Challenges in Diagnosing ADHD

When it comes to diagnosing ADHD, simply looking at a list of traits without considering the circumstances that bring out the traits can be very misleading. It is also vital to assess the persistence of these traits over time and to consider other potential causes for what may appear to be the symptom cluster called ADHD.

Other Potential Causes for ADHD Symptoms

For a variety of reasons you may temporarily have at least some of these traits. You may be under incredible stress. You may have another condition that comes and goes and mimics some of these traits like Bipolar Disorder and thyroid problems. You may also have a condition like Generalized Anxiety Disorder (GAD) where you may feel generally anxious about everything you think about much of the day. Then the question becomes, "Are your concentration issues secondary to the anxiety or is the anxiety secondary to their concentration problems?"

This is why a very careful history is important, including information from people who have known you and are willing to be honest with you. Each of these symptoms represent a way your neurons tend to default under specific types of conditions. Where, when and with whom these traits present and get in your way is very telling. When you can come up with at least ten of these situations, a clinician can usually discern the common features that define which brain circuits are struggling. For example, a spouse may complain that they, "Never know how he/she is going to act when they get home," when the person has Bipolar traits. The spouse of the person with ADHD tends to say something like, "It’s always the same, when they come home, they get angry with the kids and then escape to do something in the garage."

"Workarounds" that Make Diagnosing ADHD a Challenge

Clinicians know that it is difficult to remember ADHD traits when a child. Often you may have few actual memories for anything before ten years of age. When this is true we must rely increasingly on looking for the workarounds that you use now as an adult. Or said in another way, what might you excel in or what situations might you tend to avoid?

One aspect that can confuse is the fact that stimulation of several kinds can offset the difficulties found in ADHD. A spouse may comment that you can watch your favorite TV program for hours but are too tired to 'really talk' to or spend time with them. You also may find no problem spending hours doing something with your hands, but fall behind on anything organizational or boring to you. You may not like keeping your home or desk straightened up. You may struggle to get up in the mornings and need several cups of coffee to wake up.

One confusing workaround is when someone really enjoys reading. Most with ADHD have not read a book for years…if ever! If I recommend a book they either get the audio version or their spouse reads it and underlines the parts that pertain to their situation. Then there are those who enjoy books the way many others with ADHD enjoy video games. They love to read! They read all the time. This is a good thing to a point as they ‘know stuff’. However, the same lack of development of social skills often limits their success in life. They are smart and well read but yet may find it difficult to make or keep friendships.

It is nice to know that there is a part of the brain that helps us when we are doing something we like. But for the person with ADHD the drop off when asked to do something they find boring is greatly exaggerated. Without the stimulus of liking it, getting started on a task can feel overwhelming to even consider.

Another trigger that can confuse people is the stimulation of being late. Another part of the brain helps us to ‘wake up a bit’ as we find ourselves late for some appointment or project. This includes waiting to study or get ready to go somewhere until the last minute. Most would find any of these situations uncomfortable but for many with ADHD, this often defines their life. Many times, after a test or project is complete, the person with ADHD may say to themselves, “I’m never putting myself through all of that drama again!” only to fall right back into it the next day as the stimulus dies and they fall back into their procrastination. This trait alone has led to the end of many marriages, educations and careers. It often appears to others that the person with ADHD ‘just doesn’t get it or even care.’

Some have found another workaround as they develop a way to feel late earlier. People often say, “I’m a perfectionist or obsessive” but, when I carefully tease through what they mean, their ‘obsession’ is actually a functional workaround that stimulates them to start or keep some activity going efficiantly. When a person is a perfectionist about keeping their desk clean they get anxious sooner, adrenalin flows, and the desk stays clean. It may cause anxiety and be uncomfortable but it serves to get the job done!

Diagnosing ADHD: The Value of Knowing Our Traits and Symptoms

What is the value of you knowing you have this symptom cluster or diagnosis? This set of symptoms is correlated with a whole host of altered living situations and confusing problems. Knowing you have ADHD can help everyone involved know how to optimize their relationships. You will be better able to understand your life conditions, recognize your predispositions and engage successful strategies to deal your issues or hopefully avoid them altogether. If you are warned of the coming of a severe storm, you may want to put on a rain coat or get the family inside. People in business use tests for such traits every day to optimize a person’s chances to succeed. If their traits fall outside what the job calls for, they will advise they move to a position that favors the traits they possess.

If your mother and father have struggled with ADHD and you see similar struggles in yourself, you likely will want to take action. Given that this symptom cluster has been well researched, you can then review the literature, talk with family members, and talk with experts to work to incorporate these ideas into your life. You do this in every other aspect of your life from looking for the right diet to learning how to save money. It only makes sense to do the same for the way you process information as you think, feel and respond to your life and to all those you love.

Please also consider joining us in our educational program called, 'Patients of Oneness'.

Take Care!


The Neurobiology of ADHD
Diagnosing ADHD in Adults
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