View Full Version : Impossible to diagnose without "test"


Mphelp
01-20-12, 12:20 AM
So I saw my new pdoc today and I think overall things went well. I follow up again in 1-2 weeks, once I dig up some old blood tests and request records from my last pdoc.

My question is this:
The new doc says there's no way to diagnose ADHD without a test or a battery of tests (come to think of it, I'm not exactly sure what he said). Is this true? He said this once i had told him my last doc diagnosed me and after he asked how I was diagnosed. I explained that the doc had me fill out a whole bunch of questionnaires and we spent at least 3 hours talking.

At any rate, he agrees with the conclusion so far but does want to see the last docs notes, which I completely understand. I hope there is no trouble in getting those. After I left, I remembered that my last doc didn't take notes during any of our visits but he must have taken them afterwards, right? He had actually told me at one point that he purposely does not take notes because it would be a distraction to the patient - he is right about that.

I guess I'm throwing this out because I was under the impression that there was no actual test so to speak...only guidelines. This new doc is extremely young - appears to be fresh out of school. Does he possibly know more than the older docs or is is this inexperience? Curious to hear others take on this...

trishcan
01-20-12, 12:27 AM
It's not true... at least, not the way he put it. Tests are generally done to get a better sense of/rule out other issues.

I sometimes get the impression that doctors phrase things in a way that makes them appear ignorant because they suspect their patients don't know any better. They try to "dumb things down," and wind up looking like jerks. I wouldn't dismiss him as misinformed, but possibly unenlightened as to the degree to which adults with ADHD can understand things.

Lillianmay
01-20-12, 01:48 AM
I went to a psychologist last fall to get educational testing done because I was pretty certain I was dyslexic but did not have a diagnosis. I have poor reading comprehension, some auditory problems, problems studying and I was always losing things. My doc said she would test for ADD too. I had at least 5 sessions of 45min. of testing. Then she had me take an Adderall and reran some of the test to see if I improved. I improved on some, but not on others. I was dx with a reading disorder (dyslexia) and ADD-PI. The Adderal helped the attention deficits but not some of the reading/processing problems.

I was glad she was so thorough but it was very expensive.

I did not give my doc a previous report (3 assessments in one afternoon back in jr. high) because I thought the results were wrong (and they were) and based mostly on my older brother's diagnosis - which may also be wrong as he is being re-evaluated too. I told my doc I wanted to be looked at fresh without any preconceived notions. She said that was fine. In her report there was no mention of anything that would confirm the earlier diagnosis. I have a report of my test results and my strengths and weaknesses. I feel confident now that I know what is going on and I can start trying to deal with it.

Mphelp
01-20-12, 03:07 AM
That kind of testing sounds great. I have heard mixed reviews about brain scans and whether or not they're reliable and I assumed that's what he was referring to...but then I thought maybe there was some other test and it sounds like its what you had done. I like the idea of it pinpointing the issue but I do have to wonder how a test done over the course of a day or even three days could honestly portray an entire lifetime of having ADHD. It seems much of the results would be based loosely on how well you're able to function during a brief moment in a day, and on something you're anticipating no less. I would love to have results from this type of test as I think it could offer quite a bit of insight but at the same time I would be worried about inaccurate diagnoses being formed and made "law" based on this one test.
It certainly gives much to think about and sounds quite fascinating. Thanks for the feedback.

sarahsweets
01-20-12, 07:36 AM
Unfortunately there are no tests to diagnose adhd and the tests used are best for ruling out other learning disorders not confirming adhd.

Lillianmay
01-20-12, 10:15 AM
"Educational testing" is a battery of non-medical testing (No brain scans) that looks at cognitive and intellectual abilities in different areas like verbal and visual reasoning, memory testing (short term /working memory) and executive function skills. I went in for testing for learning disorders (dyslexia) and my doc also tested for ADD since there is a high incidence of ADD with dyslexia.

