I met with a psychologist, but I’m still not sure whether I have adult ADHD!

11 03 2009

Hi Charis and Yvonne,

I am Easter, a college student and am 24 years old. I live in Kuala Lumpur. I went to see a psychologist a month ago because I have troubles of what seems to be like Attention Deficit Disorder. This problem has been on-going for many years. However, I have realized that my functionality as a student has deteriorated drastically over the past two years. I feel almost flat zero most of the time, like I am pretty much “absent”. With my under achievements in my studies as the consequences, it has really did hit me that I should get help immediately and improve my condition, regardless of whatever the condition is. It is even the more frightening to think I’ll be going for my internship in a few months time. Hence, I am pretty “rushed” to get help.

This psychologist was recommended to me by a friend. I obtained her contact details from the internet, but I do not know what are his credentials. All I got from the internet that she was a clinical psychologist. I paid RM200 for my one hour session with my psychologist. During this hour-long session, the psychologist asked me questions about my background and the issues that I am facing. At the end of the session, the psychologist could not conclude yet of what I am suffering from. However, she mentioned that at the moment, it could be either depression or ADD.

I do not quite like the direction I am heading to with this psychologist. So I would like to find other professionals who are more specialised in diagnosing adult ADD?

Also, my friend who has bipolar disorder did mentioned before that “normal” people will have difficulty in understanding our conditions. Some do not even know the existencence of ADD, let alone the meaning of it. I am experiencing just exactly that, in which they said it is all mind over matter/your mind made it up, whenever I discussed my condition with them. I do feel a great need to explain my condition to my family especially if ever I am diagnosed with ADD. This leads me to ask you; should I get a diagnosis report (from either psychologist or psychiatrist) upon request stating whether or not I do have ADD?

Thank you for taking the time to read this email. I hope to hear from you soon.

Easter

Dear Easter,

Thank you for your email. I am by no means an expert in the field of psychology. In fact, I have very recently graduated with my Masters in Counseling Psychology in August 2008. However, based on your information, here are my thoughts.

If you really would like to know whether you ADHD or whether this is just something in your mind, then the best way to find out is to go for a comprehensive battery of psychological assessment. Because I have been away from home for several years, I honestly do not know what is the market rate that psychologist (PhD level ones!) are currently charging in Malaysia. Honestly speaking, you do not need to pay $200 per hour every week for therapy. This is a pretty steep rate for Malaysian standard. Even my medical specialist does not charge me this much!

What I suggest is that you get a qualified psychologist to do a comprehensive psychological assessment on you with a report. I’ve no idea how much such an assessment would cost in Malaysia, but I’m guessing at least RM1,000, depending on how many tests he or she uses, and the length of the assessment & report. A psychological assessment will last from anything between 3 hours to a whole day, depending on the amount of test and assessments involved. The psychologist will give you a battery of tests, which often includes an intake (I usually spend at least 45 minutes to find out my client’s historical background because I believe that it is really important for me to get to know my client during a psychological assessment), a structural interview (standardized questions specifically designed and normed to helps the clinicla determine whether you meet the criteria in the DSM-IV), an inventory (or several, such as the Beck’s Depression Inventory, the MMPI, Personality Assessment Inventory). The psychologist would often administer a psychological test to measure your attention span and should at least carry out a short-form version cognitive ability and achievement assessment. Such a test also provides an opportunity for the psychologist not only to collect valuable data from you, but also to observe your behavior and non-verbal gestures. When testing children for ADHD, not only do I do a cognitive ability and cognitive achievement assessment, but I also get teachers and parents to compete a seperate questionnaire inventory. I compare the results of the inventories completed by different people to study for similarities and differences. After carrying out a comprehensive psychological assessment, the psychologist should give you a report setting out the results and the recommendations. See, for example, this website: http://www.tlec.info/adhd_services.htm

It is well worth the money if you would really want to find out more about what you are struggling with and if you get someone who is trained to carry out such assessments. The only person who I know (from reading her credentials online – see the previous Q & A for the link given by another reader who is looking for a psychologist to do an assessment for his child)- who is trained and is currently doing such assessments is Dr Yong in Penang. She is a licensed Psychologist in US. See the previous Q & A here. Other people who may do psychological assessments are Dr Alvin Ng and Dr Ng Wai Sheng. I do not know these two people personally, but they have good qualification and I have heard good things about them.

