 10 questions
2. Adult Informant's Questionnaire ( someone who knows you now very well) this was split into two parts 9 questions each very detailed questions with separate parts for each for the person to include detailed examples - took about 30 minutes.
3. Childhood Behaviour Scale ( for someone who has known you in childhood when you were around 7 years old ) 27 questions multiple choice not a lot of information needed for this one.
4. GAD-7 Anxiety - 7 questions, multiple choice not detailed
5. Physical Health Questionnaire - 16 questions, will need things like blood pressure reading, weight, height, pulse etc
6. Weiss Functional Impairment Rating Scale - Self Report (WFIRS-S) - 7 sections, varied amounts in each so one has 7 questions one has 12 answers so on. Multiple choice. 69 questions in total.
7. Wender Utah Rating Scale - 22 questions split into two parts, most questions in part 1 3 in part 2 , multiple choice.
8. Adult Self-Report Scale (ASRS-v1.1) - Completed by yourself, 2 parts - multiple choice - 18 questions in total.
9. DIVA - 5 - the longest of them all took me around 3 tries to complete as it kept timing out, eventually did it in around 35 mins, it’s tick boxes and then detailed examples of the symptoms, from 7 years to present day - the form gives a more detailed explanation which I can send through separately but it’s very heavy and split into 4 sections, probably around 40-60 questions in total maybe? Too long to count and they aren’t numbered.
10. ID Upload - self explanatory
11. Summary Care Record - this is from your gp, they can email it and you can upload it. A detailed history of your medical records - this helps them to get more informed should you be diagnosed and opt for medication.

I spoke with my parents before I got them to do the childhood form - initially my mum was quite dismissive and would say you were fine in primary school. But she went away and I sent her some research around young girls and masking and how ADHD would present in them at home ( I’m combined type , but my hyperactivity is in my brain which would effect my sleep, my moods , I’d be irritable and was often referred to as ‘moody’ I was very very anxious as I internalised everything and masked so much in primary school, my main ADHD symptoms only showed massively once I hit puberty age 12-13 , but their were subtle signs all along, just have to get the person who’s filling it in to understand what ADHD can present like, and they will then start to realise ahh ok so what I thought was just typical pre teen actually wasn’t etc) I also got hold of my school reports for high school and even from year 7 there were obvious signs that back in the early 2000’s were put down to laziness or lack of discipline etc constant comments of ‘ not reaching potential’ ‘ needs to try harder’ ‘ she has so much ability but lacks focus and drive’ etc - I didn’t I just couldn’t work in the way I was given. Try yourself to think back to primary and high school and think of specific examples, when you get the assessment through, you go through the diva 5 really one question at a time speaking on your own experience and detailing things, so , obviously each provider and clinician is different, but the childhood symptoms is only a small part, and especially in young girls who mask heavily, shouldn’t be the only diagnostic criteria that a diagnosis hinges on. If the assessor see’s ADHD throughout your life, the childhood aspect won’t be the most important part.

I was on a waitlist for 3 years via my local nhs ADHD pathway - I then referred via right to choose end of January this year, got my forms end of March , assessment date beginning of may and started my medication mid June. To say my life has changed with my diagnosis a medication would be an understatement. You know within yourself if this is something you need to really look more into before writing it off. So I’d say go via the RTC pathway ( wait times are higher now - more 6-12 months but still significantly less than local nhs pathways - I had already waited 3 years and was told it would be another 7- 10 years) it’s also free via RTC - make sure you choose a provider, and this is detailed on the ADHDuk website in the table I mentioned earlier, that prescribes medication at the NHS cost even if your gp denies shared care. My GP denied but I just order my medication from CAREadhd directly, I get an email with an invoice , I get two lots of medication so pay £9.90 per item and it gets posted to my house. This is monthly. As long as you go to them annually and have a check up ( which does incur a cost of £140, unfortunately if you don’t have shared care) then I can continue this way of getting my medication.

It’s so confusing and so frustrating and I’m actually currently in the process of starting a business with my partner to make this whole situation more easy and accessible to understand do those of us just starting this Journey because of how difficult it’s been to get just basic information around ADHD and diagnosis. There isn’t enough research or resources but I’m hoping to create something in the near future that makes it a bit easier to understand and find.

Let me know via dm if you would like any more information regarding the questions to process etc! I’m happy to help however I can, I know firsthand how difficult this can be.

Do you mean that psychiatrists aren’t as good as clinical psychologists or the other way around? Sorry, I don’t quite get what you mean

@ShoobyDoosIm being assessed in a couple of weeks and i’m worried about this element too. However i’m 58, my parents are in their 80’s and I have nobody around that i knew at primary school except my 2 younger sisters. My parents did fill in the questionnaire but i think it will be less than helpful as it was 50 years ago
memory wise and they think that ADHD means naughty kids which I wasn’t