ADHD Diagnosis: Understanding the Importance of Accurate Diagnosis

In the face of stress and anxiety or on an odd bad day, we can each experience difficulties in focusing, paying attention and feeling organised.

Maybe you wake up, forget that appointment, realise you didn't pay attention to the balance on your metro card and are further late for your meeting. You may feel bizarre and think “Ugh, I need to plan better!” 

Many of these tasks are related to focus, attention, memory and organization, i.e., tasks of executive functioning we use to manage our everyday lives. Only, someone with Attention Deficit Hyperactive Disorder or ADHD experiences this every day all over the place, every time. 

Now one might say “Oh, this happens to me too! I guess everyone is a little ADHD...” 

However, what goes unnoticed and often misunderstood is the difficulties in managing emotions leading to outbursts and impulsivity, sleep disturbances and the struggles of someone with an “interest-based” nervous system. 

Now, you might say,

Who doesnt have outbursts?

Oh, the world is so stressful, who doesnt have sleep disturbances,Who doesn’t do that?

Ah, we are all dopamine junkies today!The truth for many with ADHD is that despite knowing that, They may end up feeling worse after as opposed to relief Their actions might be the result of feeling bored that feels physically painful, i.e., under stimulation

They would want to honour their commitments and organize better

They are facing significant financial or relational loss 

… they are unable to make these changes through the support that would ordinarily help mitigate these consequences for a person because, in a nutshell, ADHD is an impairment in the brain’s self-management system.

Importance of diagnosing ADHD 

ADHD is characterized by a neurodevelopmental difference, i.e., the brain’s development of different pathways that facilitate one’s functioning and abilities.

Now as mentioned before someone with ADHD experiences difficulty in managing their everyday life and tasks, but that does not mean they can’t manage with the right support or are without their own set of abilities. 

Many factors, including low awareness contribute to a missed opportunity for diagnosis and treatment. 

• There is a general assumption about how people should think, act, behave and do things in the world, i.e., neuronormativity. Anything away from this supposed normal often invites a lot of shame or stigma and is seen as a “deficit” to be overcome instead of strengthening other ways of being. For instance, though an ADHDer may have trouble focusing on a lecture in the classroom if it’s not of their interest, they may gain near expert level understanding of a topic they find genuine interest in. Here, what is highlighted is a general difference in how focus may work as an all-or-nothing phenomenon as opposed to how an average person may regulate their focus. A teacher may see this pupil with undiagnosed ADHD as “not trying hard enough” or “has great potential but easily distracted” and may even translated to “arrogant” for an adult.
• Many symptoms of ADHD mimic other disorders or may come with co-occurring conditions like Anxiety, Depression or even substance-use concerns and may lead to misdiagnosis. 
• It was wrongly believed that ADHD  is more often present in young boys who would run around the classroom with massive energy and outbursts that were out of the teacher’s syllabus. However, over the years, research has shown that this depiction of ADHD was limited. As a result, many children and adults have not received an ADHD diagnosis and subsequently interventions that could provide them with the right support.  

The concern with missed diagnosis is that in a world where the path of moving in a straight line is set, someone with ADHD might want to reach the goal in their way. However, not knowing of their ADHD can invite blame and stigma by themselves and others.

ADHD: Inattentive, Hyperactivity-Impulsivity or Combined?

It is important to recognize that ADHD is a difference in one’s functioning and recognition of the same allows one to create the right systems and accommodations that support our functioning in a world not necessarily designed for you.

For one to receive an accurate diagnosis it is important to notice the symptoms related to ADHD. One may show symptoms of hyperactivity-impulsivity or inattention or even both together.

Neurodevelopmental disorders are often diagnosed in childhood considering if a child can meet the milestones by their developmental stage. However, many pre-schoolers show core behaviours of ADHD as part of their typical development.

Hence, ADHD is often diagnosed when one reports some of these symptoms appeared before 12 years of age in two or more settings, like the workplace, home or even school, and are not explained by any other mental health or situational concerns.

