Receiving assessment results that suggest you don’t have ADHD can lead to feelings ranging from shock to relief to disappointment. But an assessment coming back clear doesn’t mean there’s nothing you can do about your or your child’s symptoms. Here are some steps you can take if an evaluation shows you don’t (or may not) have ADHD.
Find out more about the testing
First: “It is important to make sure the person assessing you or your child has experience in assessing ADHD,” says Dr. Gayle Jensen-Savoie, ADHD Online’s division chief of psychology and teletherapy. “They should be a qualified professional such as a psychologist, pediatrician or psychiatrist.”
It also helps to know what the original assessment covered, says Erik Newman, PhD, a clinical psychologist who specializes in evaluations for children, adolescents and adults with suspected ADHD and other disorders.
Newman notes some professionals may check for attention-related disorders using a few questions or a quick behavioral screener. “Oftentimes, patients don’t realize they’re not being fully assessed for attention problems,” he says. “In many cases, that screening may be perfectly sufficient. But in some cases, it won’t be.”
Other professionals, including Newman, use a range of evaluations to establish a diagnosis. “This means not only relying on information from an initial interview, but also collecting rating scales from the patient, parents, teachers, or observers, and administering performance-based tests of IQ, attention, executive functioning and more,” Newman says.
If your assessment didn’t include these components, Newman suggests seeking testing from a licensed psychologist or assessment and treatment company that specializes in these assessments.
Get a second opinion
You may also want to seek a second opinion relating to your symptoms. Whether you should do so depends on many factors, says Jensen-Savoie. For example, it’s something you should consider if you’ve been working with your child’s school, or a therapist, for a while and have not seen improvement in your symptoms or your child’s behavior.
It also depends on your or your child’s age. “In kids, sometimes if they are not listening or misbehaving, that’s not necessarily ADHD,” says Dr. Raafia Muhammad, MD, MPH, ADHD Online’s clinical division chief and interim chief medical officer. “It could be an age-appropriate response.”
Newman explains ADHD is most commonly diagnosed during the elementary school years. “By later adolescence and adulthood, hyperactive symptoms decrease in most individuals” he says. “Some research suggests that half the children with ADHD no longer meet full criteria by adulthood. However, challenges with inattention, disorganization, poor planning and impulsivity often persist and remain impairing, even if full criteria are no longer met.”
If you’d like a second opinion or further testing, Newman suggests acting quickly. Appointment wait lists are often long, especially for psychologists who accept insurance.
“If you’re already at crisis point, you may want to pursue diagnosis and medication treatment through your physician while you wait for your testing appointment,” he says. Newman adds that if issues with your child occur primarily in school, you might ask your child’s school district to evaluate eligibility for an Individualized Education Program or 504 plan. These are accommodations and help that federal law requires for eligible students.
Still work to manage the symptoms
Professionals diagnose ADHD using guidelines set out in the American Psychiatric Association’s Diagnostic and Statistical Manual, or DSM. Some people’s symptoms may not meet the criteria, but that doesn’t mean they don’t have an impact on a person’s functioning.
If you have ADHD-like symptoms, you can still do things to manage them. Dr. Stacy Haynes, EdD, LPC, ACS, a licensed professional counselor and educator with over 20 years of mental health experience, recommends strategies such as exercise, diet changes and training to improve executive functioning skills.
“Many people, regardless of whether they have ADHD, have executive function skills strengths and challenges,” says Taryn Dickey, an ADHD coach who has ADHD and who holds a master’s degree in counseling. “Things like stress, lack of sleep and uncertainty can all impact functions such as initiating tasks, sustaining attention and time management. Think about the last time you had a poor night’s sleep and how it impacted your concentration the next day.”
Dickey suggests finding out which skills are a challenge, then looking for ways to develop them. “Just as you’d practice basketball to get better at basketball, we must practice these skills to get better at them,” she says. “For example, to help with sustained attention, you could try a timed mindfulness practice, beginning with five to 10 minutes most days and slowly increasing.”
Consider other mental health or neurodevelopmental conditions
If assessments rule out ADHD, it’s possible another neurodevelopmental or psychiatric condition could account for your or your child’s symptoms. Newman says professionals may need to cast a wider net to look for conditions such as autism spectrum disorder, learning disabilities, depression, anxiety, bipolar disorder and disruptive behavior disorders. He recommends asking your mental health provider whether they assess these conditions as well.
Nzingha Ma’at, a licensed professional counselor, behavior specialist consultant and certified yoga teacher, agrees that various other challenges can present with similar symptoms to ADHD. “I’ve worked with many clients who have been misdiagnosed with ADHD, or believed they should have been diagnosed with ADHD but did not meet the criteria,” she says.
This includes people with a history of trauma. “A deeply disturbing event one has witnessed or experienced in their life has been linked to many symptoms that can present as ADHD, including severe distractibility, as well as irritability,” Ma’at says. “It would be beneficial, whether diagnosed with ADHD or not, to assess whether trauma has contributed to your symptoms.”
Ma’at suggests asking your health professional about taking the Adverse Childhood Experiences test.
Look for other potential causes
There are also many causes of ADHD-like symptoms not related to mental health, Newman adds. “For example, poor nutrition, poor sleep habits and a wide range of medical conditions can affect attention,” he says. “For that reason, you’ll want to consult your physician to rule out possible medical causes of inattention.”
Muhammad recommends making sure you get blood tests to rule out conditions such as diabetes or a thyroid abnormality.
Ma’at adds it’s important to consider the mind/body connection. She suggests a diet high in processed foods and sugar may contribute to difficulties remaining focused. She recommends seeing a nutritionist to assess your diet and get support for making any changes to meet your health needs.
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