May 2024 – Dr. Mario Lehenbauer-Baum

As a licensed psychologist, I specialized in working with adults with Attention Deficit Hyperactivity Disorder (ADHD). For some of my clients, it may be the first time in their adult life that they think about a possible ADHD diagnosis, and they want to get answers.

However, this idea of a “psychological assessment” or “psychological testing” might seem intimidating. Therefore, in today’s blog, I want to answer some of the most common questions about ADHD assessments, to demystify its typical procedures and to emphasize the potential benefits of obtaining a thorough assessment report by a qualified provider.

In general, to ensure an accurate ADHD diagnosis in adults, it is important to involve licensed mental health professionals (e.g., clinical psychologists, psychiatrists) that are trained in the treatment and assessment of adult ADHD.

ADHD assessments can help clients gain a holistic understanding of their “individual ADHD”, how it’s affecting their everyday life, and it’s necessary to receive individual recommendations for coping strategies based on these assessment outcomes. Another benefit is having a thorough ADHD assessment report that can serve as an objective “baseline” of certain cognitive/mental functions. Clients can revisit or re-do certain assessment parts again in a few years to see if anything changed over time.

Prevalence of ADHD

Research indicates that the estimated prevalence of ADHD among children is 11%, with approximately one-third of diagnosed children retaining the diagnosis into adulthood (Visser et al., 2014). This persistence is reflected in the overall prevalence of current ADHD among adults aged 18 to 44 years, which stands at 4.4% (Kessler et al., 2006).

If we take that percentage and apply it to today’s U.S. population ages 18 to 44 (118.3 million people), it translates to an estimated 5.1 million adults between 18 to 44 years with ADHD. For Florida alone, it would translate to 286,000 adults with ADHD.

Even though ADHD awareness has increased over the past years, there may be some barriers in recognizing ADHD symptoms by providers that are not trained in ADHD. Sometimes, ADHD symptoms overlap with depression and anxiety, so people receive treatment for (secondary) depression or anxiety, even though ADHD is the primary reason for said anxiety or depression.

While some individuals may have received an ADHD diagnosis from their primary care physician or psychiatrist, often based on symptom discussions and brief surveys, it does not automatically mean that they understand their “individual ADHD”. They may lack detailed information about their specific ADHD type, they may not know what executive function may be affected, and/or what to do to tackle very specific ADHD-related symptoms. Even though ADHD shares common diagnostic markers, it manifests uniquely in each person.

This is where I come in. As a provider trained in the treatment and assessment of adult ADHD, I usually inquire about clients’ awareness and knowledge of executive functions, exploring the intricate relationship between executive functions and ADHD.

ADHD assessments: Important steps

Here is a short summary of the usual ADHD assessment process in my private practice. Please note that other providers may handle the assessment process differently, but some of the key areas (such as executive functions, working memory) should be “gold standard” when it comes to evidence-based assessments for ADHD.

Officially recognized are three presentations of ADHD: 1.) Predominantly Inattentive, 2.) Hyperactive-Impulsive, and 3.) Combined type. It’s important to note that no single test can definitively diagnose ADHD. Additionally, ADHD is often associated with other mental health conditions like depression and anxiety as symptoms can overlap, so ideally an assessment also factors in those conditions.

Therefore, my assessment process goes beyond confirming ADHD. A comprehensive assessment can take a few hours on multiple days. Depending on how much can be done in one setting, it usually requires people to come in at least three times.

First step: Usually, the first meeting is dedicated to a thorough examination of your history. I ask very specific questions about your childhood, your education, any struggles in school or at work. If possible, I also ask clients to ask their parents or their partner for their opinions on certain symptoms. This first meeting takes about two hours, and also includes brief screenings of anxiety and depression and other mental health conditions related to ADHD.

