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Adult Diagnosis & Treatment This forum is for the discussion of issues related to the diagnosis of AD/HD

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  #1  
Old 09-24-05, 03:36 AM
dopenuts dopenuts is offline
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5-min diagnosis?

Hi there, I am new here... be gentle with me

Was wondering if any have a smilar experience/would like to comment

I was trying to udnerstand my distractability, anxiety, and stumbled on some information which led me to suspect I have ADHD (inattentive). My GP referred me to a specialist after I complained about being unable to focus, doing badly in exams but better in take-home papers.

At the first appointment, the psychatrist looked at the referral, brushed me off and said I do not have ADHD -- all in 5 min. But he insisted I have O/C traits after I answered no to the standard questions (eg going back to check the door, putting away knives, ritualistic behaviour). I was like, what the...

And throughout the rest of the consultation, I felt being pigeon-holed as he took a history to (I feel) justify his diagnosis.

I understand co-morbidity but why won't he consider the ADHD? Or even ask me questions as per the DSM-IV criteria?

cheers
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Old 09-24-05, 03:37 AM
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oops... sorry I may posted in the wrong thread. i am 30 y/o
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  #3  
Old 09-24-05, 09:21 AM
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Welcome to the forums!

I'd say get a second opinion!

Regardless if you do have ADHD or not you deserve a thorough examination and to be taken seriously!!!
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Old 09-24-05, 09:38 AM
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I was diagnosed by a pyschiatrist who specialized in ADD when I was 23. He had me take home all these questionaires and spoke with me 4 times for an hour each over a 2 week period before he diagnosed me with ADD.

Last year, right after I turned 29, I went to a new doctor that told me within 5 minutes that I was misdiagnosed. I told him he was wrong. Because of rules with medicad, I had to see him so I let him to his thing for 3 months and I told him he had 3 months. He wanted to treat the depression and anxiety first.

I told him that my previous Dr. had told me that unless you treat the main problem (ADD) the meds for the symptoms (Depression & Anxiety) will not help much. After 3 months of taking meds and not feeling much better,,, I went in and told him that now he needed to treat me for the ADD.

I told him how my days went everyday and how my depression is because I cannot stand living in my house or being in my own skin most the time because of how unorganized I am and how I get so mad cause I can't think strait and I forget everything. Well he is working with me now and he actually listens to me when I speak.
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Old 09-24-05, 11:52 AM
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I'm not sure what the standard of practice is down under or if it's similar to the UK (and the rest of Europe).

Not too long ago I posted on a thread started by someone living in Spain.

I believe she had been diagosed in the U.S.,however, it sounded like her Spanish
psychiatrist was not impressed and was looking more at "personality issues."

I went on to post some history on the split between North America and Europe on how ADHD is viewed.

In essence, European psychiatrist's viewed hyperkinesis as "very rare" and as being caused by brain damage; if I remember correctly.

This is off the top of my head, so I apologize if I'm mistaken. The point is that there were completely different takes on the subject.

About 2 weeks ago, I saw a presentation by a neurodevelopmental pediatrician from Pennsylvania.

She made mention of the differences between NA and Europe. She also said that the UK still uses the now antiquated DSM-II diagnostic criteria from 1968.

Obviously, there have been advances in the research since then.

I don't know if your psychiatrist has that viewpoint or not. However, I do know what needs to be included in an adult ADHD assessment.

The first thing I'd recommend would be for you to print a copy of the journal article:

International Consensus 2002. It's available at www.chadd.org or at Russell Barkley's website.

It contains the best overall operational definition of what constitutes a "disorder" and is signed off on by over 80 of the world's leading scientisits;all supporting the existence of ADHD as a... "medical condition/disorder".

One of the current 15 working defintions of ADHD is that it's a... "normal dimensional disorder of human behavior that all people show some symptoms of to some degree, at some points in their lives."

It's like...."everybody does those things," which is true.

However, everybody doesn't experience problems from them.

That's critical to understanding the difference. The non-ADHD population of our peers don't have problems as a result of those behaviors.