Let’s unpack these further:

1. Inattention:

• You face difficulty paying close attention to details and tend to make careless mistakes in your schoolwork or work or any other activities, especially when it holds little to no interest
• Tasks that require sustained attention seem challenging 
• It may seem like you are in a world of your own and do not seem to be listening when spoken to directly 
• You may have difficulty following through instructions, especially verbal instructions, and find it hard to complete different chores and duties despite the intention to finish tasks.
• You face trouble with executive tasks like starting tasks, organizing activities or sub-tasks within a larger task.
• You feel a certain level of avoidance or reluctance for tasks that require sustained effort or focus.
• You tend to lose your belongings and even forget things are necessary for important activities (example, you forgot your art supplies for an art exam).
• You often get distracted by stimuli/activity that may be unrelated to the present task or even flow of thought.

2. Hyperactivity-impulsivity: 

• You often feel fidgety which shows up as tapping your hands or feet or overall squirmish feeling
• You feel restless in situations where you’re expected to be seated for a long time and often leave the seat/situation
• Often move around when inappropriate or feel restless in situations where you need to move around but may be inappropriate 
• Face difficulty playing or taking part in activities quietly 
• Often feel like you’re being driven by a motor and may feel like people arent able to keep up with you
• You often talk excessively and even blurt out answers before questions have been asked to you
• Waiting in lines seems an impossible task and waiting for one’s turn as well
• You find yourself wanting to speak before you forget things but it seems like an interruption or intrusion by others

What next?

If you've been dealing with symptoms like difficulty focusing, impulsivity, or hyperactivity for at least six months, and it's affecting your work, social life, or relationships, it might be a good idea to talk to a professional. They can help you figure out if ADHD might be the cause.

A professional in the field of mental health, like a counselling psychologist, clinical psychologist or a Psychiatrist, will aim to understand your concerns and provide a space to explore them together. If both of you seem in consensus and comfortable, you may be screened for ADHD.

Screening often gives an idea if there is further assessment required and go for a diagnosis. The diagnosis is usually done through a diagnostic interview. This interview, in India, is often done by a clinical psychologist and helps confirm whether you have ADHD. If you do get diagnosed, a psychiatrist can assist you with medication and other ways to manage symptoms.

For instance, an ADHD coach can help you with practical solutions that work for you, provide feedback and encouragement, all the while being cognizant of your difficulties and strengths of your life with ADHD.

Is it not ADHD?

There is also the possibility that your symptoms, while all too real, do not meet the criterion for a diagnosis. However, it does not mean your concerns are not valid. Medical science is continuously evolving and may have not reached where you are right now.

For example, a few decades ago ADHD research participants predominantly were males, however, as advocacy for decreasing gender bias in research moved ahead, more women today are receiving their ADHD diagnosis today. 

Secondly, it may also be true that you do not have ADHD. Maybe your symptoms are caused by stress, trauma or even anxiety as the symptoms can often mimic each other. However, I invite your curiosity here: gently ask yourself – so what? Just because there isn't a diagnosis, does not mean there isn't distress.

A diagnosis aims to ease one’s journey of reducing distress, and even then, the way one experiences these difficulties may be so unique. Hence, recognizing the difficulties - diagnosis or not - helps you carve a path that serves you personally.

It's like finding the key to unlock the right kind of help tailored to your needs. So, if you're struggling, reaching out to a professional could be the first step toward feeling better and feeling less guilty about the difficulty in initiating the 5 chores left behind...

References

1. American Academy of Paediatricians. (2023). Early signs of ADHD in children. HealthyChildren.org.
2. Attention-Deficit/Hyperactivity Disorder. (n.d.). National Institute of Mental Health (NIMH)
3. Crawford, N. S. & American Psychological Association. (2003). ADHD: a women’s issue.
4. Hamed, A. M., Kauer, A. J., & Stevens, H. E. (2015). Why the Diagnosis of Attention Deficit Hyperactivity Disorder Matters. Frontiers in Psychiatry, 6.
5. Substance Abuse and Mental Health Services Administration (US). (2015). Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison - DSM-5 Changes - NCBI Bookshelf.
6. Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M. F., Evans, S. W., Flinn, S. K., Froehlich, T. E., Frost, J., Holbrook, J., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K., Winner, J. D., Zurhellen, W., & Author_Id, N. (2019). Clinical Practice Guideline for the Diagnosis, evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 144(4).