Welcome back to Adulting With ADHD! Last time, we went over some myths and stereotypes surrounding ADHD. In the first installment of this series, we covered ADHD 101. Today’s post is aimed at anyone questioning whether or not they have ADHD.
So…Do I go see a doctor? What if I’m wrong? How do I know if I should talk to my doctor?
Ok. So you’ve read enough about ADHD to have a general idea of what ADHD is and now you’re starting to think that you might have ADHD. But, what do you do now? Do you head straight to a doctor? Do you have to see a doctor? How do you figure out what to do?
Self-Diagnosis vs. Professional Diagnosis
Something often talked about in mental health communities is the idea of self-diagnosis. As the name sounds, self-diagnosis is when a person does their own research and evaluation in order to diagnose themselves.
We’ve all done this at some point. Any time you’ve declared that you have a cold after assessing your runny nose and cough, you have self-diagnosed. Self-diagnosis is actually pretty common for more minor physical ailments.
However, when we begin to talk about self-diagnosis with regards to neurodivergencies, many people balk at the idea. Much of this reaction is a whole bunch of ableism tangled up together and is something that we’re not going to cover here as it deserves its own post. However, one of the most common arguments against self-diagnosis is “but what if [he/she/they/I] is wrong?”
Well, it’s certainly possible for a person to self-diagnose themselves and be wrong, just as it’s possible, and actually fairly common, for professionals to misdiagnose people. The difference is, when a person self-diagnoses, they are able to access self-help tools to improve their life. If they are wrong about their diagnosis, at worst, they have used tools that were not helpful for them. When a professional makes a diagnosis, there are often medications involved that can have serious side effects and risks. Treating someone with the wrong medication due to misdiagnosis can be very harmful.
Before we go on, let’s talk about what self-diagnosis is and is not.
Self-diagnosis is NOT:
- Taking a quiz and deciding you have ADHD
- Reading up on ADHD for 15 minutes before declaring you have ADHD
- Time consuming
- Based on extensive self-analysis
- Often done with the help of friends/family
- A valid form of diagnosis
So, why would someone chose to self-diagnose rather than seek a professional diagnosis? Let’s look at some examples:
- Sarah was a constant daydreamer as a kid. She was always lost inside worlds in her head. However, she was quiet and “well-behaved,” so the teachers never complained about her. Her grades were good, but they probably could have been better if she wasn’t always wasting time trying to find things she had lost or just trying to get herself started. Sarah is now an adult and is struggling more and more to get through each day. After doing extensive research, Sarah concludes that she has ADHD. However, due to other medical conditions, she isn’t able to take medication for ADHD so she doesn’t see the point in going to a doctor about this, especially after the bad experiences she had with therapists in her youth.
- Brian was a textbook case of ADHD as a kid. He was constantly bouncing off the walls, talked a mile a minute, was impulsive, and struggled to pay attention to anything that didn’t interest him. Several teachers suggested that he be tested for ADHD throughout school, however, his parents were adamantly against this. They didn’t think there was anything “wrong” with their child and didn’t want him pumped full of meds. Brian’s struggles increased throughout school until he dropped out. As an adult, he has started researching ADHD and is sure that this explains his life. However, he lives in the middle of nowhere and the closest medical professional who can diagnose ADHD in adults is two hours away. Not only can he not afford the appointments and testing, but he can’t afford to take off time from his job to get there. While he desperately wants to be diagnosed and be able to access the medication that could help him, he simply isn’t able to.
As we can see in these examples, there are very valid reasons why someone may not want a professional diagnosis or may not be able to access one. Some reasons for not seeking a professional diagnosis include, but are not limited to:
- Trauma regarding mental health professionals
- Unable to afford testing or access help to pay for it
- A lack of mental health professionals with knowledge of ADHD nearby
- Worries about how other people will react to the diagnosis
- Concerns about how the diagnosis could affect them in the future
- Difficulty getting diagnosed due to identity (gender, race, class, disability, etc)
Self-diagnosis as a stepping stone to a professional diagnosis
We’ve now discussed some of the reasons that a person may self-diagnose rather than seek a professional diagnosis. However, self-diagnosis can also be helpful for those who do wish to seek a professional diagnosis.