The clinical threshold ( point where it becomes a problem) is : "Impairments in major life activities that cause "harmful dysfunction."

For kids, "major life actitivities are " school and friendships. Later on, you can add driving.

For adults, it's all of the above plus occupational/job related problems.

Adult ADHD's have more job turnover/get fired that non-ADHD's.

The quickest /easiest reference on this is Sandra Rief's 2003 book ..... The ADHD Book of Lists.

Its available at all major book stores. I got mine at Barnes & Noble.

She hasn't written a new book, what she's done is to take the research of the last 10-15 years and put it all in list form, by category and with references.

If I want to look at all 15 current definitions, all I have to do is open the book to page one.

In the States, a proper adult ADHD eval would be to have the person do a checklist, such as the Conners Adult ADHD Rating Scale (CAARS).

Then the spouse ,parents, significant others, etc., who know the person well would do the same.

There's actually research to show that adults under report their symptoms because they've compensated for them so long they seem "normal."

You'd also look at school transcripts, driving records, and occupational history.

The other important info is on prenatal and perinatal care.

Some of the biggest "risk factors" associated with ADHD are nicotine use during pregnancy, premature birth, and birth complications /difficult births.

It goes without saying that alcohol and drug use during pregnancy are huge factors as well.

Since research,mainly on twins, has shown ADHD to be 80% inherited/genetic in origin, a family history of learning problems, school dropouts, etc, is also important.

A really thorough eval would do an intelligence screening and an academic screening ; but not for diagnostic purposes.

IQ tests and neuropsych tests arre "inappropriate" for diagnosing ADHD.

It is ,however, important to get a screening to look for comorbid problems; of which learning disabilities are some of the most frequent.

Computerized test used as the only measure in an eval are also '"inappropriate" as well.

Good luck and I hope this helps you some.

take care

mctavish23 (Robert)
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Old 09-24-05, 05:53 PM
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Wow, a five minute evaluation must have felt like quite a blow off -- I don't know how you could know anything about a person in that about of time. I sure how you can see someone else soon!

Draven, just have been frustrating to have had such a through psychiatrist and then end up with such a snap judgment. Sounds like you handled it well -- much better than I could have. Maybe you've educated your need psyc doc a bit and other patients of his will benefit as well!

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Old 09-24-05, 09:15 PM
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I side, as almost always, with the doctor. You don't know what the doctor was looking at, what information he was working with, and what school of psychological thought he was coming from. You said that you listed no to the things about constant checking, and so further, but that doesn't rule out Obsessive/Compulsive traits, especially if he's referring to the Personality Disorder rather than the Anxiety Disorder. He is well within his rights to rule out ADHD.

It also seems, given the fact that you're here, that you are convinced of your own diagnosis. Because of this, you may be missing (unintentionally) points that you don't want to hear. If you believe ADHD is the answer, and it's not, then you are less likely to be receptive to the information that says it's not.

Further, I strongly dispute the idea that the diagnosis took only 5 minutes. He was looking at a referral, and you do not know what was on that referral. And you also mentioned anxiety; that is NOT part of the ADHD diagnosis, or even a common non-diagnostic symptom. While many people with ADHD do develop anxiety disorders, the amount is only slightly greater than the number who would have them without ADHD. Anxiety symptoms DO, however, bring on inattention. That means there is an as good if not a better chance that you have an anxiety problems that are making you demonstrate ADHD characteristics.

It seems to me that you need to talk to your doctor about this. Ask him to explain his rationale, because you are concerned. I am certain his rationale is sound. Not doing well on exams, but doing better on take-home tests, is not indicative (to me) of ADHD. Rather, it's indicative of "Exam Panic," a very common problem on college campuses which is often related to Obsessive Compulsive thoughts of fearing inferiority, fearing you won't function under time limits, or fearing you haven't learned adequately.