Sarah is right - there is no "medical" test like a blood test for ADD. I don't know if there is anyone studying if a brain scan would show anything. Sounds like there is some differences but I haven't heard of anyone using them diagnostically. I saw a dyslexia show where they did a brain scan while the patient read words and the processing speed was much slower - like someone reading a foreign language.

Things like reading comprehension problems can be an attention problem or a memory problem or a processing problem or some of those problems mixed together. Same with the depression and anxiety problems some ADHD people have - they could be the result of living with ADHD or they could be separate problems. It helps to know the cause because it can affect what treatment will work best.

I did like that she redid some of the test - scheduled for 1 hour after taking an Adderal - because Adderal will not significantly help non-add problems. I know some college students take it as the "smart drug" but that effect was already factored in when she looked at the testing results.

Because of the testing I know more exactly where my problems are. I have great visual reasoning skills and long term memory. My auditory skills are weak and so is my short term memory. I am hoping to learn how to use my strengths to compensate for my weaknesses.

Unless you have learning problems you probably would not have as much testing as I did and my doc had to add to the testing based on some of the early results to clarify what was going on. I did the first two sets of 45min at one appointment for 90 min total and it was too much - I did get tired so I spread the rest out. My doc even re-did some of those first test because she saw how tired I got.

Your report is yours alone - you do not have to share it with anyone except in my case since my psychologist can't prescribe medication my regular doc has the info too. I guess if you get prescribed medication, your insurance co. will also know if they cover your meds and all your docs should know what meds you take for safety. If you think a test result doesn't sound right or match your life experience, then you discuss it - maybe do some more tests to clarify. I think the first thing is to find a doc you can talk to and trust and who really knows ADHD.

Dizfriz
01-20-12, 10:35 AM
As Sara said, currently there are no tests of any type that are considered valid for primary diagnosis of ADHD. It is primarily a clinical judgement call based on symptoms and impairment.

If you want to look into this a bit further then you might go here http://www.addforums.com/forums/showthread.php?t=60130
and look at the essay titled "What is ADHD and how does it affect people?" and go to the link to the Barkley transcript. The diagnostic part begins on page 2.

Tests however are good for many things and can give a much more comprehensive picture of the individual and can be quite worthwhile.

Good luck,

Dizfriz

Mphelp
01-20-12, 02:03 PM
Yeah it's really too bad there aren't any clearcut tests that could be deemed reliable. It seems if there were, perhaps it would be easier for the people with ADHD to find competent treatment and not be frowned upon by doctors simply because they see so many patients that are just looking for meds...maybe one day they will come up with something.

susan Standlee
01-20-12, 02:27 PM
Unfortunately there are no tests to diagnose adhd and the tests used are best for ruling out other learning disorders not confirming adhd.

There are question sheets given to the parents and teachers of a child in question. The sheets are then interpreted by the person trained in using this information. It's quite easy. If the child's behavior, etc falls within a certain number of categories, he has ADHD.

If ADHD is affecting attention in school, doing homework, and social relationships, it needs to be treated. He self-esteem is at stake. There is absolutely no way a child with ADHD can "sit still" on his own.

trishcan
01-20-12, 04:05 PM
There are question sheets given to the parents and teachers of a child in question. The sheets are then interpreted by the person trained in using this information. It's quite easy. If the child's behavior, etc falls within a certain number of categories, he has ADHD.

If ADHD is affecting attention in school, doing homework, and social relationships, it needs to be treated. He self-esteem is at stake. There is absolutely no way a child with ADHD can "sit still" on his own.

Yes, there are "tests" in that there are checklists and quizzes, etc. But none that are near perfectly conclusive. Perhaps a child with ADHD can't sit still, but a child that can't sit still doesn't necessarily have ADHD.

Lillianmay
01-20-12, 04:45 PM
Mphelp, I think a book that might help is Dr. Russell Barkley’s “Taking Charge of Adult ADHD.” The early chapters talk about getting evaluated, what you can expect and why certain things are important. One part is “psychological testing” and this is probably what your doctor was talking about. These were included with my educational testing.They are part of getting the big picture – looking for other possible causes of symptoms as well as strengths and weaknesses. They are only one part – there are other important parts of the evaluation.

