The Day After: My First Adult ADHD Assessment Session

So if you were to enter a large train station, a sports stadium, or a movie theatre, and using the public address system request that 19 out of 20 people be seated, you'd end up looking at the remaining 5% of the group who'd be standing up. Those folks represent the number of adults in the general population with the neuropsychiatric condition of Adult ADHD. Most of them are undiagnosed.

I am currently on a journey of discovery about ADHD, and yesterday I attended the first of 3 sessions which constitute a psychological assessment for ADHD. Yesterday's session lasted 4 hours, and I will have 2 more shorter sessions - the next one is scheduled for a couple of weeks from now.

The first session was broken into 3 sections - I spent about 45 minutes filling in medical, psychiatric, and family history questionnaires and several depression, anxiety, life function, symptom impact, and attention ADHD measures (Note: anxiety and depression are typical and frequent co-morbidities found in ADHD adults, and the testing helps tease out the various elements at play). I believe I needed urgent medical attention after writing furiously for those 45 minutes, but didn't say anything. I put up with a cramped, aching hand and bit my tongue hard to muffle the screams: "Take the pain!" I silently mouthed. "Take it!".

I then met the psychiatrist - an avuncular, kind, calm, older man. He ushered me into a small office with a round table and four chairs and he sat with a clipboard and notepaper. He had already spent some time eyeballing my tests, and told me he had a good sense how to proceed with me. 

He first introduced himself, and explained his experience, expertise and interest in ADHD. He then laid out how we would spent the next hour or so, and how the rest of my day would go. He would ask me a number of questions, and try to get a clear sense of what might be going on, and to see if my presentation matched someone with Adult ADHD. 

He told me that a psychometrist would be spending some of the time reviewing the tests I had written, and run them through a computer program that would match my answers with a generalized population to see where I sat on a bell-curve, so to speak. I was to spend the rest of the afternoon with a psychometrist who would drill down on some of the details, and administer a computer-based test. I was also to bring home a function-focused/symptom severity questionnaire similar to my self-report questionnaire, but to be filled in by a relative or friend who knows me well. My wife filled it out yesterday evening.

I had brought report cards from elementary, middle, high school and university with me. These were apparently quite helpful and provided some perspective on my behaviour from various teachers and professionals.

I thought I would spend a few minutes writing about diagnosis, because I know it is a process fraught with misunderstanding, riddled with myths and popular falsehoods. Simple put, a diagnosis can be made when a 'patient' presents with behaviour and symptoms that match a set of criteria laid down in some sort of empirically-based manual of 'dis-ease', or conditions. 

The Diagnostic Statistical Manual (DSM) version IV is one of these manuals. Generally there is a threshold of criteria that must be met - e.g. 6 of 8 symptoms have to have existed in a significant form for a significant period of time, across several arenas of that patient's life - in such a way that it negatively affects their functioning. All of that sounds a bit vague, but the term significant isn't a subjective one. 

It is a term derived from statistical studies of populations, whereby normal behaviours or symptoms constitute a statistically meaningful 'chunk' of the bell curve, and abnormal behaviours or symptoms constitute the head or tail of the bell curve. All experiences and presentations can be clustered onto a bell curve. 

Even people's heights for example. The average height of North American men is 5 ft 8 1⁄2 inches. Most men would be scattered around this average, as in + or - several inches in height (I'm 6'). They'd constitute the vast majority of people. Few would be 5' or less, and a roughly equal few would be 6 ft 6" or greater. But it has been a long time since I took statistics in university (4 times because I kept failing), so I'm going to stop while I'm ahead and quote the Wikipedia diagnosis section in the Adult ADHD entry.

"The diagnosis of ADHD in adults is entirely a clinical one, which contributes to controversy. It requires retrospectively establishing whether the symptoms were also present in childhood, even if not previously recognized. There is no objective "test" that diagnoses ADHD. Rather, it is a combination of a careful history of symptoms up to early childhood, including corroborating evidence from family members, previous report cards, etc. along with a neuropsychiatric evaluation. The neuropsychiatric evaluation often includes a battery of tests to assess overall intelligence and general knowledge, self-reported ADHD symptoms, ADHD symptoms reported by others, and tests to screen for co-morbid conditions. Some of these include, but are not limited to the WAIS, BADDS, and/or WURStests in order to have some objective evidence of ADHD.

[...]

It should be noted that every normal individual exhibits ADHD-like symptoms occasionally (when tired or stressed, for example) but to have the diagnosis, the symptoms should be present from childhood and persistently interfere with functioning in multiple spheres of an individual's life: work, school, and interpersonal relationships. The symptoms that individuals exhibit as children are still present in adulthood, but manifest differently as most adults develop compensatory mechanisms to adapt to their environment."

My next session is in 2 weeks, and this time I'll be meeting with a clinical psychologist. In the meantime I will update this blog with posts - some of them based on my readings and learnings about Adult ADHD, and some of them will be general resources that are available out there in the form of videos, web sites, books and more. I would love to hear comments from any readers - whether ADHD affects someone in your life, or in your own life, or if you have any questions or general comments.

Wrapping up tonight's post, why not have a listen to Canadian Centre for Addiction and Mental Health (CAMH) 2009 Transforming Lives Award Recipient (ADHD diagnosed) Canadian comedian Rick Green in this video - I went to see him and Dr. Umesh Jain in a seminar on Adult ADHD at the Ontario Science Center a few weeks ago - it was a brilliant experience