Here in the ADHD blogosphere, we talk a lot about ways ADHD awareness can be improved in the general population and common misconceptions people have about ADHD. It’s great that we have these discussions because the more we’re able to spread an accurate picture of what ADHD is, the better it is for all of us in the long run.
But today I want to talk about a group of people we really shouldn’t have to spread ADHD awareness to: doctors. It’s to be expected that your average person off the street won’t know much about ADHD, but doctors are supposed to know better. It’s their job, after all.
Many people with ADHD end up getting diagnosed in spite of their doctors, not because of them. If you look through the comments on this blog alone, you’ll find many examples of people who recognized ADHD symptoms in themselves but had to visit multiple doctors before anyone took them seriously.
Now, there’s no question that some people get told they don’t have ADHD by their doctors because they really don’t have ADHD. But there are a lot of people who do legitimately have ADHD whose concerns are dismissed for reasons that no doctor with a real understanding of ADHD would give – you would’ve known by now, you’re too smart, you’re too successful, you’re too old, treating it wouldn’t make a difference anyway, etc.
The fact that so many people have to visit multiple doctors to get diagnosed with ADHD tells us that a lot of people with ADHD are simply falling through the cracks. It’s a minority of people with ADHD who are going to recognize ADHD symptoms in themselves, visit a doctor, and then persevere to get a diagnosis after being rebuffed by the first doctor they visit.
When I sought out mental health treatment for the first time, I was lucky that I had a psychiatrist and therapist working together who had the insight to consider ADHD. The doctors I’ve seen since then have been pretty hit-or-miss as far as their experience treating ADHD, and I might be in a very different position right now even if I’d just had them in a different order. If I’d started off with a different doctor, there’s a good chance I wouldn’t have gotten diagnosed with ADHD – and I probably wouldn’t have known to go get a second opinion.
It’s not that doctors don’t know the symptoms of ADHD. I’d imagine that most doctors can rattle off the DSM criteria for diagnosis. The problem is that knowing the symptoms doesn’t necessarily mean understanding the different ways these symptoms manifest in everyday life.
Like people in the general population who don’t know much about ADHD, doctors who don’t understand ADHD well tend to have a one-dimensional view of the disorder. They have a narrow picture of what the disorder looks like because they aren’t familiar with the breadth of the different ways ADHD can show up in people’s lives. As a result, they don’t pick up on ADHD symptoms in their patients, instead persisting with failed treatments for other disorders like depression or anxiety.
Understanding what the condition looks like off the pages of the DSM is where experience comes into play. Doctors who’ve worked with a lot of patients with ADHD have a more nuanced perspective on how ADHD can express itself in different people. So if you ask about being evaluated for ADHD, they won’t dismiss the question offhand based on the fact that you have a college degree – and you might not have to be the one to start the conversation about ADHD at all!
This is why my advice to anyone who thinks they might have ADHD is to talk to a doctor with experience treating ADHD. By the way, notice that I said anyone who thinks they might have ADHD. Too often the way it works right now is: if you’re sure you have ADHD, go to a doctor and then go to another if the first doctor doesn’t know anything about ADHD.
I get that GPs can’t be expected to have in-depth knowledge about ADHD, but there’s really no reason psychiatrists shouldn’t have a damn good understanding of what ADHD is and isn’t. I haven’t been to med school, so I’m not sure what the problem is here, but for some reason it appears that a lot of psychiatrists just don’t know as much about ADHD as they should.
The consequence of all this is that a lot of people with ADHD never know they have ADHD. To put that another way, a lot of people who are struggling will never know why they’re struggling and will never have access to the tools that could help them take their lives in a new direction.
Incidentally, I’m not sure underdiagnosis is the only problem here. It’s true that ADHD is also overdiagnosed in some sections of the population, and I’d guess that the same lack of awareness among medical professionals at the root of underdiagnosis in some groups also leads to overdiagnosis in other groups. Really, it’s just a problem of incorrect diagnosis, which leads to some people being diagnosed when they shouldn’t and a lot of people not being diagnosed when they should.
I started this post by saying we shouldn’t have to spread ADHD awareness to medical professionals, and I want to close by saying that I mean that literally: if you’re receiving treatment from a doctor whose comments suggest they lack the skills, knowledge and experience required to treat ADHD, there’s really no point arguing with your doctor – at best they’ll ignore you, and at worst they’ll actually listen to you and proceed to treat you for a disorder they don’t know anything about!
The solution is just to go get a second opinion from someone who does have experience with ADHD. Doing so doesn’t mean you’re guaranteed to be diagnosed with ADHD, but the point is to get an informed, professional evaluation. In an ideal world, you’d be able to get one just by going to a psychiatrist and trusting that they know what they’re doing, but the truth is that given the uneven understanding of ADHD across the medical community, making your own judgment call about when to go for another opinion is necessary at times and more than worth the trouble.
Have you dealt with medical professionals who didn’t understand ADHD? Did you have to see multiple doctors to get diagnosed? I want to hear your ADHD diagnosis horror stories in the comment section. Let’s shine some light on this problem.