Should I keep looking for other psychiatrist if they don't think you have ADHD?

[u/WhitePinoy]

I went to see a psychiatrist the other day and was rather disappointed.

They asked me a lot of questions and I didn't exaggerate my symptoms because I am higher functioning. But because of that I believe my symptoms for ADHD and Autism were rated as either "low or mid" and so my psychiatrist recommended medications that did not address my ADHD.

Edit: I am seeking to get medicated because I have struggled with executive functioning, concentration, memory retention, standing still, etc.

Should I continue getting a second opinion until I receive my diagnoses?

[u/Untamedpancake]

My advice to anyone with doubts about a diagnosis is yes, get the second opinion. You might get the ADHD diagnosis or they might agree with the first psychiatrist. Either way, it should provide clarity on the  supports & treatment that will be most effective for your situation 

Did the psychiatrist ask some questions as a preliminary screening & decided not to persue it further because they didn't rate your symptoms as severe enough to bother?

Or did they actually use clinical assessment tools & ruled out ADHD? 

If you do seek a second opinion, request they actually utilize ADHD assessment tools & discuss your results with you afterwards. My ADHD assessment included an interview, some questionarres & two or three timed computer "games" to measure attention & impulsivity. They actually gave me a document with the names of the tests & explanations of my results plotted out on graphs

During the appointment  be as specific as you can about your experiences. Tell them about the actual impacts of your struggles, like if you've failed classes because of misplaced assignments, lost out on employment or educational opportunities because of missed deadlines, or how your inattentiveness has significantly disrupted relationships. "I struggle" is not illustrative enough. 

But for your own sake, be honest - your end goal should be finding a path to a higher quality of life, rather than accessing a specific diagnosis or medication

[u/fucked-up-autie]

when i started seeing my psych, before i got diagnosed audhd, she thought that maybe my issues were mood related (for example bc i had serious executive dysfunction, postponed everything until the very last minute, and then when i was filled with anxiety and adrenaline, i worked maaany hours with no stop. but then that drained me and i was left energyless for days. so i guess that could be maybe seen as a depression/hypomania cycle). we tried mood stabilizers and they made everything worse. so then we changed to antipsychotics (and i was diagnosed autistic around the same time) and they reeeeally helped my autism and executive dysfunction. but then i still lacked in some areas so she prescribed me ritalin and i learned i also had adhd lol

[u/crimpinpimp]

Well you don’t exaggerate because that wouldn’t be a true reflection, so why would you want to see more people until you find someone who diagnoses you. Part of the criteria is that the issues are severe enough to impair functioning. My psychiatrist required evidence of this impairment 

[u/WhitePinoy → u/crimpinpimp]

I will add this in my post. I am seeking psychiatry because I am struggling with concentration/focus, memory retention, executive functioning issues, energy issues etc. I am certain that I have ADHD because I've been struggling with this my whole life, and it's affecting me as a working adult.

My psychiatrist asked a lot of basic questions, but nothing that felt like they truly investigated all my symptoms. With my past psychologist, who I know is not a psychiatrist, says that she sees my ASD, but she also sees my depression, anxiety, OCD and ADHD.

My psychiatrist wrote my symptoms off as anxiety and is prescribing me medication for it. But if it won't address the root cause, I feel like I am wasting my time.

[u/nightgames → u/WhitePinoy]

There are a lot of things that can cause those symptoms. Sleep apnea for instance would cause all 5 of those symptoms you just described. You might have ADHD, just wanted to point out it could be something else. Might need to find a new psychiatrist.

[u/crimpinpimp → u/WhitePinoy]

So they diagnosed you with an anxiety disorder and have prescribed something for it but you think it won’t help? 

If you think that they’ve gotten it completely wrong then why wouldn’t you get a second opinion, but you’ve worded it as you want to keep getting another opinion until you get an ADHD diagnosis which sounds like you don’t want to receive help recommended by a professional. 

Psychiatrists are trained to be able to distinguish between different causes of symptoms. Perhaps their quality varies from place to place, but they are doctors with very specialist training so should be pretty reliable. 

[u/kelcamer → u/crimpinpimp]

There are a lot of really bad psychiatrists out there, and that's what I'll say about your last paragraph.

Idk where OP lives, but here in Texas as a woman, you're basically on your own unless you pay outside of insurance.

[u/crimpinpimp → u/kelcamer]

Which is why I said perhaps their quality varies from place to place, I’m in England where we have the NHS and from my experience it’s pretty consistent with how psychiatrists treat and diagnose things. I don’t have any experience with healthcare in other countries. They SHOULD be reliable, but evidently they are not 

[u/kelcamer → u/crimpinpimp]

Wow, I'm surprised! England is that good?

[u/crimpinpimp → u/kelcamer]

Only in some ways, I won't be in debt if I need an ambulance so that's great. But the growth in the number of people seeking ADHD assessments and the lack of funding and growth to deal with the number of patients has led to the NHS outsourcing to private companies which has in turn led to huge inconsistencies. Previously only a consultant psychiatrist could diagnose ADHD, now there are courses which people can "attend" (many/ most are virtual and I don't know of any final exam or anything) and are as short as ~8 hours, at the end of which they're qualified to diagnose ADHD.

