In October 2023, lots of people with ADHD started posting about their experiences on Threads. Have you ever commuted to work and forgot to bring your laptop? Check. Do you frequently procrastinate a simple two-minute task for several days? Check.
As I started seeing a lot of myself in their experiences, and realized that I developed several coping mechanisms and acquired several coping technologies over time, I decided to go for a full diagnosis.
I am not a doctor. I am a computer scientist and economist. This is not medical advice. If you suspect you have ADHD, you should talk to a medical professional, like I did.
Symptoms
Whether I have ADHD or not, I do have some symptoms that are commonly associated with ADHD:
- Difficulty getting started with tasks, even simple ones. I have gone to appointments I didn’t need to because I didn’t want to call to cancel the appointment.
- Difficulty putting the finishing touches on tasks. It takes me 90% of the time to do 90% of the work, and 90% of the time to do the remaining 10% of the work.
- I lose an incredible amount of things. When I was a kid, my mom was once told that about 10% of the items of the lost and found in a 300-student school were mine.
- I have a hard time focusing on things that are not interesting to me.
- I oscillate between hyperfocus and not being able to focus at all.
Despite the difficulties, I manage to function well, because I developed a lot of coping mechanisms and technologies over the years.
Why I Decided to Get Tested
The flurry of posts in Threads due to the ADHD awareness month in October 2023 got me started. Several posts described experiences that were very similar to mine. A particular story that resonated a lot with me was the story of someone who was treated for anxiety for years when they in fact had ADHD, and only got diagnosed in their 40s.
I found out that this is a common problem. I have been undergoing treatment for anxiety, and though there was some improvement, progress has been slow. Several posts described a situation similar to mine: people that made little progress while being treated for anxiety, but once diagnosed with and treated for ADHD as adults, their situation improved significantly.
This gave me hope, prompting me to research the diagnostic process. Starting the process ended up being more confusing than helpful. The information I found online described several different processes and tests, some of which even seemed to promise a diagnostic outcome. The best advice came from Threads and it was clear: begin by consulting a medical professional and expressing your concerns, and go from there.
The Referral
The process, at least where I live, seems to be designed to make it hard for people with ADHD to get diagnosed. I had to go through several steps, and I’m still not done. I live in the state of Washington in the United States. The experience may be different in other states or countries.
As mentioned above, the first step is to talk to a medical professional. I had a previously scheduled appointment for my annual physical just a few weeks after I decided to get tested, so I waited for that appointment in mid-October. Trying to schedule a separate appointment would have taken a lot longer.
In the appointment, my PCP told me they would call me with a referral in a couple of days, but instead of calling me, they called my emergency contact, who forgot to tell me about it. Luckily, people in Threads kept reminding me to follow up, and I called my PCP office a few days later. I found the referral and called the psychologist office.
The Initial Evaluation
I called the psychologist’s office in early November. The first thing I needed to do was to set up an account in their system, which took a few days. Then, when the account was completed, they asked me to fill several standard medical forms, plus a two-page biography describing why I think I may have ADHD, and three questionnaires designed to assess whether I have ADHD and potentially autism, which tends to happen hand-in-hand. The questionnaires are below:
The first questionnaire is a screening tool for ADHD. The second is a more detailed questionnaire about ADHD symptoms. The third is a screening tool for Autism Spectrum Disorder (ASD), a common comorbidity. The first six questions serve as a screening tool: if you score in the grey areas for four out of the six questions, you should definitely talk to a medical professional.
I completed the forms December 8th. After all the forms are filled, there are three more appointments to go through, and the first can only be scheduled after the forms are completed. I received a message on the day after that I should schedule the first appointment. I only managed to call back on December 22nd, and scheduled the first evaluation for January 3rd, 2024.
The First Meeting
On Jan 3rd, 2024, I had the first meeting with the psychologist. We introduced ourselves and he asked me about the symptoms that resulted in me seeking a diagnosis. I described the symptoms I listed above, and he asked me to elaborate on each one of them. He also asked me about my childhood, and I described how I was a very good student, but I had a hard time focusing on things that were not interesting to me. I also described how I lost a lot of things, and how I had a hard time getting started with tasks.
He asked about my family history. My mom is definitely not neurotypical, but she has never sought a diagnosis. I did not have enough contact with my dad to know if he was neurotypical or not. He also asked about my children, and I told him that their school has guided me to request accomodation arrangements for them (these are called 504s). I told him that I plan to get them through an ADHD and autism evaluation as well and that the school counselor had already suggested that earlier in the year.
The whole meeting lasted about 40 minutes. We scheduled the appointment for the second meeting on January 8th, 2024.
He then gave me three more tests to fill out on my own time, which I did later at night on that same day.
- A personality test with 344 questions: the test asked a lot about whether I can control other people’s minds, whether I think they control my mind, and how frequently I think about suicide. It also repeated several questions about the usual ADHD symptoms. It would ask “Do you always feel distracted?” and offer four options for me to choose (False, Slightly True, Mostly True, True). Later, it would ask “Do you frequently feel distracted?”, and show the four options again. This one took a while to get through.
- The Big Five personality test: a standard personality test with about 50 questions, which was somewhat quick to get through.
- An attention test called IVA-AE2: this test repeatedly shows an image of a number and speaks another number. For example, it can show 2 and speak “six”. You are assigned two different target numbers, one to click when you see it and another to click when you hear it. It then speaks and shows random numbers for 20 minutes. For example, if you are assigned the number “3 when seen” and “5 when heard”, you should click if it shows 3 and speaks 6, you should also click if it shows 2 and speaks 5, but you should not click when it shows 5 and speaks 3. I think it’s pretty normal to make the mistake of clicking when you hear the number you’re supposed to click only when you see and vice-versa, and I’m sure I made plenty of mistakes, but I think most people would. This test was very tiring.