Barkley says the typical test given are 1) brief test of intelligence or general cognitive ability, 2) test involving math, reading and spelling, 3) test of attention, inhibition and memory.

I am really glad to have all the information given to me by the tests. Maybe mostly because they show I am not stupid.

I realize many people get diagnosed by their regular physician and do just fine. But, I had a friend in high school diagnosed and treated by the family GP. His mom was often mad at him about ADHD stuff – not really understanding why he acted they way he did even though she knew he had ADHD. Maybe if they had done a total evaluation and worked with a psychiatrist or psychologist he and his mom would have got better what having ADHD is all about.

Dizfriz
01-20-12, 05:09 PM
The current protocol for diagnosing ADHD in children consists of

1. ADHD specific survey, one for home and one for school.

2. Clinical observation of the child.

3. Diagnostic interview with the caregivers

4. Careful history of the child and the family.

That is it. Tests, as I said, are useful for getting a better picture of the individual and perhaps picking other issues that may mimic ADHD but the above is the current accepted method for diagnosis with children.

Dizfriz

Lillianmay
01-20-12, 06:53 PM
Dizfriz, I think you write some of the most informative and thoughtful answers on this forum, so don’t think I am being a smart aleck here.

The criteria for children seems to be missing a lot of kids – mostly girls as 3 boys for every 1 girl is diagnosed as a kid. It missed me. I realize I am a more complicated case with LDs too and maybe things have changed since I was a little kid. I don’t know how to fix it – I am just a struggling college student not a pdoc. I wonder what if I had been diagnosed sooner. My 13 year old sister is having the same evaluation I did for the same reasons – including psychological and educational testing.

I think the OP (who is an adult) had two basic questions: What tests are my doc talking about? Answer – probably psychological testing. Will they diagnosis ADHD? Answer – No, they are part of an evaluation which taken as a whole will be used to diagnose you.

Dizfriz
01-21-12, 12:30 PM
Dizfriz, I think you write some of the most informative and thoughtful answers on this forum, so don’t think I am being a smart aleck here. My goodness no. You bring up some very good points.

The criteria for children seems to be missing a lot of kids – mostly girls as 3 boys for every 1 girl is diagnosed as a kid. It missed me. I realize I am a more complicated case with LDs too and maybe things have changed since I was a little kid. I don’t know how to fix it – I am just a struggling college student not a pdoc. I wonder what if I had been diagnosed sooner. My 13 year old sister is having the same evaluation I did for the same reasons – including psychological and educational testing. The DSM-IV (diagnostic manual) was standardized primarily on boys for ADHD. At that time, it was thought that it was more sex linked than it is. As a consequence, many girls were missed and this is a problem that many have addressed and is matter of concern. The DSM-5 is supposedly trying to remedy this situation but we will have to see what they come up with.

I think the OP (who is an adult) had two basic questions: What tests are my doc talking about? Answer – probably psychological testing. Will they diagnosis ADHD? Answer – No, they are part of an evaluation which taken as a whole will be used to diagnose you. Good points.

Interesting post, thanks.

Dizfriz

Mphelp
01-21-12, 07:21 PM
As Sara said, currently there are no tests of any type that are considered valid for primary diagnosis of ADHD. It is primarily a clinical judgement call based on symptoms and impairment.

If you want to look into this a bit further then you might go here http://www.addforums.com/forums/showthread.php?t=60130
and look at the essay titled "What is ADHD and how does it affect people?" and go to the link to the Barkley transcript. The diagnostic part begins on page 2.

Tests however are good for many things and can give a much more comprehensive picture of the individual and can be quite worthwhile.

Good luck,

Dizfriz
Thanks for the link. I've printed all 40 pages and hope to read the entire thing this weekend...