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Hi there,

I am wondering if I could get advice regarding what type of professional is needed to diagnose ADHD?  What type of training, background, credentials, etc?  There have been hints that I may have ADHD (inattentive).  I have seen a clinical psychologist who told me she has neuropsychology experience (her PhD or PsyD is in Clinical Psych).  The tests she said she'd give me are the WAIS (Wechsler); the Woodcock-Johnson Cognitive Ability test, and the Taylor Manifest Anxiety Scale test (I do have diagnosed anxiety, and I have to say that IF I have ADHD , it does seem to be helped somewhat with anti-anxiety meds).  

I guess my question is this:  how much subjectivity is involved in analyzing these tests?  This provider is covered by my insurance, but I'm not super thrilled with her experience (school counselor who seems to be fairly new at working with ADHD folks).  There is a neuropsychologist in my area who is supposed to be extremely good but is not covered by my insurance and the testing/reports/recommendations would cost over $2,000 all out of pocket.  Please note that if I DO get a diagnosis of ADHD, I would not be getting counseling from either; I would simply see if adding a small amount of stimulant (or other) medication would help me.

I would rather not pay that much money IF the testing is relatively objective and the results would likely be the same regardless of who administers the tests.

Thank you!!

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@notloki do you think a psychiatrist would give the battery of tests that one of these psychologists would?  And if not, are they necessary?  

I have filled out an initial questionnaire and it did not indicate ADHD, but I was told these aren't necessarily definitive and that further testing is a good idea based on my own descriptions of symptoms.

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My psychiatrist diagnosed me without all those tests. ADHD is a neurological condition, a medical issue, better suited to a medical doctor.

I can't predict what a random doc will do.

 

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@nervousnellie, One of my former psychiatrists referred me to a neuropsychologist, who did a bunch of tests for different things.

The funny thing is, that the neuropsychologist thought I had ADHD, based on the test results......But my psychiatrist did not agree that I had it, so she never medicated me for it.

I agree with notloki, a psychiatrist can make the diagnosis without the tests....But some psychs could recommend testing, regardless.

Edited by CrazyRedhead

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I think one of the questions is whether the tests being offered will get you where you want to go.  From your list - WAIS (Wechsler); the Woodcock-Johnson Cognitive Ability test, and the Taylor Manifest Anxiety Scale  - my concern is I don't see things that are ADHD related (Conners is typical; BASC can even get you a little bit along the path but isn't great).  WAIS is a cognitive (IQ) measure, Woock-Johnson is also cognitive, and Taylor is anxiety.  So if you're trying to rule in or rule out ADHD, I don't see how you'll get there.  Possibly worth asking the psychologist.

Note that I'm not a psychologist and this is just based off a lay understanding (some special education exposure).

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@notloki, @CrazyRedhead, and @dancesintherain  These are all extremely helpful answers - THANK YOU!  I think I'm going to talk to my pdoc about all this.  The test descriptions, @dancesintherain, were especially helpful.  It definitely doesn't sound like these would give a definitive diagnosis, but rather an IQ measure (which I don't even necessarily want to know.......).  And I already know I have anxiety, so that particular test isn't going to help.  I have a feeling this psychologist is simply too inexperienced at this "branch" of practice.  

I appreciate the answers.  I may either shell out the big bucks for the neuropsychologist or more likely talk to my pdoc and see what he says.  The only reason I may go to the neuropsychologist is to figure out if there's anything else going on that I should know about, other than the anxiety.

Thank you all!

 

 

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FWIW i took a quick two sheet tests with one pdoc before for adhd, She said enough to get a stim covered, even though we were using it for depression. BUt thought i may have adhd.

Only other "test" ive ever had from a doctor relating to depression, anxiety, adhd. was a 5 question depression scale from my GDOC

But I think a pdoc can make this diagnosis. 

Generally neuropsych is dealing with the neurological disorders and how they effect behavior and function. Someone correct me if im wrong.

BUt a regular Pdoc sounds like what your looking for

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I did a psychological assessment when I was in college, at my request, seeking info on potential ADHD, learning disabilities or other reasons for my struggles in school. The assessment was done by a Psy.D who was supervised by a Ph.D. because she was a new postgraduate (I never met with the Ph.D though, but his name is on my paperwork as well as hers). I had the assessment done at a psychological center at a local university that offered sliding scale assessments by new psychologists who were not fully licensed (and so were supervised). These are the tests that were done:

  • Interview
  • Wechsler Adult Intelligence Scale-Third Edition (WAIS- III)
  • Wechsler Individual Achievement Test -Second Edition (WIAT-II)
  • Woodcock-Johnson III Tests of Achievement (Academic Fluency Subtests)
  • Brown ADD Scales-Adult
  • Integrated Visual and Auditory Continuous Performance Test (IVA)

My ADHD dx was based on the interview and the results of the Brown ADD Scales and the Integrated Visual and Auditory Continuous Performance Test ("a continuous performance task that measures an adult's ability to maintain attention to repetitive visual and auditory stimuli.")