For people who have made it to adulthood without a diagnosis, it can often be difficult to distinguish what may be traits of a neurodivergency. For many people, these symptoms are such a standard part of their own life that they don’t realize that these things are atypical. For instance, some ADHD people don’t realize that constantly losing track of what’s going on in a conversation is not typical. They think it’s something everyone experiences.
Further, even for those who do realize that their symptoms are atypical, there is often a lot of shame and self-blame that can interfere with recognizing these symptoms for what they are. For instance, someone who has struggled to initiate tasks all their life and has been told by their parents and other adults that they are lazy will likely internalize this message and view their difficulties as a personal failing rather than as an aspect of a neurodivergency.
Researching and learning about different neurodivergencies can help people realize what symptoms they are actually experiencing. This can help when going to see a professional as they know what symptoms to mention. Professionals are only able to work with what the patient tells them. If the patient doesn’t think to mention something, the professional won’t know that the symptom is a factor which could potentially lead to misdiagnosis.
Self-diagnosis can be a useful stepping stone on the path to seeking a professional diagnosis. Having an idea of what is going on can make it easier for professionals to do their job as well as making it easier for the person to know if the professional is looking in the wrong direction.
A Guide to Self-Diagnosis
Self-diagnosis is a journey of self-discovery. When starting down the road of self-diagnosis, it is important to be as honest with yourself as you can be. It can even be helpful to work with someone you trust who knows you very well. This person can be a sounding board to help figure things out and bounce ideas off of.
A self-diagnosis should involve a lot of research, self-reflection, self-analysis, and openness to change. As you start your journey, you likely have a vague idea of what neurodivergency you have. However, you may find, as you do more research, that something else actually fits better. Be open to whatever diagnosis fits you best rather than trying to make your symptoms fit a specific diagnosis.
We’re going to go through the steps of self-diagnosis which are based upon the DSM-5. The steps that we will be discussing are each based on the sections of the DSM criteria for ADHD. To see the criteria as they are in the DSM, follow this link.
Step 1. Do you have symptoms of ADHD?
If you think you may have ADHD, a good place to start is one of the many self-tests available online. These quizzes allow you to answer questions and then you are given a result about whether or not it is likely you have ADHD. The following are some quizzes you can take to see if you’re heading in the right direction:
- Psych Central’s Adult ADHD Quiz
- ADDitude Magazine’s ADHD Self-Test
- ADDitude Magazine’s ADHD Self-Test for Women and Girls
- Psychology Today’s ADHD Self-Test
If you’re willing to analyze the results yourself, you can take a look at the Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist which is often used by professionals when making a diagnosis.
Once you’ve taken a quiz (or a few), it’s time to look at the diagnostic criteria for ADHD that these quizzes are based on. You can view the DSM criteria for ADHD here. We’re also going to go over the DSM criteria which I have rewritten to be more applicable to adults.
When looking at the criteria that follow, keep track of how many of each category fit you. If you are 16 or under, you need six or more symptoms of either Inattention or Hyperactivity to be diagnosed with ADHD. If you are 17 or older, you need five or more symptoms.
Please note, the required number of symptoms (6+ for 16 and under, 5+ for 17 and older) must be present in either Inattention or Hyperactivity. Having 6 traits between both Inattention and Hyperactivity would not qualify for an ADHD diagnosis.
These symptoms must have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts social, academic, and/or occupational activities.
Now, let’s take a look at the symptoms (remember to keep track of how many apply to you):
- Often shows a lack of attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has difficulty paying attention to important tasks or desired activities (difficulty remaining focused during lectures, conversations, or lengthy readings)
- Often appears to not listen when spoken to directly (doesn’t hear when others are speaking because mind is wrapped up in thought or highly focused on the task at hand)
- Often has difficulty completing tasks (loses focus, becomes side-tracked, etc.)
