ADHD – Dr. Mario Lehenbauer-Baum | Licensed Psychologist

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).

Perfectionism and ADHD? How does that go together? In my private practice, I work a lot with adult clients with ADHD. It does not matter if ADHD was diagnosed late in life, or early on in their childhood: A tendency for perfectionism is something I frequently notice and work on with my clients.

I usually like to explain that there is a complex relationship between ADHD and perfectionism. On one hand, some individuals with ADHD may struggle with perfectionism and wanting everything they do to be flawless, while on the other hand, others may struggle with procrastination and difficulty with completing tasks. These struggles seem to be on the opposite end of perfectionism, but are ironically connected to ADHD and perfectionism as a coping mechanism.

What is perfectionism?

Usually, perfectionism can be characterized as a personality trait that leads to setting impossibly high standards for oneself; people strive for flawless performance in all areas of life. While striving for excellence and having high standards can be positive traits, perfectionism can become problematic when it interferes with daily life and causes excessive stress or anxiety. It can sometimes also be problematic when people try to work on “perfectionism”, but are also afraid of failure if they’re not “perfect” anymore. There is a tendency to attribute their success to perfectionism instead of attributing it to their skills (that are there regardless if there’s perfectionism or not).

People who struggle with perfectionism may believe that they need to be perfect in order to be accepted or valued, and may be highly critical of themselves when they fall short of their expectations. There can often be a rigid mindset and people can be highly critical of others as well. They may have difficulty delegating tasks or asking for help, and may feel anxious or overwhelmed when things don’t go according to plan.

Perfectionists may engage in behaviors such as overworking, overthinking, and overanalyzing, which can interfere with their ability to complete tasks and achieve their goals. They may also experience feelings of guilt, shame, and self-doubt when they fail to meet their own high standards.

Perfectionism as a coping strategy

I see it in my work a lot that for individuals with ADHD, perfectionism can sometimes be a coping mechanism, a way to compensate for difficulties with attention and focus. By striving for perfection, individuals with ADHD may feel a greater sense of control over their environment and their abilities, and try to make up for procrastination and difficulty with completing tasks with delivering “perfect” results.

However, this can also lead to feelings of frustration, disappointment, and self-criticism when they inevitably fall short of their unrealistic and high expectations.

The pursuit of perfectionism can lead to negative consequences, such as increased anxiety, self-doubt, and burnout. Individuals with ADHD who struggle with perfectionism may find themselves engaging in behaviors such as overworking, overthinking, and overanalyzing, which can interfere with their ability to complete tasks and achieve their goals.

Perfectionism can also create a vicious cycle of self-criticism and negative self-talk. When individuals with ADHD set unrealistic standards for themselves and fail to meet them, they may experience feelings of shame, guilt, and self-doubt. This can lead to a negative cycle of perfectionism, in which the individual sets even higher standards to avoid the negative feelings associated with failure.

Strategies to combat perfectionism

It’s important for individuals with ADHD to recognize the role that perfectionism may be playing in their lives, and to seek support and strategies for managing it. Some strategies that may be helpful include setting realistic goals, practicing self-compassion, and focusing on progress rather than perfection.

Additionally, seeking support from a mental health professional who is experienced with ADHD can be beneficial in developing individual coping strategies and improving overall well-being. Perfectionism can usually be treated with cognitive-behavioral therapy, which involves identifying and challenging negative thought patterns and learning new coping strategies for managing anxiety and stress.

It is important to realize that sometimes good enough is just that – GOOD ENOUGH!

You can also view a short video of me explaining perfectionism here: https://www.instagram.com/reel/CqL0mitjl9R/?igshid=YmMyMTA2M2Y=

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).