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  #1  
Old 06-30-10, 11:19 AM
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Why is ADHD so hard to diagnose?

Well, I have no idea that's why I'm asking.


Is it harder to diagnose than bi-polar? Is it harder to diagnose than schizophrenia?


Is it REALLY that hard to diagnose? It seems like a trained monkey can get a diagnosis for bi-polar (at least that's my experience)


Is it hard because the implications of ADHD squick many an ideology?


I am actually curious?


In part I feel that it's not being diagnosed not so much because it's hard but because of professional negligence. The I don't want to prescribe schedule II's so ADHD doesn't exist..

Maybe I'm just making some assumptions that aren't true but I am seriously curious.
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Old 06-30-10, 12:13 PM
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Re: Why is ADHD so hard to diagnose?

I think a lot of it is simply ignorance about the condition on the parts of both doctors and patients. Certainly doctors bear the blame for not educating themselves on the symptoms of Adult ADHD, but because diagnosis is such a subjective and clinical process, the patient bears a lot of responsibility for bringing the issue to the doctor's attention. This is difficult for a couple of reasons.

First, I think adults with ADHD are more likely to consider their problems to be the result of character flaws, not an actual medical condition. Because there is such a strong stereotype of what ADHD looks like, most patients are not likely to even consider that as an issue.

Second, when you've lived with attention deficit for your whole life, you just assume that that is normal. I think with a lot of other disorders, patients will notice a change in their thinking or behavior. With ADHD, you aren't likely to notice a change, because really, there is none. Instead you have to REALIZE that your thought processes and behavior are somehow outside the norm. This is not an easy thing to do.
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  #3  
Old 06-30-10, 12:24 PM
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Re: Why is ADHD so hard to diagnose?

I have been told that my ADD symptoms mimic those of depression which I am also diagnosed with. Whenever someone tells me this, I am irritated no end. Yes, I suppose there is some truth in this statement, but when someone tells me this I feel as if I'm not being taken seriously - almost as if my difficulties are only the result of a bad mood, and I should just snap out of it.

Also, many people - including medical practitioners - think ADDH is a childhood thing. Adults should have outgrown it or something.

The only reason the clinic I attend was willing to treat me for ADD is that I presented them with my 11 page neuropsych evaluation which showed in no uncertain terms that I suffered from the symptoms of ADD.

A complete neuropsych exam is time consuming - I went in for 4 hours every day for two weeks - and expensive. Many people can't afford one and even if they can, their doctor won't refer them for the tests. I was seeing a neurologist who ordered an MRI scan. The MRI showed nothing and the neurologist wanted to tell me nothing was wrong. I had been told about neuropsych evals and asked him to refer me for one. He seemed surprised by my request, but he did give me a referal.

Given my experiences, I am not surprised that ADDH is "hard" to diagnose.
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Old 06-30-10, 12:34 PM
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Re: Why is ADHD so hard to diagnose?

I actually told my then-psychiatrist on my first visit that I feel like I have ADD. (this was 3 years ago) I knew very little about the condition, just layperson's knowledge, but that's how I felt.

She diagnosed bipolar.

I actually fought her on it (hmmmm... in retrospect probably not the best idea...). I said I really don't have much that can be considered mania.... anxiety and aggression, sure, but mania?

She then decided I am bipolar 2.

She gave me depakote and klonopin, which, to be fair, helped a lot with the anxiety, mood swings, and some other things.

My current moron refuses to add an additional antidepressant to supplement my dopamine (which I have decided I need due to my lack of energy) He says that Lexapro (which I am taking) is providing that.

-sigh-
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Old 06-30-10, 12:37 PM
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Re: Why is ADHD so hard to diagnose?

Ginniebean, I think it's because everyone has some of these symptoms some of the time. So where does one draw the line between charmingly "absent-minded" and "disordered"?

Even my therapist yesterday was brushing aside things I had to do but forgot to do or my reading difficulties as something "everyone does". Sheesh.
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Old 06-30-10, 12:59 PM
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Re: Why is ADHD so hard to diagnose?

I wasn't aware it was hard to diagnose. My doctors have always been pretty certain I had ADD.

They're pretty well versed in ADD, though.

My current psychiatrist leads ADD research in this area.
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Old 06-30-10, 02:06 PM
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Re: Why is ADHD so hard to diagnose?

Every one on this earth thinks they've had it bad and have their own opinions,even docs or those of a high figure in society...leading to lose of understanding by that person.If one says it they all say it.

I mainly blame the media and lack of re-sits for practitioners(docs of any kind).(UK at least.)

Maybe because some of us,as in adhd do not have a problem...i assume a lot of adhders are out there skipping around quite happily without knowing,for what ever reason,positive thinking,being a nice person or being sly,so they would call it ball.
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Old 06-30-10, 02:42 PM
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Re: Why is ADHD so hard to diagnose?

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Originally Posted by eclare View Post
I think a lot of it is simply ignorance about the condition on the parts of both doctors and patients. Certainly doctors bear the blame for not educating themselves on the symptoms of Adult ADHD, but because diagnosis is such a subjective and clinical process, the patient bears a lot of responsibility for bringing the issue to the doctor's attention. This is difficult for a couple of reasons.

First, I think adults with ADHD are more likely to consider their problems to be the result of character flaws, not an actual medical condition. Because there is such a strong stereotype of what ADHD looks like, most patients are not likely to even consider that as an issue.