If you go and see a psychiatrist, a psychiatrist would usually not have the time or training to do anything other than to ask you a bunch of questions (to determine whether you meet criteria in the DSM-IV) and at most a structural interview. This usually takes about an hour (or less!). He or she will give you a diagnosis and proceed to advise you on whether or not you need medication, and if yes, what are your options. If the psychiatrist is smart and believes in a multidimensional treatment plan, he will then refer you to a psychologist (for a further psychological assessment) and/or a therapist (to work on some coping skills).

One thing I know for sure. One hour is just too short for a psychologist to come up with any conclusions. What your psychologist did during that one hour with you was probably at most an intake and an ADHD screening. After an ADHD screening, if the psychologist feels that there may be a possibility that you have ADHD or depression, then she will make a recommendation for further testing or evaluation. Why she did not refer you for a further psychological assessment, I do not know. Remember, for ADHD, there is no absolute test to determine for sure whether or not a person has ADHD. The level of ADHD also varies Some people, however, may have mild ADHD without hyperactivity, and if they have learned enough coping skills, they are able to function quite well without medication. Others, take medication, but still need to learn coping skills to optimize their performance. If a psychologist does strongly feel that you may have ADHD, then he or she would be able to discuss the pros and cons of taking psychotrophic medication, and address your fears and concerns.

When seeing a psychologist or even a psychiatrist (or any professional for the fact), I’d advise you to get his or her resume. Do not feel shy or awkward about asking your psychologist for his qualification, licensure and experience. You are entitled to ask, and you have in fact paid for his or her services. In US, for example, a psychologist’s license has to be displayed in his room or should be available to be produced to his or her client upon request. The client also has a right to ask for the license number. Unfortunately, in Malaysia, there is no regulation for the licensing of psychologists, so just about anyone with a psychology degree (even a Bachelor’s degree!) can call themselves as psychologist. This is why it is all the more important for you to do your homework, Esther!

Once you get the psychological report, then I’d strongly encourage you to go for supportive therapy, an hour a week at least for a period of time. Your therapist need not be a psychologist, and need not be a Ph.D graduate. What is most important is that your therapist needs to have knowledge of adult ADHD and preferably some experience working with people with ADHD. You should feel comfortable with your therapist and be able to develop a trusting relationship with him or her. Your therapist should work as a collaborative team with your psychologist (who did your psychological assessment) and psychiatrist (if you have one). THis means that you will authorize him or her to contact the psychologist/psychiatrist should the need arises.

About what your friend said, that normal people having difficulty understanding your mental situation, that is very true. In particular, many people still think that ADHD is as myth, and is a result of bad/inconsistent parenting, personality, headstrong children etc. This may cause them to be adverse into considering medication. On the other end of the spectrum, there are other people or parents, who believe that simply popping pills into their children’s mouth will miraculously solve their concentration problems. I remember one of my 9-year-old client with ADHD telling me and his parents during therapy, “I take my medication every morning. It’s not working!” Even with the medication, you still need to learn coping skills and you still need to work through some of the problems in your life or issues related to ADHD. ADHD can even affect your relationships and career, and put stress not only on yourself, but also your significant others.

Yes, a person (in general) is often an expert of his or her ownself. You know yourself the best. A good therapist would be able to provide you with support as you continue to discover yourself and work towards achieving your dreams and maximizing your potential.

Take care, Easter. And keep me updated, okay?

charis


Dr. Kuan Li-Ann, Ph.D., is a Malaysian and an Educational Psychologist who is currently practising in USA.

Dear Easter,

Easter, it is not uncommon for one to be diagnosed with ADD with no more than information gathered from an interview. However, I will add that because you know so little about this particular psychologist (i.e., has s/he seen many ADD patients and made accurate judgment, what sorts of questions are asked during the interview, what her training background is, etc.) is a little unsettling. In most instances these interviews are accompanied by some psychological testing for IQ and specific processing skills, just to rule out other disabilities that can bring about the ADD-like symptoms. I would also argue that an hour long session is NOT enough to gather the personal history needed to make a good diagnosis. But even as I say this, if the psychologist has seen enough ADD clients and has a set of questions that get at the ADD efficiently, an hour may suffice. Still, I am doubtful.