The Second Meeting
On January 8th, 2024, I had the second meeting with the psychologist. This meeting was markedly shorter. He sent me an email with a link to the MOXO d-CPT ADHD Assessment, a test that has visual and auditory distractions, for me to do during the meeting, while he scored my previous tests.
The test is similar to the IVA-AE2 test I did for the first meeting. It repeatedly shows images of several playing cards, but I have to identify a specific one (the Ace of Hearts) and press the space bar when I see it, while a lot of distractions happen simultaneously. The test takes 18 minutes to complete, and is also somewhat stressful and tiring.
I downloaded a demo from their website and edited the video to show a 15-second snippet of the most difficult part below.
After I completed the test, he asked me a few more questions:
- Do I play videogames a lot? (I used to, but I don’t anymore)
- How did I feel about the IVA-AE2 test? (I felt it was very tiring)
- Did I have any childhood trauma? (I wouldn’t call it trauma but my father left my life quite soon, and my mom is not neurotypical, and we have some money difficulties, which led me to work really early in my life)
I imagine the first question was related to my reaction time, but I’m probably only going to learn about that in the third meeting.
We ended the second meeting somewhat early, after just 30 minutes, and scheduled the feedback meeting for Wednesday January 10th, 2024.
The Third Meeting: The Diagnosis
The doctor I used, Dr. Richard Wemhoff, Ph.D., from Emmaus Counseling Center, is a specialist in adult ADHD diagnosis. If you read the whole process above, you will see that it was very comprehensive. He goes through ten steps, seven of which are questionnaires. I’ll describe the process and the final diagnosis below.
- Do your symptoms get in the way of your personal or work life? Although this is a simple question, it’s an important one. For me, the answer was yes.
- Did this happen when you were young? Again, this was true in my case. ADHD that appears in adulthood is unusual, and it’s important to rule out other causes.
- Brown ADD Scales: this test goes from a scale of 0 to 120. 0-40 means ADHD is unlikely. 41 to 55 means is possible, and 56+ means it’s likely. I scored 67, and it was significant in all the five components: attention, activation, emotion, memory, and effort. One interesting thing is that if some components are too significant, this may indicate a different condition. For example, a high score on emotion (meaning that the person is feeling very bad about the symptoms) may indicate depression. That was not my case in any of the components.
- DSM-5: a set of 18 questions, 9 to screen for inattention and 9 to screen for hyperactivity. I scored 7/9 on inattention and 8/9 on hyperactivity, again, indicative of ADHD. There are three types of ADHD: innatentive, hyperactive, and combined. I scored high on both, so, according to this test, I’m likely to have combined ADHD.
- Can the symptoms be due to another condition? This is where the long tests done after the first meeting come into play. He scored the results and I don’t seem to have any other condition. The only thing that was a little above average was “social detachment”, but still within normal range.
- Family history: ADHD tends to run in families. My mom has some condition, as of yet undiagnosed. My kids have ADHD symptoms and given a screening, they should be tested, so there’s definitely a family history.
- Adult ADHD Self-Report Scale (ASRS): an 18-question test, similar but not exactly the same as DSM-5. This also resulted in a high score, and it’s a good indicator of ADHD.
- MOXO d-CPT ADHD Assessment: this is the test I did in the second meeting, and is considered to be very precise. I scored “ADHD present”. The test has four components. I only had a normal score on “impulsiveness”, meaning I’m not overly impulsive. I scored below average on “attentiveness”, and far below average on “timeliness” and “hyper reactivity”. This last one means that I overreact to distractions, and I felt it in my soul.
- IVA-AE2: to everyone’s surprise, I passed on this attention test. The doctor said that this is not that unusual, people with ADHD can hyperfocus.
- Autism Spectrum Quotient (AQ): this is a test to screen for autism, not to diagnose it. Autism is present in 25% of the ADHD cases, so it’s important to rule it out. I scored way above the cut-off range, which means that I also need to be evaluated for autism.
In summary, the result is that I definitely have ADHD, and that information was sent to my PCP to discuss treatment options, which may include medicine. I also need to be evaluated for autism, which is a different process that I will document in a different article. The doctor also said that I should be proud of myself for having accomplished the things I did in life given my condition, and that things should improve a lot when I start treatment.
I am describing my process with the treatment at this article.
Do I recommend this process?
During this whole process, I felt conflicted. End-to-end, it took months, and for a while I was so distracted with other things that I ended up delaying my diagnosis. I heard stories of people that get their diagnosis very quickly, in a single appointment. My process had several steps, and I had to do a lot of tests, and I was not sure if it was going to be worth it.
There is, however, an immense advantage in going through a process that was so comprehensive. I feel very confident about the diagnosis. I know that I have ADHD, and I know that I don’t have any other condition that masks the symptoms. And now I know what to do about it.
Reactions
I posted about my experience in Threads, and I got a lot of reactions. Most people are supportive and describe their own experiences being diagnosed. Some people, however, are skeptical. They say that ADHD is overdiagnosed, and that it’s a fad, or a quick excuse to be lazy and forgetful. While I disagree, I have seen some websites that promise a “quick and easy” diagnosis and to get you medications fast. It feels similar to advertisements for Viagra and off-label Ozempic.
Overall, having documented this process through posts has been a good experience, and I really hope it helps other people.
Treatment
I have been documenting the progress with my treatment. I have written a 1-week update and a 4-week update.
What about you?
If you suspect you may have ADHD, I recommend that you talk to a medical professional. Your PCP is a good place to start. Online communities, such as the ones in Threads, can also be a good place to start.