How to prepare for an adult ADHD evaluation

An adult ADHD evaluation is mostly a careful conversation about your history, so what you bring to it shapes how much the clinician can conclude. Preparation does not mean rehearsing symptoms. It means collecting evidence the clinician cannot get any other way: what you were like before age 12, how things go in more than one part of your life now, what medications you take, and what else is going on with your health.

Start two to three weeks ahead if you can. Old records and conversations with relatives take longer than people expect.

What the clinician needs to establish

The lists below map to the diagnostic standard. According to NIMH and CHADD, an adult diagnosis requires at least five symptoms of inattention or of hyperactivity and impulsivity lasting six months or more, several symptoms present before age 12, symptoms in two or more settings, clear impairment, and a judgment that another condition does not explain the picture better. Each item you gather speaks to one of those points. For a walk-through of the appointment itself, see what happens during an adult ADHD evaluation.

Records worth gathering

For records held by a New York practitioner, state law (Public Health Law section 18) gives you the right to inspect your records within ten days of a written request, and the Department of Health considers 10 to 14 days a reasonable time for copies. Paper copies may cost up to 75 cents a page. Ask early, in writing, and name the practice the copies should go to.

Many adults have none of the childhood paperwork. That does not rule out an evaluation. The options are covered in getting evaluated for ADHD without childhood records.

Who to ask, and what to ask them

CHADD lists information from a partner or parent as part of a full evaluation, and the American Family Physician review of adult ADHD names collateral information as one of the elements of diagnosis. Two kinds of people help:

• Someone who knew you as a child (a parent, older sibling, aunt, long-time family friend). Ask what teachers said, whether homework was a nightly fight, whether you lost things, interrupted, could not sit through meals, or daydreamed through class. Specific stories with rough ages are the most useful.
• Someone who sees you now (a partner, roommate, close friend, trusted colleague). Ask what they notice about lateness, unfinished tasks, forgetting, interrupting, and what they have to pick up for you.

A way to ask a parent without starting an argument: "I'm being evaluated for attention problems and the doctor asks about childhood. Could you tell me what you remember about me in school before sixth grade, and whether you kept any report cards?" Write down what they say, with their name and the date. Ask the practice whether it wants the person to fill out a rating form or join part of the visit. Nobody is required to bring a relative, and a clinician can work without one.

The lists to write before the visit

Medications and substances

• Every prescription you take now, with the strength and schedule copied from the label.
• Every psychiatric medication you have taken in the past, roughly when, and why it was stopped.
• Over-the-counter medicines and supplements, including sleep aids and decongestants.
• Caffeine, nicotine, alcohol, cannabis and any other drug use, with honest amounts.
• Any time you have taken a stimulant that was not prescribed to you.

Accuracy matters here for a practical reason. Before writing a controlled-substance prescription, a New York prescriber must check the state Prescription Monitoring Program registry, which shows the controlled substances dispensed to you in New York over the past year. A list that matches the registry makes for a short conversation.

Health history

• Current medical conditions, including thyroid problems, sleep apnea, seizures, head injuries and anything involving your heart or blood pressure.
• A recent blood pressure and pulse reading if you have one. A large Swedish registry study linked long-term ADHD medication use to modestly higher rates of hypertension, which is why prescribers track both.
• Past and current mental health diagnoses and treatment, including hospitalizations.
• Sleep: usual bedtime, wake time, snoring, and how rested you feel.
• Family members with ADHD, learning problems, mood disorders, substance problems or early heart disease.
• Pregnancy, plans for pregnancy, or breastfeeding.

Examples, by setting

Clinicians need concrete incidents more than adjectives. For each of work or school, home, money, driving and relationships, write two or three things that happened in the past six months and what they cost you: a missed filing deadline, a late fee, a fender bender, a job warning. Then do the same for childhood from memory. One page is enough.

Screeners and forms

If the practice sends questionnaires, complete them before the visit and answer for how you are most of the time, not on your worst day. An online screener can be brought along, but treat it as a starting point. In the validation study of the six-question ASRS screener for DSM-5, about one in three people who screened positive in the general population did not have ADHD on a full interview.

The day of the appointment

1. Have photo ID, your insurance card, and the name, address and phone number of the pharmacy you use.
2. For a video visit, be physically in the state the clinician told you to be in, in a private room, with your notes in front of you. The clinician's license has to cover the place where you are sitting.
3. Keep the records and lists in one folder or one file you can share.
4. Bring your questions about treatment, follow-up and cost.

What not to do

• Do not study the criteria and shape your answers to fit. The point is an accurate answer, and an inaccurate ADHD diagnosis can leave the real problem untreated.
• Do not leave out substance use, past medications or other diagnoses. They change which treatments are safe.
• Do not wait for a perfect file. Bring what you have and tell the clinician what is missing.

When you are ready to schedule, the adult ADHD evaluation page explains how the evaluation works at this practice, and the new patients page lists what is requested before a first visit.