I am not sure if you are planning to follow-up with the psychiatrist the psychologist recommended. If you do, please be sure to talk to the psychiatrist in detail about his/her experience with ADD. You just want to be absolutely sure that the doctor can tell the ADD and depression apart, and identify whether it is ADD or depression that is the root cause of the problems that you are experiencing. You just don’t want to go on a wild goose chase thinking you have one condition when you really have something else. You can do so by asking questions about how often he sees patients with ADD.

I want to add that people don’t generally have the right understanding of ADD. It is a very misunderstood condition which is why if your healthcare providers are NOT experienced enough, they can misdiagnose due to misconceptions for the disability.

I find it interesting that you suspect ADD or depression. From the literature I have read, these are not uncommon co-existing conditions. When one is depressed, you can have problems with attention. And if one has ADD, the challenges presented in life can create depression. Also, there is brain scan research that suggests that the affected areas of the brain for a type of ADD (there are apparently 6 different types!) is similar to depression. To get to the bottom of whether the issues are ADD-triggered or depression-triggered, is really in the treatment. If you treat the depression and the attention problems go away, then you probably have depression. I say all of this so that you can self-monitor once you are on meds. I have also been told if you do not have ADD the stimulants prescribed will generate very clear physiological reactions (you’ll be jittery and very anxious, essentially you will feel you have had 20 cups of coffee).

I personally know someone who was misdiagnosed with depression for many years and as a result, untreated for ADD. Since this person’s depression was caused by the ADD, his depression did not go away with anti-depressants. It was only after he was properly diagnosed with ADD, and received medication to treat his ADD, did his condition improve drastically!

I recommend that you check out the website for the Amen Clinic below. There are is a section where you can do a self-test for ADD, this will cost US$4.95. Daniel Amen is the psychiatrist whose brain research work suggests 6 different types of ADD.
http://www.amenclinics.com/

There are also a couple of national organizations in the US where you can get the most current information about ADD in general.
CHADD — http://www.chadd.org/
ADDA — http://www.add.org/

There are some life-style changes that will also help improve symptoms. For example, if you smoke an drink it will probably be good to stop, since studies do show that these self-medicating techniques tend to slow down the brain and damage it with long term use. Try to exercise once a day for about 30-45 minutes at an increased heart-rate (walking slowly does not qualify). Also, we tend to eat a lot of sugar and simple carbohydrates, try to cut down on those. I hear the Zone diet is a good place to start for people with ADD. Dietry supplements such as St. John’s Wort (for depression) or L-Tyrosine may be helpful. I want to add that please do some research on the supplements I suggest above because I am not a medical doctor. I read recently that these are supplements that could help ADD when coupled with exercise and a good diet. You may want to try this life-style change first prior to seeing a psychiatrist, just remember that supplements tend to take 6 weeks to kick in. If your symptoms have reached a point where they are unbearable to you please seek medical treatment for them.

One last thing that may be helpful to you is taking fish oil with omega-3 fatty acids. Some people with ADD have found that the effects of taking this supplement were immediate! My friend mentioned above used to have a lot of nightmares at night. After taking omega-3 fish oil for only 2 days, he reported that his nightmares stopped and it’s only been on fish oil for only 2 days. Fish oil, I read, has a good calming effect, helps with mood swings, depression. I am sharing this with you because I really hate for you to spend any more money on therapists that don’t really know what they are dealing with, Easter.

Good luck! Please let me know if you have more questions. It is difficult to do all of this via the web because there are many questions I’d like to ask. But check out the websites, if you haven’t already.

Dr Kuan Li Ann

******************
Note: The above answers were prepared independant of each other. Neither of the above authors read each other’s reply prior to drafting their respective answers.

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5 responses

12 03 2009
Gina Pera

Hi Easter,

If I may chime in here….