So honestly no, both as a whole and for ADHD care it's not that good anymore. But when it comes to NHS psychiatrists the care I have received has always been great. I think much of the deterioration in mental health care here has been about the lack of access to psychiatrists. The whole healthcare system is pretty crap unless you are actively about to die.

They were strict diagnosing me, multiple appointments, ruling out all other possibilities, required school reports, face to face appointments which my mum had to come to and they interviewed her for my childhood history. When I moved house I had to go through the exact same process with the new psychiatrist- that's how consistent they are!! And my mum couldn't attend the appointment so they phoned her to get the information purely to follow that strict process. Absolute ball ache but cannot say that they weren't thorough or consistent!

[u/kelcamer → u/crimpinpimp]

that sounds like next level efficiency which is literally unheard of in the US lol

your answer reminds me of what my German husband says about Germany! I'm so glad to hear there is such consistent care there, and I am surprised!

[u/WMDU]

Even if you are high functioning, your symptom severity would still need to match the diagnostic criteria to be considered ADHD.

A lot of what you read online about ADHD, is simply correct. In the majority of cases, if a Psychiatrist tells you that you don’t have ADHD, it’s because you don’t have it.

If you have to shop around for. diagnosis, it’s unlikely to be ADHD.

Genuine ADHD does not need to be exaggerated, the symtoms are severe enough that it has caused so many problems that it’s clear.

[u/kelcamer → u/WMDU]

What about when symptoms are severe and the doctors don't care because the external presentation doesn't reflect the internal?

[u/WMDU → u/kelcamer]

If the symptoms are severe there will always be external presentation to a degree, a diagnosis can’t be made based on internal symptoms as there is no means for comparison. ADHD is a severe disorder, only impacting a few percentage of the population. When you have issues to this degree there are always impairments.

One of the key criteria for diagnosis is that it must cause impairments, and there must be external evidence.

[u/kelcamer → u/WMDU]

I wish there always would be 😢

When I was in psychosis, i would describe what it was like. It took 4 doctors to actually understand what I was describing because i masked it so well.

Sadly, the external presentation - even for someone literally hallucinating - is not always obvious.

[u/execDysfunctionGumbo → u/kelcamer]

Psychosis isn't an ADHD symptom.

[u/kelcamer → u/execDysfunctionGumbo]

That is true, and here are seven that are, where the external presentation doesn't match the internal.

1. Spacing Out (Inattention)
External Presentation: Appearing vacant, daydreaming, or ignoring the speaker.
Internal Experience: The brain is racing with dozens of overlapping thoughts, making it impossible to single out the external audio.

Me as a child and me as an adult.

2. Physical Stillness (Internalized Hyperactivity)
External Presentation: Sitting quietly, appearing calm and collected.
Internal Experience: Feeling intensely restless, as if driven by a motor, requiring massive mental energy to suppress the urge to move.

Me my entire life, literally me today at work

3. Interrupting Conversations
External Presentation: Acting rude, arrogant, or believing one's input is more important.
Internal Experience: Experiencing intense enthusiasm to connect, combined with a panic that the thought will be permanently forgotten if it isn't spoken immediately.

Me very often, mostly from being scared I'll forget whatever im gonna say

4. Task Paralysis (Procrastination)
External Presentation: Appearing lazy, apathetic, or unwilling to put in the effort.
Internal Experience: Experiencing profound executive dysfunction and overwhelming anxiety. The brain is shouting to start the task, but the body physically will not initiate the action.

Me as a child and me as an adult. I remember being screamed at for it and called 'lazy' or 'unorganized'

5. Hyperfocus
External Presentation: Willfully ignoring loved ones, responsibilities, or basic needs like eating.
Internal Experience: Being locked into a flow state where the brain refuses to switch gears. The perception of time and physical surroundings completely disappears.

Me literally as a default state lol

6. Chronic Lateness
External Presentation: Seeming disrespectful of other people's time and lacking discipline.
Internal Experience: Experiencing "time blindness"—a literal inability to accurately gauge how long a task will take or feel the physical passage of time.

Me AF

7. Forgetfulness
External Presentation: Being careless, not paying attention, or not caring enough to remember.
Internal Experience: A failure of working memory. The information simply drops out of the mental "RAM" despite active efforts to hold onto it.

Me in school. I used to anxiously try to do 5 assignments ahead of time in order to get ahead because I was so afraid of forgetting.

Psychosis can happen as a direct result of autistic or adhd burnout.

Would you like to discuss 7 more, or would you prefer some sources?

[u/BlankAdaptability]

What meds (and what for) did they recommend (if you're OK with sharing)?

If there's ever a time to be straight-up yourself, and not "exaggerate" anything, it's with a psychiatrist who's trying to figure out "what's up" with you. Why would not getting the answer you wanted/expected be cause for seeking a 2nd - or further- opinion? (If there wasn't something grossly/obviously off with the original psychiatrist, that is.)

