Attention-Deficit/Hyperactivity Disorder (ADHD) is a neuro-developmental brain disorder that is highly heritable (approximately 90%). You are born with it and have it for life. Essentially, the frontal lobe does not manage neurotransmitters efficiently, resulting in symptoms that come and go from moment to moment. Symptoms for ADHD are in fact the same executive functions that all individuals utilize in their frontal lobe, that are not working efficiently or consistently for those with ADHD.

Mental skills that enable goal-directed behavior and everyday tasks. The frontal lobe is the control center of the brain and uses executive functions to efficiently manage various abilities such as thoughts, bodily control, emotions, and behavioral decisions.

As an example, I refer to the picture above of the lego figure to describe this for my clients. This individual has ADHD. His front lobe employee, in the control center of his brain, was not given the correct directions on when to push the buttons and pull the levers. These mechanisms control when he thinks about his decisions, stops impulsivity, helps manage emotions, pays attention to details, stops moving, creates a plan, etc. He is haphazardly pushing the buttons and pulling the levers at the wrong time, which results in all kinds of daily mishaps that impact his functioning at home, school, work, and in relationships. For many with ADHD, taking stimulant medication is like giving the frontal lobe employee the right instructions for how to use the frontal lobe effectively for the first time. Buttons and levers are being used at the right time. His daily functioning subsequently improves. While somewhat of a simple description, hopefully this highlights how significant executive functions are for everyone’s functioning.

ADD is an outdated term that is no longer used. It used to mean someone who displayed what we would now call an Inattentive subtype of ADHD without impulsivity and hyperactivity. Now we only use ADHD as a diagnosis and then identify one of three subtypes: Inattentive, Hyperactive/Impulsive, or Combined.

Yes and no. Diagnostic Criteria for ADHD focus on three major executive functions: Inattention, Impulsivity, and Hyperactivity. These are some of the easiest symptoms to observe in one’s behavior, but there are many more executive functions involved with ADHD such as motivation, hyper-focusing, emotional dysregulation, auditory and visual processing speed, word and information retrieval, speech and writing organization, organization of space, time awareness and management, planning and prioritization, hyperactive thought process, working memory, vocal self-stimulations, etc. Effective evaluation of ADHD will consider executive functioning beyond just Inattention, Impulsivity, and Hyperactivity.

Yes and no. Obviously, you have to take all online information with a grain of salt, although I have been impressed with how many individuals have appropriately sought out, especially adult females, ADHD evaluation after watching social media posts. There is a lot of good content out there including the personal testimonies of those who have ADHD and do not have a typical presentation of symptoms like diagnostic criteria suggests they should. For those individuals self-diagnosing based on social media posts, I would really stress the importance of finding a specialized professional who is able to conceptualize and identify atypical presentation of ADHD symptoms. It will pay off as you will gain a better understanding of yourself and your symptoms, while decreasing the risk of being rejected or shamed by non-specialized providers.

Yes. The current diagnostic criteria for ADHD do not emphasize the need to consider how one compensates for chronic executive functioning symptoms. This compensation, which is commonly present for everyone with ADHD to some degree, often minimizes presentation of symptoms for many (such as females, intelligent individuals, and adults), which results in them not being deemed to have clinically significant symptoms and thus they do not receive a diagnosis. Social masking is the term used to highlight that individuals conceal many of their symptoms, but this term tends to minimize the actual costs of such compensation strategies. Many with ADHD drastically over-compensate for their symptoms with their time, resources, and energy; which causes other problems for them. Specialized evaluators of ADHD will help you to differentiate between what is a symptom, what is a compensation strategy, and what is a secondary symptom of ADHD (e.g., anxiety, depression, etc.).

Psychologists, Psychiatrists, Pediatricians/Other Medical Doctors, and therapists

Comprehensive evaluation from a Psychologist tends to be the most robust diagnosis, which also both rules out other possible causes of symptoms (including organic brain conditions) and identifies co-occurring conditions (e.g., mental health, learning disabilities, etc.). Psychologists are able to give learning disability diagnoses.