First off, I’m very pleased to hear that Adult ADHD is on the “radar screen” in Malaysia and that you’ve found a clinician that at least acknowledges the possibility. It is often difficult, outside of North America, to find professionals (or others) who “believe” in ADHD in adults.

Second, that’s great that you are following your instincts in thinking that this wasn’t a very thorough evaluation. It sounds as though you weren’t asked to complete a questionnaire, and that’s an important part of the intake process. Diagnosing ADHD is not a science; it’s more of an art. Taking a history is important, and so is learning about current difficulties. But there is a set of criteria that should be considered.

The current criteria, however, is geared more for children. And the clinician has to adapt it to adults. This is tricky. With the upcoming revision of the DSM (the guide for diagnosing professionals), we should have criteria geared for adults.

You can learn more about ADHD at a website that is a collaboration of CHADD (the national non-profit devoted to ADHD support and education) and the US Centers for Disease Control: http://www.help4adhd.org

I also offer a PDF of the book I’ve just written — a guide to understanding Adult ADHD, including the evaluation process, treatment strategies, and ADHD’s effect on relationships — precisely so people who live overseas and find mail costs prohibitive can access the information.

Whether in the US, the UK, or anywhere else, the adult with ADHD does best by learning the facts first and then pursuing professional help. Otherwise, it’s very easy to be frustrated by professionals who don’t understand what you are up against.

Best of luck,
Gina Pera
http://www.ADHDRollerCoaster.com

21 03 2009
charis

Thanks, Dr Kuan, for your very insightful comments.

I once attended a talk by the nutritionist who works at my university. She mentioned that fish oil with omega-3 fatty acids is one of the most beneficial supplements to take. This is still a relatively new treatment for ADHD, but I remembered reading a journal article that reported the positive effect omega-3 fatty acids had in treating people with ADHD. After the talk, I spoke to the nutritionist to discuss this. The nutritionist shared with me that her son as ADHD, and she took him of psychotrophic medication because it was sedating him too much. Instead she got him to take this fish oil with omega-3 and his condition improved significantly. However, she said that usually a high dosage is required for this treatment. If you are interested, I’d suggest that you do further research and consult a nutritionist who has some knowledge on this.

charis

21 06 2009
Thalasiah

Hi Esther,
One thing good as you realised that you have the ADHD syndrom. That make it easier for you to outgrown the ADHD . I have a 24 years old boy and slowly he is coping up with ADHD very well. ADHD is not stopping him to excel in life.

21 06 2009
Thalasiah

Dear Esther,

When 1st time I learnt about ADHD 14 years ago, I was the only local parents struggling to find out what is ADHD after I read a few books and did my own recherches on my child shortcoming and disabilities. I have a normal child who is a pilot by profession and luckily I only have 2 children. At that time not even psychiatrist and psychologist in Malaysia could give me some light. I was very dispaired and frustrated but I am happy know that my son who is a director of my company and always thinking of going back to college to further his education. No college or University in Malaysia catered such ADHD student so he will be enrolling himself in US.

Supplements like Fish oil, grape seed oil, and etc etc etc etc. maybe will help but I don’t think so. I have spend thousands of dollars importing supplements from all over the world for my son. Just name it i have given to him as early as 4 years old but the dopharmine the so call chemical neuro transmitter did not improved.
I am in Malaysia residing in Kuala Lumpur

Try New becalm, or brain food .

10 07 2009
charis

Thalasiah,

Thanks for your sharing. A reminder to all that THERE IS NO MAGIC PILL to vanish ADHD symptoms. Just like Viagra can make a man remain hard, but does not guarantee female pleasure during sexual intercourse, so no pill, be it prescription medication or herbal supplements, can guarantee total elimination of ADHD symptoms. Medication should be accompanied by non-medication intervention such as therapy and behavioral intervention to learn coping skills, anger management, token system, work on self awareness, self-esteem issues and etc.

Adult ADHD may not only affect studies and career, but also affect relationship with significant others as well, which is why therapy is warranted. Contrary to popular belief, you cannot outgrow ADHD, but you can learn coping skills to help you focus and organize your life despite having ADHD.

Charis Wong, M.S., LPCI, LMFTA

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