- Often has difficulty with organization (difficulty managing sequenced tasks, difficulty keeping belongings in order, messy or disorganized work, poor time management, difficulty meeting deadlines)
- Often avoids, dislikes, or is reluctant to do tasks that require long periods of mental effort (preparing reports, completing forms, reviewing lengthy papers)
- Often loses things (phone, keys, wallet, glasses, paperwork, etc.)
- Easily distracted (by own thoughts or things in the environment)
- Often forgetful in daily activities (forgets to do chores or run errands, return calls, pay bills, keep appointments, etc.)
- Often fidgets/stims (taps hands, bounces leg, squirms in seat)
- Often has difficulty sitting when expected (needs to leave seat often)
- Often feels restless (may include running around or climbing in situations where this is not appropriate)
- Often has difficulty being quiet when expected
- Very active, as if “driven by a motor” (unable to/uncomfortable remaining still for extended time)
- Often talks more than is considered socially acceptable
- Often answers questions before the question has been completed (completes other people’s sentences, cannot wait turn in conversation)
- Often has difficulty waiting
- Often interrupts or intrudes on others (butts into conversations, games, or activities, may use other’s things without asking permission, may take over what others are doing)
Now that we’ve tallied up the symptoms that fit, what does it mean?
If you have 5* or more symptoms in Inattention and less than 5* in Hyperactivity, then you likely have Primarily Inattentive Type ADHD.
If you have 5* or more symptoms in Hyperactivity and less than 5* in Inattention, then you likely have Primarily Hyperactive-Impulsive Type ADHD.
If you have 5* or more symptoms in Inattention and 5* or more in Hyperactivity, then you likely have Combined Type ADHD.
*5 or more for people 17+, 6 or more for people 16 and under
Step 2. Did you show signs of ADHD prior to the age of 12?
As ADHD is a neurodevelopmental disorder, it must have been present as your brain developed. As it can be difficult to notice the signs of ADHD in young children, the DSM uses the cutoff of 12 years of age to determine whether symptoms were present during brain development (though the brain continues to develop for many more years).
There is an exception to this criteria for those who have secondary ADHD from a traumatic brain injury. If you have been diagnosed with a TMI and suspect you have secondary ADHD, please talk with your medical team about this matter.
So, what do you do if you don’t remember what you were like before you were 12?
Talk to family members. Talk to former teachers. Talk to family friends. Talk to anyone who knew you as a kid who may remember things. Ask them questions to help get a sense of whether or not you showed symptoms of ADHD as a kid.
Some questions you can ask are as follows:
- Was my room always a mess? Was I messier than other kids?
- Did I often seem zoned out or like I was daydreaming?
- Did I have a hard time memorizing times tables and spelling even though I generally did well with math and writing?
- Did I often get injured attempting various stunts?
- Did I interrupt people a lot?
- Did I have a hard time following directions?
- Did I get really sucked into things I was interested in? Maybe to the point of not responding to people or forgetting to go to the bathroom?
- Was I forgetful?
- Did I lose things a lot? Did I forget important objects at school that I needed to bring home or vice versa?
These are just a few sample questions you can ask. Look at the diagnostic criteria and try to come up with some of your own questions as well.
Step 3. Do these symptoms affect at least two parts of your life?
Criteria C of the DSM-5 criteria reads:
C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities).
Basically, do the symptoms of ADHD affect you in at least two areas of your life?
Do your symptoms affect:
- School/work performance– do any of your ADHD symptoms affect the grades you get or your performance reviews? Do you find yourself having to work much harder than other students to get the same grades due to the ADHD symptoms you experience?
- Home– do any of your ADHD symptoms affect your ability to manage life at home? Do your symptoms make it hard to complete chores? Do you struggle with self-care activities (showers, brushing your teeth, etc.)?
