You are behind in all of the meetings this month. Your workload continues to increase but your attention decreases. You’ve read the articles, taken the online quizzes and asked yourself, yet again, if you actually might have ADHD.
So asking a question does not equal being informed. The first step to knowing is an accurate assessment.
You are not alone if you are an adult who is thinking about having an evaluation for ADHD. Millions of adults are diagnosed year after year, many of whom have attributed their troubles for decades to laziness, anxiety or just not being a morning person. A formal evaluation turns that story upside down, one that ends uncertainty, and guesswork with clarity.
Please read this to find out exactly what to expect, one step at a time.
Why Adult ADHD Often Goes Undiagnosed
To grasp why so many adults live without an ADHD diagnosis until their 30s, 40s, or even in some cases, 60s, it helps to first understand why that is.
Until recently ADHD was mainly viewed as a childhood disorder with a tendency to “grow out of” by adolescence. Now it’s known that doesn’t happen. ADHD affects about 4-5% of the adult population in the world; many of these people were undiagnosed children. Girls are often missed because they may have inattentive symptoms, teachers and parents often miss them!
People who have ADHD as adults often have learned to develop more complex coping strategies so the disorder is not visible. On the outside may look very functional, but on the inside very exhausted and overwhelmed. This is the reason why a comprehensive multi-stage assessment is important – you cannot judge an interview at face value.
Step 1: The Initial Consultation
Evaluation is started prior to formal testing. The first meeting is usually a direct intake talk, sort of as if your psycho or psychopath is getting a grasp on all of you before going into specifics.
During this session, you’ll discuss:
- You’re concerned about the primary concerns – What’s bringing you in? What are the problems in your life, work or relationships?
- Your personal narrative – education, work, family, and any prior mental or psycho-social care received
- Presence of current symptoms – How often do you forget what you are doing? Can’t hold attention? Are you constantly interrupting others or fidgety?
- Medication History – Any past or current medications, including psychiatric and non-psychiatric
The first consultation is also an opportunity for your provider to determine if your symptoms are primarily for ADHD or if a different condition is responsible (more about that later).
Step 2: A Thorough Symptom History – Including Childhood
One thing that many adults who are thinking about getting an ADHD diagnosis may be surprised by is that the assessment process is retrospective – it isn’t performed based on who you are right now.
The DSM-5 (the diagnostic manual for mental health professionals) stipulates that symptoms of ADHD need to be observed prior to age 12 to meet the criteria for a diagnosis. There’re many adults who don’t have a childhood diagnosis. It does mean that your evaluator will be making a request for you to reflect back.
Questions might include:
- Have trouble sitting still in the classroom?
- Did you often hear that you were “day dreaming” or “in your own world”?
- Has failure to complete tasks been a problem, even if you knew what to do?
- Did teachers call home due to discipline or was there an issue that required discipline?
Bring old report cards, records or a parent/sibling who can give perspective if available. It can actually be helpful; not for any purpose of proving, but for filling a picture in.
Step 3: Standardized Rating Scales and Questionnaires
Formal ADHD evaluations are carried out with valid and standardized questionnaires, which are not random questionnaires but questionnaires clinically developed so that it can measure the frequency and severity of specific symptoms.
Common tools used in adult ADHD evaluations include:
- Conners’ Adult ADHD Rating Scales (CAARS) – One of the most widely used scales, covering inattention, hyperactivity, impulsivity and self-concept
- Adult ADHD Self-Report Scale (ASRS) – Developed in collaboration with the World Health Organization
- Brown Attention-Deficit Disorder Scales – Focuses on executive functioning
- Barkley Adult ADHD Rating Scale – Measures symptoms across a variety of life domains
These will frequently be filled out by yourself and occasionally by someone else, a partner, a close friend or a family member, who will be asked to do a version. Part of this is outside perspectives because many people with ADHD don’t know exactly how to judge their own symptoms and it’s not because they are lying to you, it’s because they have not noticed them and they have been their normal way of life every day their entire lives.
Step 4: Neuropsychological Testing (When Applicable)
Neuropsychological testing may not be used during all adult ADHD evaluations but may be recommended, especially when the situation is complicated.
These tests are practical neuropsychological evaluations that evaluate aspects such as:
- Working memory – Are you able to hold and manipulate information in your mind?
- Processing speed – What is the speed your brain can take in?
- Sustained attention – Do you show sustained attention?
- Executive function – Planning, organization, impulse control
Note: Remember these tests are not used as a diagnostic tool for ADHD alone. It’s possible for someone to score within the normal range on cognitive tests, while also being diagnosed with ADHD – and the other way around! The idea behind neuropsychological testing is that it provides another set of data that will be part of the clinical picture and aid in your provider’s diagnosis.
If you’re undergoing cognitive testing, expect a longer visit – it may last anywhere from 1 to 3 hours.
Step 5: Ruling Out Other Conditions
This is one of the most crucial – and usually the least recognized – component to a grownup ADHD assessment.