This is not the right place to second guess your doctor or even ask if he's on the ball, as most people here, having or thinking they have ADHD, will be far more likely to side with you. As a group, individuals here often attribute many things to ADHD, by the simple availability of knowledge about ADHD. If you only know about ADHD, and not other possible disorders, you're much more likely to assess any problem as ADHD; not because it's the best fit, but because it's the best fit _that you know of_. And, because you have already decided, it seems, that you have ADHD, you are less likely to see the reasoning, however sound, that you have something else with inattention features.

People here saying the doctor may be wrong or the doctor is a bad doctor are jumping on a bandwagon. We don't know your case history and we don't know your situation, so people saying you "probably have ADHD" despite your doctor saying you don't are not working with the necessary information.

Trust your doctor on this one: he has a lot more schooling and training in the matter; and while he might not know you as well as you know you, he might just have a little better insight into what makes you tick. "Educating" your doctor so he changes your diagnosis is not in your best interest: remember, you don't have ADHD just because that's the conclusion _you_ came to. The chances are, if the doctor doesn't think you have ADHD, you probably don't.

I'm sorry I rattled on and likely made some people very upset, I just want to make the point very clear: people on an ADHD board are more likely to assume any symptoms are the result of ADHD, even if they aren't. If you think you have ADHD, you're less likely to understand the reasoning that proves you don't, even if it's very solid.

Most importantly, your psychiatrist has training and experience in making diagnoses. He didn't review that referral in the 5 minutes you were there, he probably had it a few days in advance, and reviewed it in depth. He likely has seen similar cases. He definitely knows more about this than you do. He, and you, are both looking for an explanation of your behaviors using the information you have; and he has much, much more information and experience.

Finally, ruling out ADHD is not difficult; if there are other symptoms, then the ADHD symptoms normally fall under that. DSM-IV has very clear rules: make the diagnosis which best explains ALL symptoms present. If there is another diagnosis, even if it's Anxiety Disorder Not Otherwise Specified, he SHOULD use that instead of ADHD, JUST because the Anxiety is there, and that's not part of ADHD, while the inattention IS part of anxiety. DSM-IV is designed to use the fewest possible diagnoses to explain an individual; your ADHD-like symptoms probably fall under something else - something that he knows, because he has studied it, and you don't, because you haven't studied it. It's fallacious to assume it's ADHD, which you discovered and likely researched and read about because you thought it was correct, and not one of the literally hundreds of other diagnoses that HE knows about, into which your symptoms probably fit much, much better. That's not saying you did a bad job, it's just saying you probably don't know what disorder your symptoms better fit, because you haven't read DSM-IV, and he does, because he has.

In brief: I side with the trained doctor rather than the hopeful patient in diagnosis. It's absolutely wrong in every way for any of us here to think the doctor is incorrect, because we a) don't know the history and symptoms, and b) don't know all the possible diagnoses those symptoms can indicate, and c) have a tendency de facto to assume everything is related to our own disorders, by virtue of the fact that it's all we know about.
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Old 09-24-05, 09:20 PM
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Mctavish, not to labor the point, but while all those things need to be included in a proper diagnosis, they are NOT necessary to discount a diagnosis. All that needs to be present to make the diagnosis NOT ADHD but instead something else is a single symptom that makes the symptoms fit that better than ADHD. If, for example, he has a single anxiety symptom, and not all the ADHD symptoms, it's an anxiety disorder, and ADHD is not diagnosed at all...and inattention alone does NOT make ADHD-PI.
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Old 09-24-05, 09:28 PM
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Allow me to inject here that I have been a "victim" of a 5-minute diagnosis, not for a mental disorder but for an injury.

If only that diagnosis had been made in the US instead of Japan, I'd be set for life on my nice, fat malpractice settlement.

Doctors can, and sadly often do, make mistakes. Seeking a second opinion is the right, nay the responsibility of the patient.