Medical doctors (Pediatrician, Family Doctor, Psychiatrist) are the quickest and cheapest way to get diagnosed, but many do not specialize in ADHD. And outside of Psychiatrists, many have limited training in mental health conditions. They are unable to give learning disability diagnoses.

Some therapists (Master’s Level Counselors or Social Workers and Doctoral Psychologists who do not complete comprehensive evaluations) feel comfortable diagnosing ADHD, although medical providers, schools, and various services may not always deem this a credible diagnosis for services (e.g., medication, work or school accommodations, etc.), especially without a comprehensive evaluation report.

School evaluators in the school system are not able to give a clinical diagnosis of ADHD. If they use the term ADHD it is used as an educational designation to guide development of needed accommodations within that particular school system.

Psychologists who complete comprehensive evaluations gather detailed history of symptoms/functioning (intake), detailed ADHD and Executive Functioning screening measures, mental health/psychological measures, cognitive testing (FSIQ), learning disability related measures if appropriate, and often executive functioning and memory measures (rules out brain injuries and other organic causes and also helps to establish cognitive/neuropsychological strengths and weaknesses). Other measures may be included, especially if co-occurring conditions are present like Dyslexia, Autism Spectrum Disorder, Trauma, etc. A feedback appointment is scheduled to review all results and discuss recommendations for treatment. A comprehensive evaluation report is provided.

Medical doctors will generally gather brief history and may use brief ADHD screeners filled out by an individual, other family member, and/or teachers at school. Some local psychiatric clinics are utilizing a Continuous Performance Test (CPT) as a form of evaluation for ADHD. Psychologists who specialize in testing evaluations would consider a stand alone CPT as only a screener instrument and not an actual evaluation. For many medical doctors, response to medication will really be the confirmation of ADHD diagnosis (i.e., diagnosis via functional medication trials).

Therapists will generally gather an initial history at the intake appointment and then further history and observation of symptoms over the course of ongoing therapy. Screeners for ADHD and other symptoms may be used as well.

Psychologists’ comprehensive evaluations will generally run from $1,500 to $2,500 locally with all testing measures being administered in one day. It is important to note that the Treasure Valley has relatively few psychologists who provide comprehensive evaluations for ADHD and other issues. Many of the psychologists who do test are Neuropsychologists. They often complete extremely comprehensive evaluations, 2 to 4 days of testing, which tends to run from approximately $4,000 to $12,000 dollars per evaluation. This is excessive for many seeking diagnosis of ADHD.

Medical doctors’ evaluations for an initial diagnosis of ADHD will usually just cost the amount of the diagnostic appointment unless lab work or other follow up appointments are needed. No evaluation report is provided.

Therapists' diagnosis of ADHD is likely to not be made in the first appointment, which means it would take as many appointments as needed for them to feel sure ADHD is the right diagnosis. No evaluation report is provided.

It depends. If you were looking for a therapist it would be important to find out if they specialize in what ails you (e.g., trauma with dissociation, ADHD, issues related to giftedness, Dyslexia, OCD, learning disabilities, etc.). The same can be said for Psychologists that complete evaluations. We all have different specialties.

For individuals with highly complex histories of speech delays (i.e., nonverbal), severe motor limitations, rare genetic conditions that impact cognitive functioning, severe head injuries, and complex multiple medical conditions that impact cognitive functioning, then a Neuropsychologist is typically going to be the best fit.

I mention this because over the years I had had countless individuals who were told they could not possibly have ADHD, who clearly do have ADHD. This is more common for females, adults, and intelligent individuals who do not present like 5-8 year old males that are obviously struggling with hyperactivity and impulsivity. My advice for such individuals, and for anyone seeking an evaluation for ADHD, is make sure you find a provider that is specialized in ADHD whether it is your first or your fifth evaluation. Highly specialized professionals for ADHD evaluations are actually rather rare.