Second, when you've lived with attention deficit for your whole life, you just assume that that is normal. I think with a lot of other disorders, patients will notice a change in their thinking or behavior. With ADHD, you aren't likely to notice a change, because really, there is none. Instead you have to REALIZE that your thought processes and behavior are somehow outside the norm. This is not an easy thing to do.
I agree with this post. In addition, because of the genetic component I always felt "normal" because I grew-up around family members just like me, married someone like me and have children like me.
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Old 06-30-10, 03:58 PM
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Re: Why is ADHD so hard to diagnose?

Many mental conditions are hard to diagnose. The reasoning being that symptoms vary significantly and everyone is different. Some people have severe add while others not quite. A line must be drawn to differentiate normal and abnormal and that is pretty subjective. It is impossible to get into someone elses head and establish what is "normal." More and more is being learned but the diagnosis is largely what the patient reports.

I think many people think they have add / hd when they really don't and visa versa. That has helped create this association between laziness and add.
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Old 06-30-10, 04:01 PM
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Re: Why is ADHD so hard to diagnose?

I think it's hard because we are trained from an early age to think of Civilized behavior as that which is not primal or tribal and I think people who have ADD are living in the past when everyone was hunters or gatherers and not farmers and tax collectors.
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Old 06-30-10, 04:49 PM
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Re: Why is ADHD so hard to diagnose?

UHM Meridian ?? Not everyone has difficulties reading, ....I know it's common for ADDers, but not universal........I have always been a great reader, the only preoblems I have ever run into are when I have to read something like a astronomy textbook ( ha I never in my whole life felt as stupid as I did taking THAT subject, absolutely NO affinity for it ! .....ANY of my math classes were a lead pipe cinch compared to astronomy !)

and I tried to teach myself how to make silver jewelry by reading ....nope, could not do that either .......

other than that......reading is like breathing to me .....

so, your doctor is really really wrong there eh ?
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Old 06-30-10, 06:11 PM
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Re: Why is ADHD so hard to diagnose?

Ginniebean

McTavish is really our expert on this but I will chime in the best I can.

What makes a disorder like ADHD hard to diagnose is that so many other issues can mimic the symptoms. As an example, the symptoms of major depressive disorder in adults can parallel closely inattentive symptoms of ADHD. It can be hard to differentiate between these but it must be done in order to arrive at a good diagnosis. You will see on the forum often someone discussing the doctor wanting to treat for depression and not ADHD.

A major problem is that it is often easy to see that someone is ADHD for example but it is hard to determine if someone is not. The problem areas in diagnosis are not at the extremes but near the borderlines. This is where differential diagnosis is hard and where the disorders that mimic ADHD are so difficult to rule out.

With adult ADHD, one of the problems is that we yet do not have criteria for adult diagnosis. It means that there is often limited consistency in the diagnosis between professionals. This is a major problem that is being addressed in the studies for the DSM-V.

With children the situation is even more difficult since they cannot really discuss their feelings and thoughts all that much and the symptoms are often different with children and adolescents than with adults.

A good way of describing the diagnostic dilemma is "This person looks like a case of ADHD but is it really?" Fill in ADHD with any other DSM diagnosis and this is where the difficulty lies.

And I am not even getting into comorbids.


Oh yes, you suggested that diagnosing Bipolar disorder is simple. It is not. Bipolar disorder has (if I counted correctly) 32 separate possible diagnosis. Hardly simple.

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Old 06-30-10, 08:26 PM
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Re: Why is ADHD so hard to diagnose?

Quote:
Originally Posted by salleh View Post
UHM Meridian ?? Not everyone has difficulties reading, ....I know it's common for ADDers, but not universal........I have always been a great reader, the only preoblems I have ever run into are when I have to read something like a astronomy textbook ( ha I never in my whole life felt as stupid as I did taking THAT subject, absolutely NO affinity for it ! .....ANY of my math classes were a lead pipe cinch compared to astronomy !)

and I tried to teach myself how to make silver jewelry by reading ....nope, could not do that either .......

other than that......reading is like breathing to me .....

so, your doctor is really really wrong there eh ?
I LOVE reading! By the 6th grade I was already reading/comprehending post-high school books.

But youre spot on about the textbooks that I find boring/not worth my time. I can try for hours to read and actually obtain information from the texts and still end up maybe remembering one insignificant detail (that was probably more about something else rather than the subject.)
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Old 06-30-10, 08:46 PM
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Re: Why is ADHD so hard to diagnose?

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Originally Posted by ginniebean View Post
Well, I have no idea that's why I'm asking.

Is it harder to diagnose than bi-polar? Is it harder to diagnose than schizophrenia?


Is it REALLY that hard to diagnose? It seems like a trained monkey can get a diagnosis for bi-polar (at least that's my experience)
Interestingly, I just read about a study done last year from Rhode Island Hospital that indicated that more than half of 145 patients who had previously been given a diagnosis of bipolar disorder using the Mood Disorder Questionnaire (MDQ), did not in fact, have bipolar disorder.

I think a great deal of it depends on the knowledge and experience of the clinician and how thorough they are.
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Old 06-30-10, 08:46 PM
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Re: Why is ADHD so hard to diagnose?

Well, for me Bipolar symptoms are more noticeable but there's a lot of controversy about ADHD still. There's the stereotype of bad kids who won't sit still, then there are those that think it's been diagnosed too much. If you have a particularly arrogant and ignorant doctor with their own view of ADHD (even to go as far as doubting the existence) then it's going to be a lot harder to diagnose.

I had to have an MRI scan and I think I was also supposed to have a qEEG, but the waiting list was 6 months and it was $1000 up front if I wanted one sooner. I've been lucky though when it's come to getting diagnosed and medications. I don't know why but people around me say the mental health system in my country has gone down the drain but it's not the case with me. I think it's because I'm doing a lot worse than other people. People have worked, gone to college or have a few friends - not me.
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