Clinical Assessment of ADHD in adults

ADHD in context

For long decades in the history of psychology, ADHD has been understood as a developmental disorder, starting in individual’s early life and persisting, to a smaller degree, into adulthood. Contemporary neuroscientific observations sustain this medical model, pointing to the differences in healthy versus ADHD brains’ structure and functions. On such a premise, a whole psychopharmaceutical industry developed that now medicates millions of children worldwide, especially in North America and parts of Europe.

One problematic area in relation to this trend is the negative long-term effect of medication on the developing brain. Another is the absence of mental health awareness in the educational systems across countries. However, this article focuses on still another problem  – the self-diagnosing adult.

Тhink critically about ADHD

In the world of abundant information that we live in today, the human brain is challenged to process tons of environmental stimuli. And because we are all different, we have different capacity to do such processing. At times, we all face certain difficulties. What you are about to read below is how those difficulties are presented as symptoms of a disorder:

Difficulty with Time Management

This is what you would frequently read in pop psychology websites: Time management issues often feel like a hallmark of ADHD. People with ADHD may struggle with both punctuality and task duration estimates. As a result, they might be frequently late, underestimate the time needed to complete tasks, or even lose track of time altogether when deeply focused on something. This can lead to difficulties at work, in relationships, and even with personal goals, as missed deadlines or forgotten commitments create a sense of frustration and guilt. While it is true that people with ADHD experience hardship in completing tasks, information presented in the way above predisposes the reader to jump to a conclusion and put themselves a diagnosis. When clinicians speak of tasks, what they refer to is simple tasks of attention, measured during the evaluation, not complex weekly projects at the workplace.

Procrastination and ‘Analysis Paralysis’

Many people with ADHD find themselves putting off tasks until the last minute. This isn’t always due to laziness or lack of motivation but rather because of an executive function challenge—difficulty in initiating tasks that seem overwhelming or unclear. In addition, adults with ADHD can sometimes feel “paralyzed” when making decisions, a phenomenon often called analysis paralysis. It can feel as though the weight of choosing “right” leads to stalling on choices altogether, which is especially frustrating in situations that require quick or decisive action. This is another example of how a fact – poor executive function – is presented in all-encompassing way that includes nearly all mankind. Mental health specialists have tools to discern normal from abnormal brain functioning. And normal consists of a great variety. Your brain is not “abnormal” just because it performs “worse than…” be it a person, a period of one’s own life, or the ambiguous ‘average’. Besides, hardly is there a mental health challenge that doesn’t include procrastination as a symptom. But when you read a paragraph like the one above, you cannot but wonder, “Maybe I have it, too”.

Managing Impulsivity

Impulsivity is one of the core aspects of ADHD. For adults, this might manifest in spending sprees, quick decisions without enough forethought, or interrupting conversations. Impulsive behavior may create issues in personal and professional relationships and can lead to financial or legal trouble if not managed appropriately. Again, poor executive function is interpreted here as a hallmark of ADHD. By that logic, all impulsive people need ADHD medication – very convenient for sellers, but very far from reality. Yes, adults with ADHD have difficulty managing impulsivity, but losing patience in conversations occasionally doesn’t count for a dysregulated brain.

Difficulty with Consistency

Many adults with ADHD experience inconsistency in their performance, with some days of productivity and other days where tasks seem unmanageable. These fluctuations can create internal conflict and self-doubt, as well as misunderstandings with coworkers, family, and friends who may misinterpret these ups and downs as a lack of commitment or effort. God forbid you have a bad day! As if we are all productive and focused every day, all the time. And when we are not, our brain is at fault.

Struggling with Self-Esteem

Many adults with ADHD develop low self-esteem over time. Growing up with ADHD, particularly if undiagnosed, often includes negative reinforcement from teachers, parents, or peers. Constantly being told to “try harder” or to “stop being lazy” can lead adults to internalize these messages, affecting their self-worth and fostering a self-critical inner dialogue. This, in turn, makes navigating life with ADHD even more challenging, as self-doubt compounds the struggles they already face. OK, I agree the lack of mental health awareness in the education system can truly affect children’s self-esteem. This is why in my work with parents I stress the importance of understanding teachers’ limitations and the system’s pitfalls. However, with or without ADHD, a lot of children are exposed to both implicit and explicit negative messages concerning their performance.

My point here is none of these “symptoms” on its own can justify a diagnosis. Even if they are all present, there are tons of other considerations that must be taken into account. The way information is present online is often misleading.

The dangers of self-diagnosing

With the rise in awareness of ADHD, there is also a rise in self-diagnosis. While self-awareness is important, self-diagnosis has risks. Here’s why:

Misattribution of Symptoms

Symptoms of ADHD can overlap with other mental health conditions, such as anxiety, depression, PTSD, or bipolar disorder. Without a full evaluation, someone might assume they have ADHD when they actually have another condition or a combination of conditions. Self-diagnosis can lead individuals to seek out treatments that may not address the real underlying issues.

Overlooking Nuances

ADHD is complex, and not everyone’s symptoms will fit a particular mold. A clinical diagnosis by a qualified mental health professional considers the subtleties of each person’s situation, including co-occurring conditions, environmental factors, and personal history. Self-diagnosis, particularly without a clear understanding of these nuances, may miss these critical factors.

The Danger of Labeling

Labels can sometimes be helpful, offering individuals a way to understand and contextualize their experiences. However, labels can also become limiting or stigmatizing, especially if they’re inaccurate. When someone self-identifies with ADHD without a clinical basis, they may lean into unhelpful stereotypes or feel discouraged by their presumed limitations.

If you have made it up to here, you probably have some solid base to doubt your attention abilities. So let me tell you what the official assessment comprises of.

Psychological evaluation for ADHD in adults

The most reliable tool known to clinicians so far is a battery of neuropsychological tests. Such a battery I use in my clinical practice. None of the tests is explicitly designed to measure the presence or absence of ADHD, as such a test doesn’t exist, but taken together, they shed light on possible flaws in your brain functioning, indicating which networks are compromised. They take about an hour to complete and are exclusively done face-to-face. Besides the tests, we also do an interview – you will talk about your symptoms and your life history. You will also fill out questionnaires and discuss your answers with the clinician. The whole assessment session lasts for two hours. Within two working days, you will receive your formal Evaluation Letter. Have you been refered to evaluation from a third party, they will also receive a copy of your Evaluation Letter. The protocol from the assessment is securely stored for a period of a year, so shall you request a second opinion from another clinician, they may request your information.

Further steps

In case you would like to complete a formal evaluation for ADHD, you can book two consecutive hours through my online calendar. No preparation is required. As you sign an informed consent form prior to test administration, you have to be 18 years old at the time of the assessment.