Conversely, doctors do not have a "right" to make the diagnosis they see fit; they have that prerogative, within certain bounds, but the rights lie on the side of the patient.
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Old 09-24-05, 09:33 PM
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I think in this case a 5 minute diagnosis is not having occurred. From what I can make of the case, we're in no position to second-guess the diagnosis. If the patient feels so, a second-opinion is _always_ warranted, but not necessarily good. I'm more warning against the idea of assuming the OP HAS ADHD and was misdiagnosed. There is absolutely 0 evidence that he has ADHD outside of his own opinion. It's fallacious, therefore, to second-guess the doctor saying he doesn't have ADHD. We don't have any reason to doubt the doctor's diagnosis, and based on the OP's own self description of "anxiety" as a major symptom, we have at least one good reason to support the doctor in the Dx being an anxiety disorder, not a childhood-onset behavioral disorder.
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Old 09-24-05, 10:29 PM
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We do not know if the psychiatrist was specializing in ADHD.

Anyways, doctors are not perfect and they might make mistakes.

I don't think anyone is saying that dopenuts do in fact have ADHD, just that the diagnosis doesn't seem to be so thorougly done.

He (the psychiatrist) might have taken more than 5 mins to decide, yes. But with what material? We do not know how well dopenuts explained her/his problems to the GP or if the GP got what s/he said right.

At least I think that the psychiatrist should have given the reason why he didn't think dopenuts had ADHD, why he wouldn't even consider doing a proper evaluation. (By this I mean deep interviews, check lists, talking to parents, ruling out physical conditions, etc). He should also have explained why he kept at the OCD-diagnosis. Like "Well, you see OCD is not only about....it can also be...."

Doing a proper evaluation is not the same as saying someone has ADHD.

And by the way; KMiller, how can you be so sure about where the anxiety comes from? Do you know dopenuts? Did you see the material the doctor based his decision on? No, you didn't and neither did I or anyone else here.

What about comorbidity?

Isn't there a number of people who have been diagnosed with depression, etc. earlier in their lives before it was found out that they had ADHD?
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Old 09-24-05, 10:58 PM
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Hi dopenuts.


*Silence*

Hmmmm...dopenuts seems to have left the building, at least for now.

I'm wondering if he or she had taken any of the online ADD or ADHD tests.
And "dopenuts"? Just wondering if the screen name implies that he or she (or you, if you're still here or back again) might have been 'under the influence' of some self medication when the doctor did the 5 minute evaluation.

In addition to all the great dialogue above, one other thing to consider is that OCD and ADHD and all the other Disorders are mere labels for collections of symptoms. The fact that there is frequent comorbidity dillutes the value of these labels even further. Perhaps the doctor just wants to focus on the most obvious (to him) symptom first.
Or maybe, because amphetamines are often used in the treatment of ADD and ADHD, he prefers to hold back on them until he's sure the new patient is serious about dealing with ADD or ADHD and not just wanting the controlled substance.
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Old 09-25-05, 12:21 AM
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The first Dr. I saw in 1997, said, to me, after he look at what I was in to see him for,
You don't look the type, to have AD/HD, I walked out
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Old 09-25-05, 12:59 AM
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It seems some doctors are just hell bent on avoiding it.I dont know why myself.I went through the same experience and then some.I had to practcally fight my way to treatment for it!I couldnt believe how hard it was,but I never gave up because I knew what was wrong and had gained all info I could to arm myself with.

I stayed persistant with friends and family rolling eyes the whole time.In the past I would have never have thought enough of myself or had the energy to do such.After I had my children that changed.I had too and I deserved to get a fair shot at treatment.

My opinion,Go to another doctor and if you have to,another.You know how you feel inside.Also,I battled depression and anxiety attacks almost my whole life.I was a mess.Once I got treated for ADD that all turned around.I believe its all connected.Good luck to you.
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Old 09-25-05, 01:28 AM
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Quote:
Originally Posted by Fasthummingbird
The first Dr. I saw in 1997, said, to me, after he look at what I was in to see him for,
You don't look the type, to have AD/HD, I walked out
Is it at all possible that he was trying to compliment you, but he had no social skills? Even if so, it would probably not been a very productive relationship.
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