Building a Thorough Adult ADHD Diagnosis

This episode, "Building a Thorough Adult ADHD Diagnosis," follows the panel as they walk through what it actually takes to reach a confident diagnosis in an adult patient.

Dr. Feld walks through the practical steps of diagnosing ADHD in adults, starting with simply looking for it. Most adults arrive already carrying diagnoses of anxiety or depression, so clinicians must actively screen underneath those existing labels. He anchors every evaluation around the question of why the patient is presenting now, probing for a new job, a new parenting role, a DUI, or relationship trouble that has exposed longstanding symptoms. Dr. Feld explains he never diagnoses an adult after a single visit, because he needs a full developmental history, since most adult patients had childhood symptoms that were compensated for or never recognized. He describes patients whose families came from cultures or countries where ADHD was rarely diagnosed, and stresses collecting collateral information from parents, spouses, or children through rating scales completed by people outside the patient. That process sets expectations for what a second appointment should surface.

Dr. Patel agrees that clinicians often shortchange themselves on the time needed to reach an accurate diagnosis. She lets patients sit with difficult questions and return weeks later once they have had time to process and generate concrete examples, which yields a more refined diagnostic picture. Dr Parcells notes this luxury of time is not always available, particularly in general pediatrics, where visit length is often dictated by scheduling constraints. Speaking as a pediatrician, Dr. Parcells describes how parents frequently recognize their own ADHD symptoms while she is diagnosing their child, prompting emotional "that was me too" moments in her office. She routinely discusses genetics with families during pediatric evaluations, and describes parents identifying each other's symptoms, underscoring why identifying ADHD across an entire household matters for effective, family-based treatment strategies.

Our next episode, "Underdiagnosis and Comorbid Conditions in Adult ADHD," turns to why so many adults with ADHD go undiagnosed, and how comorbid anxiety, depression, or eating disorders can obscure the underlying condition.