Second Step: After a thorough examination of your history, you will come in for two or three more times for specific psychological tests. These tests are usually administered digitally on an iPad, to assess cognitive and executive functions, such as attention, working memory, cognitive flexibility, etc. It provides valuable insights into specific cognitive strengths and weaknesses. Some of these tests may include:

Continuous Performance Tests: These tests measure sustained attention and response inhibition.
Executive Functioning Tests: These tests assess various aspects of executive functioning, such as working memory and cognitive flexibility.
IQ/Cognitive Functioning Tests: These tests provide a measure of overall cognitive functioning and how working memory impacts certain cognitive functions.
Memory Tests to assess verbal and non-verbal memory.
Tests for Comorbid Conditions: Specific brief surveys designed to assess symptoms of depression or anxiety that may co-occur with ADHD.

The third step includes compiling all of the data into one easily understandable and comprehensive evaluation report (appr. 15-25 pages). In a feedback meeting, I will go over all of these results with clients, and I will also discuss individualized recommendations for ADHD coping strategies based on these outcomes.

Summary:

After a comprehensive ADHD assessment, clients have a better understanding of individualized recommendations for ADHD strategies. The assessment provides clients with a thorough understanding of their individual ADHD, its impact on daily life, and serves as a baseline for tracking cognitive function changes over time.

When selecting a provider, I can encourage you to ask about their specific training and experience in working with adults with ADHD. Qualified professionals are typically willing to share details about their training and experience working with adult ADHD. Any reluctance to provide such information in response to reasonable inquiries should raise concerns, and it may signal the potential need to seek assistance from a different professional.

Sources:

Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E., & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American journal of psychiatry, 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716

Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., Perou, R., & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. Journal of the American Academy of Child and Adolescent Psychiatry, 53(1), 34–46.e2. https://doi.org/10.1016/j.jaac.2013.09.001

Disclaimer: My information is strictly for educational and informational purposes, and not intended to replace any professional therapy or medical advice. I strive to be accurate, but I cannot guarantee that the information is suitable for every individual or situation. The content provided on this blog is for informational purposes only and is not intended as a substitute for professional therapy, diagnosis, or treatment. Please seek the advice of a licensed professional for any questions or concerns you may have regarding your mental health. Never disregard professional advice or delay in seeking it because of something you have read on this blog. Furthermore, I am not responsible for any actions you take or do not take as a result of the information provided in this blog. Please consult with your healthcare provider or mental health professional before making any changes to any treatment plan. By reading my blog, or watching my videos, you acknowledge that you have read and understood this disclaimer. Important: If you experience a crisis or mental health emergency (and you are located in the US), please call 911 or visit the nearest emergency room (do not send me a message or call me, I am not able to respond to messages online).

Addressing conflicts is crucial for building healthy relationships and effective communication. However, most people shy away from conflicts. It’s normal to feel uncomfortable when you have to address certain things.

And as it happens with most things that feel uncomfortable, our mind tries to avoid doing thinking about it. This avoidance has a clear benefit – it provides relief now because we don’t have to address it right here and right now. However, this avoidance comes with caveats – long-term consequences. Today’s article tries to shed some light on these consequences, and why we tend to avoid conficts.

Where does conflict avoidance come from?

Conflict avoidance can have various roots, and it often stems from a combination of psychological, emotional, and interpersonal factors. Understanding the root causes of your individual conflict avoidance is essential for personal growth and developing healthier communication patterns. Addressing these underlying factors often involves self-reflection, building communication skills, and, in some cases, seeking support from therapists or counselors to explore and overcome barriers to addressing conflict. Here are some of the most common reasons why people avoid conflicts:

Fear of rejection: People may avoid conflict because they fear that expressing their opinions or confronting an issue might lead to rejection or disapproval from others. This fear of being disliked or rejected can be a powerful motivator for avoiding conflict. Sometimes, people turn to the other extreme of “pleasing people”, just to avoid any potential for being disliked.
Low Self-Esteem: A lower self-esteem may go hand in hand with fears of rejection where people hesitate to engage in conflict because they doubt their ability to handle the situation effectively. They may fear that expressing their needs or concerns will result in negative judgments.
Past Trauma: When people grow up without emotional validation and without an opportunity to express their emotions without repercussions from parents or caregivers, it may contribute to a reluctance to engage in conflict. Especially traumatic experiences can contribute to a fear of reliving or exacerbating past hurts.
Lack of Communication Skills: Some people may avoid conflict simply because they lack the communication skills that are necessary to express their thoughts and feelings effectively. They may feel overwhelmed by the prospect of navigating a difficult conversation.
Cultural or Family Upbringing: Cultural or family backgrounds that discourage open expression of emotions can also contribute to conflict avoidance. Individuals raised in environments where conflict is viewed negatively may find it challenging to engage in healthy discussion and confrontation.
Desire for Harmony: Some individuals simply value harmony and peaceful interactions, and they may avoid conflict to maintain a sense of peace and stability in their relationships. The discomfort associated with conflict may override their willingness to address issues.
Avoidance as Coping Mechanism: For some, avoiding conflict serves as a coping mechanism to manage anxiety or stress. If there’s a lot of stress going on in their lives, it makes sense to avoid any additional stress, and they may believe that avoiding conflict is the best way to maintain an emotional equilibrium.

How to address conflict avoidance:

Conflicts are a natural part of relationships, especially when it comes to communicating and establishing boundaries. Even though it is uncomfortable in the beginning, addressing conflicts and boundaries in a healthy way can lead to growth and increased understanding long-term. However, it is essential to approach conflicts with the intention of finding solutions and maintaining the overall well-being of the relationship. Here are some general recommendations how to address conflict avoidance:

Self-Reflection: Take time to understand your own feelings and reactions to conflict. A diary may help you with Identifying any patterns or underlying fears that contribute to avoidance.
Communication Skills: There are many books and videos online that explain communication skills. Effective communication skills, including active listening, expressing yourself clearly, and using “I” statements to convey your feelings without blaming the other person, are very helpful to get to a solution that works for both parties.
Understanding Conflict: Conflict is not automatically negative. It may be helpful to change your perspective on conflict. If you see it as an opportunity for growth and understanding rather than a negative experience, you may recognize that not all conflict is harmful and that addressing issues can lead to stronger relationships.
Embrace Uncomfortable Conversations: The more you engage in having difficult conversations, the less uncomfortable you will feel about it, and the more skilled you will become. Start with smaller issues before tackling more significant concerns.
Choose the Right Time and Place: Right in the morning before leaving for work is not the best time to address conflict. Try to pick an appropriate time and setting for the conversation with both partners in mind. Make sure both parties are in a calm and receptive state of mind.
Focus on Solutions: Shift the focus from blame to finding solutions. Collaborate with the other person to work towards resolutions that benefit both parties. If needed, don’t hesitate to involve a neutral third party, such as a psychologist or counselor, to facilitate the conversation. They can provide guidance and help create a safe space for open communication.
Set Boundaries: Establish and communicate your boundaries. Be clear about what behavior is acceptable and what is not, and encourage the other person to do the same. However, also discuss consequences if boundaries are not respected. Those consequences are often the hardest part about setting boundaries, but they are necessary otherwise your boundaries won’t be respected.

Summary:

Avoiding conflicts might provide immediate relief, but it often leads to long-term negative consequences in relationships and personal growth. Understanding the roots of conflict avoidance—such as fear of rejection, low self-esteem, past trauma, lack of communication skills, cultural upbringing, desire for harmony, and using avoidance as a coping mechanism—is crucial for addressing it effectively. By engaging in self-reflection, improving communication skills, reframing the perception of conflict, embracing uncomfortable conversations, choosing appropriate times and places, focusing on solutions, and setting clear boundaries, individuals can overcome conflict avoidance and foster healthier relationships. If needed, seeking support from psychologists or counselors can provide valuable guidance and help create a safe space for addressing conflicts constructively.