Question: There are many providers who don't recognize or diagnose ADHD that does not directly present as the DSM definition.  Do you have recommendations for how to approach your healthcare provider (or family/friends for that matter) if you suspect ADHD but in atypical form (subthreshold, late onset, high performing, etc)?
Answer: Thanks for raising this important issue.   Nonexpert clinicians are often reluctant to diagnose atypical forms of ADHD.   When I lecture on the topic, I recommend;
  
  1. If one suspects subthreshold ADHD, document that impairment occurs in two or more settings before making the diagnosis and be sure that no other full threshold diagnosis requires treatment first.
  2. For late onset ADHD, try to find some evidence of ADHD related impairments in childhood.  Get info from a parent if possible. Determine if childhood symptoms may have been masked by compensatory resources  (e.g., high IQ, high creativity, social support).  Also follow #1 above.
  3. For high performing ADHD, assess compensatory resources define impairment if the person is functioning at a level that is lower than expected given their aptitude even if their level of functioning is higher than average.
content: Q: There are many providers who don't recognize or diagnose ADHD that does not directly present as the DSM definition.  Do you have recommendations for how to approach your healthcare provider (or family/friends for that matter) if you suspect ADHD but in atypical form (subthreshold, late onset, high performing, etc)?
   Ans: Thanks for raising this important issue.   Nonexpert clinicians are often reluctant to diagnose atypical forms of ADHD.   When I lecture on the topic, I recommend;
  
  1. If one suspects subthreshold ADHD, document that impairment occurs in two or more settings before making the diagnosis and be sure that no other full threshold diagnosis requires treatment first.
  2. For late onset ADHD, try to find some evidence of ADHD related impairments in childhood.  Get info from a parent if possible. Determine if childhood symptoms may have been masked by compensatory resources  (e.g., high IQ, high creativity, social support).  Also follow #1 above.
  3. For high performing ADHD, assess compensatory resources define impairment if the person is functioning at a level that is lower than expected given their aptitude even if their level of functioning is higher than average.