Attention Deficit Hyperactivity Disorder (ADHD)
Assessment of ADHD
We provide comprehensive assessments for the diagnosis of ADHD. This includes testing for the presence of ADHD symptoms and for co-occurring difficulties such as anxiety, learning difficulties, and emotional regulation difficulties. The assessment will include ADHD client/informant questionnaires, cognitive and neuropsychological tests, a clinical assessment, and written report with recommendations.
Please note, for ADHD assessments we provide a provisional diagnosis. If there is compelling evidence from our assessment of ADHD symptoms across settings and developmentally we recommend obtaining a GP referral to see a Psychiatrist to rule out medical issues and review for final diagnosis and/or medication management. We can recommend psychiatrists with ADHD expertise. We do not prescribe medication for ADHD as this requires a Psychiatrist/medical specialist consultation.
We provide cognitive/academic testing and personalised feedback regarding your cognitive, executive, and memory functioning (e.g., strengths/weaknesses), which a Psychiatrist will not typically include as part of their evaluation. In complex cases (where learning difficulties, cognitive delays, comorbidity may apply) this information will be very informative to aid the psychiatrist's final assessment, and for the client and their family.
A comprehensive ADHD assessment requires a multistep process of excluding other possible causes. Our assessment results will give you a strong picture of whether ADHD is a likely diagnosis, whilst ruling out other possible explanations (e.g., specific learning difficulties, intellectual disability, mental health issues) and these results are summarised in our Final Report, with recommendations to address your specific referral concerns.
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a common behavioural disorder that affects around one in 20 adults. Seven out of 10 children with ADHD will mature into adults with ADHD. The three main features of ADHD are:
• Difficulty paying attention (e.g., workplace tasks, conversations, or personal belongings)
• Hyperactivity (e.g., fidgeting or being unable to sit still, talking a lot)
• Impulsivity (e.g., interrupting conversations, being unable to wait in line)
Some adults will display a mostly ‘inattentive subtype’, others will have a ‘hyperactive/impulsive subtype’, while many will have a ‘combined subtype’ involving inattentive, hyperactive, and impulsive behaviours.
Causes of ADHD
Despite intensive research, we do not know the exact cause of ADHD, and it is possible that a number of factors may contribute to its development. ADHD tends to run in families, so the leading theory is that ADHD is an inherited neurodevelopmental disorder. Possibly, it is caused by structural and chemical differences in the brain. The fact that some people can manage their ADHD with medication suggests that brain chemicals are at least partially involved.
Signs of inattention include:
Does not seem to hear you when you ask them to do something (needing to ask a number of times to get a response)
Difficulty processing and remembering spoken information (e.g., instructions given in work meetings)
Difficult remembering peoples’ names, or to do things at a future date (e.g., service the car next week, attend an appointment)
Difficulty keeping attention on the task at hand, resulting in slow pace of work, unfinished tasks, or careless work
Easily distracted by noise and activity
Not following through on what has been asked despite agreeing to do so (e.g., pay a bill, buy groceries, hang up washing)
Losing important belongings (e.g., wallet, phone, keys)
Not paying attention when driving (accidents, near misses)
Focusing better on mentally challenging tasks in the quiet of night. Hence staying up too late to get things done
ADHD also commonly affects the following areas of an individual's functioning:
Organising and planning
Difficulty prioritising tasks (not knowing which one to do first)
Difficulty organising complex or multi-step activities (e.g., researching and writing a report, organising an overseas trip)
Procrastination around activities that are uninteresting or challenging (putting off phone calls, tax return preparation, household tasks, writing an essay or report)
Messy and disorganised house (e.g., drawers/cupboard doors left open, piles of clean and dirty clothing, unwashed dishes)
Motivation
Difficulty getting started on activities in the absence of a deadline, or despite a deadline
Taking short cuts to reduce effort resulting in sloppy work, penalties
Difficulty persisting with activities that require commitment or mental effort (e.g., learning to drive, learning to use a necessary computer program)
Time management
Losing track of time and regularly running late
Underestimating how long things will take (e.g., travel time, getting ready)
Missing appointments or turning up late
Leaving things to the last minute
Signs of Hyperactivity include:
Fidgety and restless (e.g., jiggling legs and feet, clicking pens, tapping fingers on table)
Difficulty sitting for long periods of time
Impatience
Talking constantly or too loudly
Interrupting other people’s conversations, or talking over the top of people or finishing their sentences for them
Difficulty falling asleep due to a racing mind
Rushing through activities without care in order to get them done quickly, typically resulting in poor quality work (e.g., washing dishes without cleaning them properly, writing a report without proof-reading for mistakes)
Signs of Impulsivity include:
Starting an activity without thinking through the consequences (e.g., starting a recipe without checking for ingredients).
Blurting out hurtful comments to others
Difficulty tolerating boredom
Getting excited about something new, then losing interest
Overeating and making poor food choices
Impulsive use of addictive substances such as smoking, alcohol, illegal substances, gambling, internet pornography
Impulsive sex or unprotected sex
Engaging in high risk sports or activities
Carelessly spending money on unnecessary items
Difficulty resisting the stimulation of internet, TV, and gaming
Difficulty delaying rewards
Committing to too many activities at once
Driving difficulties (speeding tickets, parking tickets)
Quality of Life & Emotional Regulation
When ADHD is moderate to severe and left untreated, an adult can experience a wide range of associated difficulties. Some researchers believe that emotional regulation difficulties such as anger outbursts are a prominent feature of ADHD. ADHD can make life difficult and therefore create secondary emotional challenges. These can include:
Feeling overwhelmed
Low self-esteem due to chronic feelings of underachievement
Short temper / brief outbursts of anger
Bouts of tearfulness or sadness with stress
Feeling socially anxious
Other common life difficulties
Failing to achieve life goals, or taking longer to achieve such goals (e.g., not completing a degree)
Working long hours due to inefficiency
Receiving warnings at work for performance issues
Problems with career development due to regular job changes (e.g., constantly restarting a different career)
Difficulty developing a long-term relationship due to getting bored with partners, being unreliable, not putting in adequate effort
Arguments with loved ones due to disorganisation or not fulfilling expectations (partner gets fed up with acting like a “mother”)
Financial difficulties due to impulsive spending
Health issues due to not taking care of oneself (e.g., dental decay, cholesterol or high blood sugar from poor diet, unplanned pregnancies, STDs)
You don’t need to have all these symptoms to be diagnosed with ADHD.
ADHD & Executive Functioning
The cognitive functions required to organise, begin and complete a task can be thought of as our “executive functions”. Each day we engage in a series of goal directed tasks or activities, from simple tasks like getting dressed through to more complex activities like completing an essay or a tax return.
Getting a task done involves recognising or remembering that the task needs to be done, paying attention to the task, resisting distraction, finding the motivation to get started, making a plan, locating important tools, persisting in the face of boredom/frustration, monitoring progress, and making changes as needed until the task is complete. People with ADHD often find it difficult to execute all of these steps, and thus often have difficulty completing life activities in line with their goals and needs. ADHD can therefore be thought of as a neurodevelopmental disorder of executive functioning.
(Adapted from ADHD Australia https://www.adhdaustralia.org.au/ February 2018)