- Socially– do your symptoms of ADHD impact your relationships? Do you find it hard to keep friends? Do these symptoms put strain up on your relationships with friends or family?
- Other Activities– do any of your ADHD symptoms affect your ability to engage in leisure activities/hobbies/other activities that don’t fall under the previous categories?
To be diagnosed with ADHD, you must be impacted in at least two of these areas, though many of us with ADHD find that it affects all areas of our lives, though it may not always be obvious how it affects us.
This criteria is basically making sure that the symptoms a person is experiencing are not context specific which could point to a different problem. For instance, if a student is only experiencing symptoms at school, then there may be a problem at school that is affecting the student’s performance rather than ADHD.
Step 4. Do these symptoms interfere with, or reduce the quality of, social academic, or occupational functioning?
Criteria D of the DSM-5 reads:
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social academic, or occupational functioning.
Are your grades lower than they should be? Have you struggled to maintain friendships because you often cut people off or say things impulsively? Have you gotten in trouble at work or school for not paying attention or for forgetting to do things? Have you been in a lot of car accidents or gotten a lot of tickets?
In essence, do your ADHD symptoms actually cause you problems?
ADHD is a disorder and, as such, to be diagnosed with ADHD, it must be having some kind of negative impact on your life.
If you get to this point, and feel that these symptoms don’t impact your life negatively, then it’s time to take a break from the research and step away for a little while. Go read a book or play a video game or go for a run or listen to some good music. Do something to get your mind off of this.
When you’ve given your brain a chance to reset, come back and consider whether or not these symptoms have a negative impact on your life. If your answer is still no, then you don’t have ADHD, and that’s ok! Everyone is different and there are many people who fit some or many of the criteria of a diagnosis but don’t actually qualify for that diagnosis for a myriad of reasons. Work on accepting that you learned a lot about a neurodivergency that will allow you to be a better ally to those with ADHD and that you can still relate to ADHD things without being ADHD yourself.
Step 5. Are your symptoms better explained by something else?
Ok. So you’re pretty sure you have ADHD. You’ve spent a lot of time working on the first four steps and have come to the conclusion that this fits you.
But what if it’s something else?
The symptoms of ADHD are not unique to ADHD. There are a variety of physical and mental health conditions that can cause the same symptoms and it’s important to look into these possibilities as well. This step is what the professionals refer to as Differential Diagnosis.
To start, let’s look at sleep. If you are getting less than the amount of sleep your body needs, then you could be giving yourself ADHD. The Sleep Foundation lists these symptoms of sleep deprivation in children:
- Oppositional behavior
- Moodiness and irritability
- Difficulty waking up in the morning
Notice how similar these symptoms are to ADHD symptoms?
So, if you’re not already getting enough sleep, try getting enough sleep for a few weeks and see if that improves or eliminates your symptoms. If it does, then you may not have ADHD but rather a sleep deficiency.
If you are able to, go to your doctor and request some blood tests including: a Comprehensive Metabolic Panel, a Complete Blood Count (CBC), and a Thyroid Panel. These tests will show evidence of many of the physical disorders that can mimic ADHD if you have one of these disorders. Have your vision, hearing, and auditory processing tested. Basically, rule out any physical conditions that could be causing ADHD symptoms.
For a list of conditions that can mimic ADHD, check out this link.
We’ve looked at some of the physical things to eliminate, but there are also a lot of neurodivergencies that can be confused for ADHD. The following are some resources to help you look into some of the conditions that can be mistaken for ADHD.
(Please note, the information below is intended to help you start looking into these other conditions. To do a thorough differential diagnosis, you will likely need to do further research into one or more of the conditions we are about to cover.)
Oppositional Defiant Disorder (ODD)
ODD is characterized by a resistance to conforming to others demands. A person with ODD will display negative, hostile, and defiant behavior. This must be differentiated from an aversion to school or mentally demanding tasks due to difficulty in sustaining mental effort, forgetting instructions, and impulsivity associated with ADHD. Something of note is that people with ADHD may develop secondary oppositional attitudes towards such tasks due to the difficulties they face.
