Navigating ADHD Diagnosis and Treatment Options for Adults

ADHD-related issues

Hello Dr.
Liu,
I am currently 20 years old.
Since childhood, my mother has mentioned that I might have mild symptoms of ADHD, but I have never been formally diagnosed.
My general symptoms include significant mood swings, hitting walls, and being unable to control my impulses when I'm happy, leading to loss of control, among other things.
As I have grown older, my impulsivity seems to have gradually diminished (though I still easily succumb to peer pressure and act impulsively).
However, difficulty concentrating has become a major issue that troubles me.
I often sit at my desk for 1-2 hours without studying, getting up to walk around more than ten times during that period (if I sit for too long, I experience a tingling, uncomfortable sensation that I cannot suppress without moving).
This issue has bothered me for a long time, although I can focus for extended periods on things that interest me.
In high school, I tried to eliminate all external factors that might affect my concentration, but the results were very poor.
Therefore, I hope to manage this with medication in college, but I have heard that diagnosing adult ADD or ADHD can be challenging.
Recently, I visited a large hospital and mentioned to the doctor that I would like to use a central nervous system stimulant to help me, but the doctor only prescribed Sertraline to help increase my serotonin levels and improve my focus, stating that in Taiwan, adults over 18 are prohibited from using Adderall.
I have several questions:
1.
Is it possible to diagnose ADD or ADHD in adults without having received treatment as a child?
2.
The doctor mentioned that I appear to be doing well, but can ADD be visually assessed?
3.
Are there any alternative medications or central nervous system stimulants to Adderall? (Sertraline has had no effect on me.)
4.
How should I explain to my doctor that I would like to undergo an evaluation to confirm these issues and receive appropriate medication treatment? (I am concerned the doctor might dismiss me because I seem to be doing well on the outside.)
5.
Should I see a general psychiatrist, or should I specifically consult a child and adolescent psychiatrist? (I have heard that some doctors are willing to see adults.)
Thank you for your assistance!

A Tian, 20~29 year old female. Ask Date: 2019/04/22

Dr. Liu Shikai reply Psychiatry

Hello, A-Tian.
Attention Deficit Hyperactivity Disorder (ADHD) in adults can indeed be diagnosed.
This involves evaluating the individual's history from childhood along with current symptoms, and there are computerized attention tests that can be administered.
In addition to medications like methylphenidate, there are other options available for adults.
Currently, the diagnosis and treatment of ADHD primarily fall under the expertise of child and adolescent psychiatrists.
I recommend that you consult a medical facility where you can make an appointment.
Large hospitals often have age restrictions in their child psychiatry departments, while private practices usually cater to a mixed age group, making it easier to find a child psychiatrist who can assist you.
Wishing you all the best!

Reply Date: 2019/04/22

More Info

Navigating the diagnosis and treatment of ADHD as an adult can be challenging, especially when you have experienced symptoms since childhood but have not received a formal diagnosis. Here’s a comprehensive response to your questions based on the information provided.

1. Can adults be diagnosed with ADD or ADHD without prior medical consultation in childhood?
Yes, adults can be diagnosed with ADD or ADHD even if they did not receive a formal diagnosis in childhood. However, the diagnostic process may be more complex. Clinicians typically look for evidence of symptoms that were present before the age of 12. This can include obtaining information from family members, reviewing school records, and assessing current symptoms. If you can provide documentation or accounts from your childhood that support your claims of attention difficulties or impulsivity, it will strengthen your case for diagnosis.

2. Can ADD be visually assessed by a doctor?
ADD or ADHD cannot be diagnosed solely based on visual assessment. While a clinician may observe certain behaviors during an appointment, a comprehensive evaluation is necessary. This often includes standardized questionnaires, interviews, and possibly cognitive testing to assess attention, impulsivity, and executive functioning. Your self-reported symptoms, along with any corroborating evidence from family or educational history, will be crucial in the diagnostic process.

3. Are there alternatives to Ritalin (Methylphenidate) for treatment?
Yes, there are several alternatives to Ritalin for treating ADHD. Other stimulant medications include amphetamines (such as Adderall or Dexedrine). Non-stimulant options include atomoxetine (Strattera) and guanfacine (Intuniv). If you find that the medication prescribed (like the one you mentioned, which seems to be an SSRI) is not effective for your attention issues, it is essential to communicate this to your doctor. They may consider adjusting your treatment plan or exploring other medication options.

4. How should I communicate my desire for evaluation and treatment to my doctor?
When discussing your concerns with your doctor, be clear and specific about your symptoms and how they impact your daily life. You might say something like, “I have been struggling with attention and impulsivity, which I believe may be related to ADHD. I would like to undergo a thorough evaluation to confirm this and discuss potential treatment options, including medication.” Providing a detailed account of your symptoms and their effects on your academic and personal life can help convey the seriousness of your situation.

5. Should I see a general psychiatrist or a specialist in child and adolescent psychiatry?
Since you are an adult, it is generally advisable to see a psychiatrist who specializes in adult ADHD. However, some child and adolescent psychiatrists may also treat adults, so it’s worth checking if they have experience with adult cases. If you feel more comfortable with a specialist, you can seek one out, but many general psychiatrists are well-equipped to handle adult ADHD diagnoses and treatment.

In conclusion, navigating ADHD diagnosis and treatment as an adult involves understanding the complexities of the condition and advocating for your health. It’s essential to communicate openly with your healthcare provider about your symptoms and treatment preferences. If you feel your concerns are not being taken seriously, consider seeking a second opinion. Remember, effective management of ADHD often involves a combination of medication, therapy, and lifestyle adjustments. Good luck on your journey to better understanding and managing your symptoms!

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