The testing also confirmed my MDD and GAD diagnoses, and the psychologist recommended a variety of accommodations. I took the results of the assessment to my college disability services office which granted the accommodations, and my GP agreed, based on the dx, to prescribe stimulants (I did not have a pdoc at the time, I had no insurance - this was before Obamacare). 

These days, my pdoc is prescribing my stims. I don't remember if I gave her a copy of the assessment paperwork, or if she initially continued those on the basis of my GP's notes or what. I've been seeing her for 6-ish years though, so I assume she would've stopped the stims if she disagreed with the diagnosis.

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@Geek Thank you for that!  That seems much more comprehensive than the tests that the psychologist was going to give.  And @lookingforanswers, thanks for your experience as well.  Very helpful.

Still confusing, though, because so many people get "diagnosed" based on a questionnaire, and on the questionnaire I completed didn't show ADHD.  In addition to ADHD (inattentive), I've read about slow-processing speed and really, THAT'S what I think I have.  I also have somewhat of a tough time making decisions, but that could be caused by anxiety I suppose (the slow-decision-making is why I am on this board with analysis paralysis trying to decide what to do; having said that, there is $2k at stake....).

In my heart of hearts I think I need to spend the $2k to get a full, thorough evaluation.  The bummer is, if it turns out I don't have ADHD but rather have slow processing, I don't know that there's anything that can be done.  Stimulants don't work for slow processing speed, do they??   

And btw, I can't stand the phrase "slow processing speed."  It conjures up a dim-witted, slow person.  I have read there is no connection between this and IQ, though, so I'm sticking with that... :)

THANK YOU ALL!!

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For what it's worth, I don't think you need to go to a super fancy specialist and shell out gobs of money to get a reliable diagnosis. My question is, once you've got the diagnosis... then what? Are you looking for meds? Affirmation?

The testing I did took one full day. I paid $800 for it, cash (I had no insurance). The testing I did also showed I had comparative deficits in processing speed and working memory. No, there are no meds for fixing those things, but it's something that I keep in mind and knowing it has helped me focus my choice of coping skills to get by at work and in life.

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10 minutes ago, nervousnellie said:

@Geek Thank you for that!  That seems much more comprehensive than the tests that the psychologist was going to give.  And @lookingforanswers, thanks for your experience as well.  Very helpful.

Still confusing, though, because so many people get "diagnosed" based on a questionnaire, and on the questionnaire I completed didn't show ADHD.  In addition to ADHD (inattentive), I've read about slow-processing speed and really, THAT'S what I think I have.  I also have somewhat of a tough time making decisions, but that could be caused by anxiety I suppose (the slow-decision-making is why I am on this board with analysis paralysis trying to decide what to do; having said that, there is $2k at stake....).

In my heart of hearts I think I need to spend the $2k to get a full, thorough evaluation.  The bummer is, if it turns out I don't have ADHD but rather have slow processing, I don't know that there's anything that can be done.  Stimulants don't work for slow processing speed, do they??   

And btw, I can't stand the phrase "slow processing speed."  It conjures up a dim-witted, slow person.  I have read there is no connection between this and IQ, though, so I'm sticking with that... :)

THANK YOU ALL!!

Just spitballing here. Why not go to a pdoc first. Its obviously less expensive. See what they have to say. If you are not satisfied, move on. Perhaps even ask the pdoc their opion on neuropsych, while reporting what your saying here. Slow processing i think would be treated with some form of therapy, speech therapy perhaps, and additional compensatory strategies. 

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5 hours ago, Geek said:

For what it's worth, I don't think you need to go to a super fancy specialist and shell out gobs of money to get a reliable diagnosis. My question is, once you've got the diagnosis... then what? Are you looking for meds? Affirmation?

This is a really good question and one that I've asked myself.  If I did get a diagnosis of ADHD, I would try stimulants, but would not want to be on them all the time if possible.  If I do have this, I've been living with it for many, many years (decades), and have been somehow able to compensate for it.  I've always been a super hard worker, and I think that has helped me get by.  I guess my reason for pursuing this is that I'm curious about whether ADHD meds would make my life easier; if I wouldn't have to work quite so hard at things.  I am also thinking about going back to school (very short-term), and I wonder if it would come much easier to me if I were on meds.  I got straight A's in high school, but I studied like no one else I know.  I also very often have a hard time seeing the forest for the trees, and I guess I have this curiosity about whether a big light bulb would go on while on meds, and I'd just be able to think differently.  I have no idea if this makes sense; just rambling.

5 hours ago, looking for answers said:

Just spitballing here. Why not go to a pdoc first. Its obviously less expensive. See what they have to say. If you are not satisfied, move on. Perhaps even ask the pdoc their opion on neuropsych, while reporting what your saying here. Slow processing i think would be treated with some form of therapy, speech therapy perhaps, and additional compensatory strategies. 

Yep - you're right - my pdoc could probably have been the first person I asked about this.  I just don't see him for a while, but I've gone this long without testing anyway what's a little more time :)

5 hours ago, dancesintherain said:

Do you have any phD or PsyD level schools in your area?  You might get someone to do it for the sake of being willing to have an intern complete it.

