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 am happy, leading to loss of control.
As I have grown older, the impulsivity seems to have gradually diminished (though I still easily succumb to peer pressure and act impulsively).
However, inattention has become a major issue that troubles me.
I often sit at my desk for 1-2 hours without studying, getting up to move around more than ten times in between (if I sit for too long, I experience a tingling and uncomfortable sensation that I cannot suppress without moving).
This problem has bothered me for a long time, although I can persist with activities that interest me.
During high school, I tried to eliminate all external factors that might affect my concentration, but the results were very poor.
Therefore, after entering university, I hope to manage this with medication, but I have heard that diagnosing adult ADD or ADHD can be more 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 for an adult to be diagnosed with ADD or ADHD without having received medical attention in childhood?
2.
The doctor mentioned that I seem 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 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 that the doctor might dismiss me because I appear to be doing well.)
5.
Should I see a general psychiatrist, or should I specifically seek out 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: 2021/02/05

Dr. Liu Shikai reply Psychiatry

Dear Mr.
A-Tian,
I appreciate your observations and detailed descriptions, and I can sense your inner turmoil and confusion.
Regarding your questions, here are my responses:
1.
Diagnosing ADD (Attention Deficit Disorder) or ADHD (Attention Deficit Hyperactivity Disorder) in adults can indeed be more challenging.
According to diagnostic criteria, it is essential to determine whether symptoms were present before the age of 12.
Having objective evidence, such as descriptions from family members, report cards, or evaluations from elementary school, can be very helpful.
2.
The key to diagnosing ADD and ADHD lies in clarifying the medical history, as mentioned earlier.
If necessary, a psychological assessment can also assist in evaluating current attention levels.
It is important to note that many factors can contribute to difficulties in maintaining attention, and it is not solely limited to ADD or ADHD.
I recommend collaborating with healthcare professionals to clarify these factors for accurate diagnosis and treatment.
3.
The medications you mentioned, such as Adderall or other central nervous system stimulants, are indicated for ADHD.
Therefore, a confirmed diagnosis is required before prescribing these medications.
4.
As stated in points 1 and 2, having clear and specific symptom descriptions, along with objective evidence, will aid in accurate diagnosis and differential diagnosis.
5.
Whether adults can register for a child and adolescent psychiatry appointment depends on the regulations of each hospital.
Physicians will assess the situation based on their professional judgment and may provide referrals as needed.
Wishing you health and well-being.

Reply Date: 2021/02/05

More Info

Navigating the diagnosis and treatment of ADHD (Attention Deficit Hyperactivity Disorder) in adults can be a complex process, especially for those who have not been diagnosed in childhood. Your concerns and experiences are valid, and it's important to address them comprehensively.

1. Diagnosis of ADHD in Adults: Yes, it is possible to diagnose ADHD in adults even if there was no formal diagnosis in childhood. The key is to establish a history of symptoms that align with ADHD criteria, which typically include inattention, hyperactivity, and impulsivity. While the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) requires evidence of symptoms present before age 12, adults can still be diagnosed based on retrospective accounts from themselves or family members, as well as academic records that may indicate difficulties consistent with ADHD. A thorough evaluation by a mental health professional, including clinical interviews and standardized assessments, is essential.

2. Visual Assessment of ADHD: ADHD cannot be diagnosed solely based on appearance or casual observation. Symptoms such as inattention and impulsivity are internal experiences that may not be visible to others. A clinician will rely on detailed histories, behavioral assessments, and possibly standardized tests to determine the presence of ADHD. If a doctor suggests that you appear to be managing well, it’s important to communicate your internal struggles clearly, as ADHD symptoms can often be masked by coping strategies or may not be apparent in a brief consultation.

3. Alternative Medications to Ritalin (Methylphenidate): If Ritalin is not an option for you, there are several other medications available for treating ADHD. These include other stimulant medications like amphetamines (e.g., Adderall, Vyvanse) and non-stimulant options such as atomoxetine (Strattera) or guanfacine (Intuniv). Each medication works differently, and it may take some time to find the right one for you. Discussing your lack of response to current medications with your healthcare provider can help them consider alternatives.

4. Communicating with Your Doctor: When discussing your concerns with your doctor, be open and specific about your symptoms and how they affect your daily life. You might say something like, "I've been struggling with maintaining focus and managing my impulses, and I believe these issues are significantly impacting my academic performance and overall well-being. I would like to explore a comprehensive evaluation for ADHD and discuss potential medication options." Providing specific examples of your experiences can help the doctor understand your situation better.

5. Choosing the Right Specialist: While you can see a general psychiatrist, it may be beneficial to consult with a specialist in adult ADHD or a mental health professional who has experience with adult patients. Some child and adolescent psychiatrists may also see adults, but it’s essential to confirm this with the clinic. If you feel more comfortable, you can also seek out clinics specifically focused on adult ADHD.

In summary, navigating ADHD diagnosis and treatment as an adult requires clear communication with healthcare providers, a thorough understanding of your symptoms, and an openness to exploring various treatment options. It’s important to advocate for yourself and seek a provider who understands the complexities of adult ADHD. Remember, you are not alone in this journey, and there are effective treatments available that can help improve your quality of life.

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