There are many other conditions that present symptoms similar to ADHD, and some of them are commonly seen co-occurring with ADHD. A competent evaluator will not just tick the ADHD box if symptoms become evident. They will systematically review alternative/exclusive explanations such as:
- Anxiety disorders – Problem focusing is an important anxiety symptom, and not only for ADHD
- Depression – Poor concentration, lack of motivation, forgetfulness are signs of depression
- Sleep disorders – Untreated sleep apnea or chronic insomnia can manifest all the symptoms of ADHD
- Thyroid dysfunction – Hypothyroidism in particular, which leads to brain fog
- Trauma and PTSD – Hypervigilance and dissociation may seem a lot like attention issues
- Anxiety disorder – Particularly during depressed or mixed phases
- Learning disabilities – whether Dyslexia or dyscalculia can lead to academic challenges alongside ADHD
Your evaluator might order blood tests or other medical studies to help exclude physical causes. This is not a delaying game, it is good medicine.
Step 6: Collateral Information and Life Context
A detailed assessment involves acquiring context from a variety of perspectives beyond your own report and formal assessment.
This might include:
- Collateral interviews –With a spouse, parent, or close friend who knows you well
- Record review – Review of prior school records, notes of old therapy, or prior psychological evaluations (if available)
- Occupational history – How have your symptoms impacted your work? Were you fired, skipped promotions or bounced from job to job?
- Relationship patterns – Do you often interrupt, forget important dates or find it hard to follow through on commitments?
Life context is important because ADHD is not merely a pattern of this brain, it’s a pattern of behavior that occurs in relationships, at work, and in daily functioning. The more complete the picture, the more confident (and accurate) the diagnosis.
Step 7: The Feedback Session
After you’ve provided your evaluator with all the information, you’ll meet for a feedback session, probably the most pivotal appointment during your evaluation process.
During this session, your provider will:
- Explain the results of the evaluation to them.
- Describe if the criteria are met for ADHD and the type of presentation (inattentive, hyperactive-impulsive, or combined)
- Review all other diagnoses/conditions found
- Address questions responsively and substantively
- Summarize suggested action steps
Next steps could involve medication, therapy (especially cognitive-behavioral therapy geared to ADHD), coaching, workplace accommodations, or a combination of the above. Diagnosis is just the starting point; it’s not the end of the journey.
What to Bring to Your Evaluation
To get the most out of your evaluation, you need to be ready:
- Proof of insurance and photo ID are required
- Current medication list (prescribing provider, name, dosage)
- Any records of psychological or psychiatric history
- Previous report cards or school records, if available
- If your evaluator allows it, a trusted person you know well (collateral informants)
- List of your top concerns: It’s easy to forget in the moment, especially if you have ADHD.
How Long Does an Adult ADHD Evaluation Take?
This differs depending on the provider and the situation’s difficulty. It is simple to get a psychiatrist to perform an evaluation that can take place in two or three visits. A detailed neuropsychological assessment may require a series of several hours of testing over several sessions.
The whole process (consultation to feedback) can take between 1 and 4 weeks, depending on scheduling and the type of tests conducted.
A Final Word
Adults with ADHD need to take a leap of faith to be evaluated for their ADHD. It requires saying that you need to get a real answer, too many guesses, too much self blame and another year and another year of wondering.
Regardless of the result, you’re getting something precious, which is clearness from a thorough evaluation. And clarity, as anyone who’s been diagnosed with the right disease has experienced, is the starting point of all things.
If you’ve been considering getting an evaluation, then this is your clue. It’s long enough you have been trying to work it out by yourself.
Frequently Asked Questions About Adult ADHD Evaluations
Q: Do I need a referral to get an adult ADHD evaluation?
Not always. A number of psychiatrists and psychologists will take self-referrals, which means that you can schedule an appointment with them without having to make another appointment at your primary care physician’s office. But a few insurance policies need a referral to be covered, so it is best to call your insurance company before booking a reservation. Don’t hesitate to begin with your primary care physician – they may even be able to exclude medical causes of your symptoms in the early stages.
Q: Will I definitely be prescribed medication if I’m diagnosed?
No, drugs are a tool – not an inevitable end result. Your provider will explain all possible treatment options to you, such as behavioral therapy, ADHD coaching, adjusting your lifestyle, getting assistance in the workplace, or any combination of these. Treatment with medication is very effective for ADHD; however, this is always determined by the individual’s needs, health history, and personal preferences.
Q: What if I’ve already tried to manage my symptoms on my own for years? Does that affect the evaluation?
Does not disqualify you, but is noteworthy to mention. Tell your assessor of any strategies, routines, drops-in or other informal coping skills that you have used over time. Even if you have also learned to cope with your ADHD symptoms, an adult with undiagnosed ADHD may be good at concealing their disorder.
Q: How is an adult ADHD evaluation different from one done for a child?
The underlying classification of symptoms is similar, but in practice it looks very different. Evaluations for adults focus more on a person’s self-report, life history, functioning in work or relationships, and exclusion of conditions more common in adults. The clinician will place greater emphasis on collateral interviews and validated adult-specific rating scales since these are not always available from the teacher or parents. It’s also a more collaborative way of conversation – you’re a character, not being observed.