Yes, I live by a huge university - this is actually an excellent idea, as long as it's supervised by someone with experience (which it would likely have to be).

These forums are awesome, and I very much appreciate all the input.

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So Nellie, if you already have a pdoc and you would want to try adding ADHD meds to your cocktail (which would presumably be prescribed by your pdoc), the place to go for discussion and diagnosis is your pdoc. 

Just because your currently scheduled appointment isn’t for a while doesn’t mean you can’t ask to go in sooner. That appointment was made on the assumption that things stay pretty much the same as they were at your last appointment. If you’re looking for help and a new dx, things have changed. 

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4 minutes ago, Geek said:

So Nellie, if you already have a pdoc and you would want to try adding ADHD meds to your cocktail (which would presumably be prescribed by your pdoc), the place to go for discussion and diagnosis is your pdoc. 

Just because your currently scheduled appointment isn’t for a while doesn’t mean you can’t ask to go in sooner. That appointment was made on the assumption that things stay pretty much the same as they were at your last appointment. If you’re looking for help and a new dx, things have changed. 

Yeah @nervousnellie @Geek Has a replay good point. You can always call for an earlier appointment. 

I just had this pst week. My stimulant was actually giving me severe Raynaud’s phenomenon. My pcp told me to get my butt into the pdoc ASAP and get my meds changed. And if they couldn’t get me in he could call. 

Anyways like all things medical, things are assumed stable unless otherwise stated. Call and see what they can do.

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1 hour ago, Geek said:

So Nellie, if you already have a pdoc and you would want to try adding ADHD meds to your cocktail (which would presumably be prescribed by your pdoc), the place to go for discussion and diagnosis is your pdoc. 

Just because your currently scheduled appointment isn’t for a while doesn’t mean you can’t ask to go in sooner. That appointment was made on the assumption that things stay pretty much the same as they were at your last appointment. If you’re looking for help and a new dx, things have changed. 

I agree about the discussion part for sure, but not sure about the diagnosis part.  Do you really think pdocs, as knowledgeable as they are about serious mental illness and meds, are as good at giving a comprehensive diagnosis for ADHD/slow processing/etc?  It's sort of how I feel about therapy.  I LOVE my pdoc for figuring out what meds I should be on for anxiety - he's brilliant at that.  But if I wanted to go to someone for therapy, I think I'd go to a psychologist who has extensive experience in CBT, etc.  So I guess I was thinking the same about ADHD etc.  

@looking for answers, yeah I can  schedule another appointment.  My pdoc is out-of-network, so that's another chunk of change for his opinion, but that's probably what I should have done in the first place instead of bugging you all :)  And I know people will say to change pdocs to an in-network doc, but this pdoc has "fixed" some absolutely terrible anxiety, and I will probably never change docs.  I am worried about the day he retires...

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7 minutes ago, nervousnellie said:

I agree about the discussion part for sure, but not sure about the diagnosis part.  Do you really think pdocs, as knowledgeable as they are about serious mental illness and meds, are as good at giving a comprehensive diagnosis for ADHD/slow processing/etc?  It's sort of how I feel about therapy.  I LOVE my pdoc for figuring out what meds I should be on for anxiety - he's brilliant at that.  But if I wanted to go to someone for therapy, I think I'd go to a psychologist who has extensive experience in CBT, etc.  So I guess I was thinking the same about ADHD etc.  

@looking for answers, yeah I can  schedule another appointment.  My pdoc is out-of-network, so that's another chunk of change for his opinion, but that's probably what I should have done in the first place instead of bugging you all :)  And I know people will say to change pdocs to an in-network doc, but this pdoc has "fixed" some absolutely terrible anxiety, and I will probably never change docs.  I am worried about the day he retires...

First off, i understand on the PDOC. I finally got to a good one. THis was after I did an IOP stint. He was a doctor that followed people in the IOP program, however, he was not mine. I went to him when i was discharged. He listens, he works with you, hes not afraid to try meds and combos. Hes also very old. He cant be practicing much longer, and that scares me. My General doctor is also older, and i have a great relationship with him. I fear losing them both , but moreso Pdoc. 

With regards to the Pdoc making that diagnosis, absolutely they can.

  • A psychologist, a psychiatrist, or a neurologist is best equipped to diagnose adult ADHD. A master level therapist is recommended only for the initial screening.

taken right from https://www.additudemag.com/self-diagnosis-adhd-how-to-find-professional/

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@looking for answers Same with my primary - nearing retirement age.  I do not look forward to doctor shopping, but definitely more so for the pdoc.  I take Klonopin (actually I see I take precisely the same amount you do at night; we have the Trintellix in common as well except I take 10mg), and I worry that the next pdoc will be benzo-phobic and pull me off the Klonopin which I have been on for years.

Thanks for the link - I would definitely find a way to ask him the questions at the bottom of that article.  I know he would tell me he could diagnose me, but I would like to know about his experience in diagnosing.

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