Intermittent Explosive Disorder
Like ADHD, Intermittent Explosive Disorder is characterized by high levels of impulsive behavior. However, people with Intermittent Explosive Disorder display serious aggression towards others which is not an aspect of ADHD. Further, those with intermittent explosive disorder do not experience difficulty with sustaining attention as is seen in ADHD.
- Intermittent Explosive Disorder DSM-5 312.34 (F63.81)
- How Do I Know if I Have Intermittent Explosive Disorder?
- Impulsivity: Is it ADHD or IED, Intermittent Explosive Disorder?
Specific Learning Disorder
Children with specific learning disorder may appear inattentive because of frustration, lack of interest, or limited ability. However, inattention in individuals with a specific learning disorder who do not have ADHD is not impairing outside of academic work
- What Is Specific Learning Disorder?
- Types of Learning Disabilities
- Specific Learning Disorder
- A Summary of the DSM-5 Diagnostic Criteria for Specific Learning Disorder Diagnosis
- The ABC’s of Specific Learning Disorder
Autism Spectrum Disorder
ADHD and autism have several overlapping traits including social dysfunction. However, the social difficulties with ADHD are directly related to ADHD traits, such as impulsiveness, inattention, and hyperactivity while autistic social difficulties are the result of difficulties understanding social rules, behaviors, and nonverbal cues.
- Autism Spectrum Disorder Checklist
- Autism Self-Diagnosis Masterpost
- DSM Criteria for Autism Explained
- Differences Between ADHD and Autism
- Autism With a Side of ADHD
- Autism vs ADHD
ADHD shares symptoms of inattention with anxiety disorders. However, ADHD people are inattentive because of their attraction to external stimuli, new activities, or preoccupation with enjoyable activities. This is distinguished from the inattention due to worry and rumination seen in anxiety disorders. Restlessness can be an aspect of both anxiety disorders and ADHD, however, restlessness with anxiety is directly tied to worry and rumination.
- Generalize Anxiety Disorder Checklist
- Social Anxiety Disorder Checklist
- Obsessive-Compulsive Disorder Checklist
- Post-Traumatic Stress Disorder Checklist
- Anxiety Screening Quiz
- OCD Screening Quiz
- How Generalized Anxiety Disorder Is Diagnosed Using the DSM-5
- GAD DSM-5
- DSM-5 Definition of Social Anxiety Disorder
People with depression may display an inability to concentrate, however, this difficulty with concentration is only present during depressive episodes.
- Major Depressive Disorder Checklist
- Depression Screening Test
- Major Depressive Disorder DSM-5
- Cyclothymic Disorder DSM-5 301.13 (F34.0)
- Cyclothymic Disorder Symptoms and Cyclothymia
People with bipolar disorder may have increased activity, poor concentration, and increased impulsivity, but these symptoms are episodic, occurring only during mood episodes. In bipolar disorder, increased impulsivity or inattention accompanies elevated mood, grandiosity, and other symptoms of a manic or hypomanic episode. ADHD people may show significant changes in mood within the same day but this mood instability does not last long enough to be considered part of a mood disorder (4 days for a manic episode, 2 weeks for a depressive episode).
- Bipolar Disorder Checklist
- Bipolar Screening Quiz
- Diagnosis Guide for Bipolar Disorder
- Diagnosis by the DSM
- 9 Descriptions for Bipolar Disorder (According to the DSM-5)
- NAMI Bipolar Disorder
If you find yourself relating a lot to one of the above neurodivergencies, look into it more. Research that diagnosis thoroughly. However, keep in mind that it is not necessarily either/or. You could have ADHD as well as one of these conditions. Autism and ADHD, especially, are frequently comorbid (occur together).
This concludes our guide to ADHD self-diagnosis. Tune in next time for what to do after diagnosis.