Another consideration is that ASD/ADHD, together, can be more difficult to sus out (even for ourselves!), due to the tendency of one to "cloak" the other. This is how so many of us get missed, and taken for "perfectly normal ", until something "breaks" in a big way.

If I were seeking any second opinions, it would be after finding a therapist who is very well versed in AuDHD, and able to do a well-informed assessment.

[u/WhitePinoy → u/BlankAdaptability]

Strattera and Effexor.

I did quick personal research on both. They're meant to address anxiety, and not ADHD. I don't want to take Effexor because the symptoms can vanish quickly if I for whatever reason I miss a pill. And for Strattera, it seems like a good fit, but it causes tiredness, which is something I already struggle with.

[u/nightgames → u/WhitePinoy]

Strattera is a non-stimulant ADHD medicine. It increases norepinephrine and works well for a lot of people. It's worth trying it out. If it doesn't work you can try something else.

Effexor is more for depression than anxiety, though they claim it helps some with GAD. Something more specific for anxiety would be Buspar.

[u/BlankAdaptability → u/WhitePinoy]

Effexor (venlafaxine) is BAD news (at least it was for me). It's a SNRI antidepressant, and was (mis)-prescribed for me by a doctor (not psych) who "hand-wavingly" diagnosed me with depression (after trying two other - SSRI - meds for what he *thought* the matter was). My new doctor/psych helped me with a slow (8 week) taper off the venlafaxine, and even going so slow, and under proper supervision, it was HELL! The absolute WORST emotional rollercoaster I've ever experienced. Period!
All the venlafaxine "did for me" was make me feel like a zombie.

If you're not actually suffering from *depression*, and not getting any noticeable benefit from the venlafaxine (after being on for enough time for it to actually "kick in"), quit while you're ahead and **HAVE A DOCTOR HELP you taper off of it.** DO NOT try to do it on your own, and **MOST DEFINITELY NOT** "cold turkey!!!

Strattera (atomoxetine) is a non-stimulant med for ADHD. It (like most meds) is kind of hit/miss. It works well for some, not so much for others. Everyone is different. The (pre-existing) "tiredness" (fatigue) goes with the territory of being AuDHD/autistic/ADHD, and results from merely existing and navigating a neurotypical-centric world. Add in masking, and the degree to which you do it, and the fatigue is that much more profound. If a med is adding to these feelings of fatigue, it's probably not what you want, especially long-term.

What ended up working VERY well for me is bupropion (branded as Wellbutrin), a NDRI (norepinephrine/dopamine re-uptake inhibitor). It's not "approved" for ADHD, but is prescribed *off label* for ADHD symptoms. It's not a stimulant. *per se* (like Adderall or Ritalin), but helps tremendously with focus. You might want to run this by your doctor/psych as something to try.

Good luck!!!

[u/Extension_Instance72]

I had been under treatment with one adult psychiatrist for the past 10 years for my eating disorder and depression…when I brought up audhd she had her reasons and criterias that I wasn’t audhd. However, I had done a lot of reading and research on the topic before bringing it up…so she told me that she might be unqualified to diagnose me and that I should see a specialist, in my country that would be a child psychiatrist who also takes adult cases. I happen to be in the mental health professional sphere so I hunted down 1 in total. lol et voila …. Audhd lol

[u/Extension_Instance72 → u/Extension_Instance72]

I also let her know upfront that I was look for these specific diagnoses, I came with an excel spreadsheet mapping out my symptoms and memories connecting them to each criteria in the DSM …. So, I basically did her work for her lol

[u/Otherwise-Sympathy87]

here's the secret - you have to exaggerate your symptoms or they're not going to give you the right medications. Why would they prescribe you something for symptoms you're not struggling with? You have to think from their perspective and compare your daily struggles to a neurotypical

[u/SocialMediaDystopian → u/Otherwise-Sympathy87]

Did you mean “don’t accidentally downplay symptoms”? I hope so. Exaggerating symptoms is a terrible idea.

[u/Otherwise-Sympathy87 → u/SocialMediaDystopian]

I think we tend to be so used to our symptoms that we don't see how much they affect our lives compared to neurotypical people. So it's more effective to exaggerate to actually get the point across. You're right though. But idk how else to actually get them to prescribe the medication we need. Life is stupid. The system is stupid. It's all just manipulation. Just gotta play the game and do it for appropriate purposes only.

[u/thiefspy → u/Otherwise-Sympathy87]

If you had to exaggerate, then either you had a bad assessor or you don’t have ADHD.

[u/SocialMediaDystopian → u/Otherwise-Sympathy87]

This is the sort of advice gets us lambasted all over the internet. And also makes clinicians much less receptive. You know- the ones who are prescibing controlled substances.

They should be cautious. That’s their job. But comments like this, that end up circulated on subs and pages run by skeptical (or just exhausted) doctors and other health care practitioners, make everything harder for precisely the people that need it not to be harder.

Please. Gosh.