My ADHD Evaluation, Diagnosis, and Treatment Plan So Far

A brain dump of (hopefully!) helpful information.

Listen as you read (I listened as I wrote):

I know these changes hurt like hell

But underneath your bandages I swear you’re getting well

Call yourself a victim, and that’s what you will become

Lay it down, let it go, and run

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Hi, it’s me.

Last week I felt antsy about sending another ADHD-related newsletter because I’m already bored, which is hilariously so ADHD that the cliche is embarrassing. And today I have another one! Are you as tired of reading about this as I am of sharing it for all these weeks?! 🫣

Actually, don’t answer that yet. I’ll ask you for real when this is over.

I’m willing myself to be encouraged by your response so far—it seems my story is resonating, as you can see by a few comments:

Thanks again so much for sharing your journey. I have hesitated a long time to talk to my primary care provider about all this…and reading about your experiences has given me the courage to talk to her about this. -Libby

Thank you for being so open and sharing so much. Now i don't feel quite as out of place as i usually do! -NJ

Awesome, awesome, awesome. Awesome, Jen. Hard relate - particularly the employment history. -Rebecca

I feel like you just took me on a journey through joy and confusion and hope and grief, etc., all wrapped up in one. It's such a great reflection of what this whole experience is like. Thank you for that! -Hanna

If you’d like to catch up on previous installments, access the full series here in one place. This week I’m sharing a little brain dump of information about my present day circumstances.

Hi, it’s me.

My whole life it never occurred to me I might have ADHD.

Not a single time. Growing up in the 70s and 80s, it was framed as a thing that kept hyperactive boys from staying in their chairs at schools. I was vaguely aware that parents judged each other for medicating or not medicating their kids, college students took Ritalin to stay awake studying all night, and critics complained that kids just needed to be properly parented.

Me? I was nowhere near hyperactive. People kept telling me to pay attention! Pick up the pace! Just get it done, already! My thoughts and actions never flitted from here to there and back around again like a hummingbird. Instead, I daydreamed during class and struggled to organize the steps to get a project done. As a parent of young kids, I struggled to start the day and get everyone out the door on time–not because I was easily distracted, but because I would lay on my bed after showering and stare at the ceiling. 

None of this pointed toward the hyper schoolboy version of ADHD that I was aware of. At worst I was lazy and disorganized. At best, I was depressed. It seemed entirely reasonable to me that I just sucked at everything.¹

Below you’ll find some high-level information about my diagnosis and treatment journey, in case you’re exploring and want to know what it might be like. At the end, happy to answer any questions you might have in the comments.

Thanks for following along!

Until next time,

Jen

Here is where I remind you that I’m not a healthcare professional and my newsletter is literally called Pretend You’re Good At It.

I’m here to share my experience only. Please do your own research and talk to your doctor.

Evaluation

I finally pursued an evaluation with a specialist on the recommendation of my therapist. This involved a discussion with a trained healthcare practitioner about my symptoms and how they were currently impacting me, some discussion of how it might have shown up in my childhood, any related family history, and a formal diagnostic questionnaire. 

Diagnostic standards require 5 or more symptoms for an adult diagnosis–I scored 7 out of 9 for the Inattentive Criteria and 0 out of 9 for the Hyperactive-Impulsive Criteria.²

Here is a simple description of the difference between Inattentive and Hyperactive ADHD:³

• Predominantly Inattentive Presentation: This term applies to individuals with ADHD who primarily struggle with executive functions, such as planning, staying on task, organization, and focus.

• Predominantly Hyperactive-Impulsive Presentation: This term applies to individuals with ADHD whose symptoms primarily center around excessive movement and impulsivity⁠—for example, fidgeting, struggling to sit still, and interrupting.

• Combined Presentation: This term applies to individuals with ADHD whose symptoms include both inattention and hyperactivity/impulsivity.

I didn’t know this Inattentive variety existed before last year. 

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Treatment

Coaching. Immediately after my diagnosis, I pursued ADHD Coaching as recommended. The fee for this was about the same as therapy but not covered by insurance, so I only engaged in the coaching for about three sessions. I appreciated these sessions because they centered around practical ways to manage my daily tasks, energy, and motivation. I know I can watch videos or read articles on this sort of thing, but I benefited from being able to brainstorm solutions for specific personal scenarios. 

Medication. I learned there are a variety of medication options, both stimulant and non-stimulant, and short term or long lasting. Right now I’m taking Concerta, a stimulant with the active ingredient methylphenidate.⁴ It’s a long acting slow release drug, so I take it once a day early in the morning to avoid it impacting my ability to fall asleep. I experimented with three dosage levels and landed on the one in the middle.

Every day for the first week or so of taking medication, I could literally feel a rush of euphoria flow into my brain behind my forehead. It felt like my brain was waking up, rolling over in bed to make eye contact with me, and sleepily saying, “Good morning, gorgeous. I’ve missed you.” I don’t really feel that rush of euphoria anymore, but I definitely feel the impact on days when I don’t take my medication.

Side Effects. The main side effects I experience are appetite and thirst suppression, and difficulty falling asleep. Despite being warned of these side effects, I still found myself feeling cotton-mouthed and headache-y during the first week, suddenly realizing I’d barely drank (drunk?) any water for a few days. I have to be intentional about filling my water bottle and getting through it twice a day, because I just don’t feel thirsty. Similarly, sometimes I start to feel low blood sugar-y in the middle of the afternoon because I forgot to eat lunch, so I’ve had to establish routines to make sure I eat on a schedule.

I will also mention that I’ve experience some out-of-the-blue anxiety and chest tightness that may be panic attacks or maybe I’m dying. Hard to say. I’m also in perimenopause with wildly fluctuating hormones which seems like the more likely explanation. Neither my medical doctor nor my prescribing practitioner have connected these symptoms with my medication, so it’s more likely that I’m dying.⁵

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Questions?

So that’s an overview of my personal experience–I don’t want to bore you with the pesky details unless it’s helpful. Feel free to ask me anything, whether out of curiosity or in search of data to support your own hunches. I’m happy to share what I know or point you to resources I’ve found.

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Next week is the final installment!

⭐️ October 2: I’ll share how I discovered a language around my “life work,” realizing how everything I’ve ever done has instinctively orbited around one North Star, even in my chaotic ADHDness. In other words, I’m not as undisciplined as I thought!

1. “ADHD symptoms continue to be overlooked in young girls and teens, even when they are struggling. Most experts conclude this is because girls more often exhibit the predominantly inattentive presentation of ADHD, while parents and professionals expect to see the predominantly hyperactive-impulsive presentation more often seen in boys. Previously, it was assumed by some medical professionals that ADHD was a condition mainly found in boys, and they did not evaluate girls without the hyperactive-impulsive presentation for the disorder” (source).

2. You can read more about all the criteria considered for a diagnosis HERE.

3. Source for the descriptions is HERE.

4. For context, Ritalin is also a methylphenidate, and Adderall is an amphetamine. They’re both stimulants, but they have different formulations.

5. Relax. Dark humor is how I cope.