Help advocating for myself with ADHD

It has come to my attention recently, per my therapist, that I might have ADHD. I never thought about it before; I thought my brain was just naturally scattered and inattentive. But what I've been reporting as "anxiety" is apparently more in line with ADHD. Inability to focus, restlessness (people always ask me about whether I am anxious because of how much I fidget), forgetfulness, and most importantly, executive dysfunction and an inability to start or complete tasks. Once she pointed that out it all made sense. I actually feel hopeful, that maybe my brain doesn't have to be this way.

I have an appointment with my psychiatrist on Wednesday. The problem is that he is not the most attentive psychiatrist. I've been disclosing my symptoms for months but he wants to focus on decreasing self-harm, which is fair. But I really need some tips on how to advocate for myself regarding ADHD, because if I do have it I'd like to try medication for it and see if it helps. Does anyone have any suggestions about how to advocate for myself?

[Storyteller.]

Disclaimer: I haven't been diagnosed with ADHD, so I'm far from an expert on the subject.

Unfortunately, ADHD is one of those conditions that tends to be overlooked or misdiagnosed if it doesn't present in a certain way, so it's not uncommon for the more inattentive traits to go unnoticed or be attributed to other causes (such as anxiety). It also means that finding someone with both the knowledge and ability to diagnose it can be tricky, so it might be worth looking into your psychiatrist's specialties to get a sense of whether he's likely to be receptive. Even if you do advocate for yourself here and it doesn't turn out the way you're hoping for, it doesn't necessarily mean you don't have ADHD and it definitely doesn't mean you should give up on trying to seek support.

That said, you'll likely have to demonstrate that your symptoms:

• have been present since before age 12
• are evident in multiple settings (work, home, school, etc)
• significantly interfere with your functioning/quality of life
• aren't better explained by another condition

To that end, it can be helpful to have specific examples of how these symptoms have affected or are affecting your life. Saying something like "I often forget things" will have less of an impact than being able to say "I forgot x thing and y happened as a consequence". If possible, it might also be useful to talk to people who knew you when you were younger and/or have known you for a long time, since they might be able to provide further examples or at least an outside perspective so you're not solely relying on self-reporting. In particular try to have examples for different contexts, e.g. your forgetfulness has caused friendships to deteriorate, your restlessness made studying difficult, your executive dysfunction forced you to leave a job. That way you can show that it's something inherent to you, rather than due to the situation you're in.

If you have the time and the inclination, you might also like to look up stories from people who have similar symptoms or experiences, particularly those with your AGAB and those diagnosed later in life. Knowing that other people have gone through similar things can be validating, for a start, but might also give you some ideas of how to navigate the diagnostic process. Depending on your psychiatrist's expertise/viewpoint you may get some pushback, so doing some research beforehand can help you counter that if necessary. If you're comfortable with it, you could also see if your therapist would be willing to talk to your psychiatrist about it, since sometimes mental health professionals are more likely to listen to other professionals than they are to listen to their patients.

In terms of your psychiatrist wanting to focus on decreasing self-harm, I'd recommend highlighting how these symptoms have been contributing to your reasons for self-harming. Obviously I don't know enough about those reasons to be able to properly weigh in, but it could be something like "part of why I self-harm is because of low self-esteem, and part of the reason for that is my issues with executive functioning". If you can directly trace a line between these potential ADHD symptoms and the behaviour your psychiatrist wants to focus on, it might make him more willing to hear you out and act on what you're telling him.

You could also tie it in to any goals you may have, in an "if I wasn't struggling so much with these issues I'd be better equipped to work towards my goals, which would increase my overall mental health and decrease my desire to self-harm" kind of way. Is there anything you want to achieve or work towards that the focus issues/inattentiveness/executive dysfunction is preventing you from doing? Would you feel more confident in striving for them if you were able to effectively treat the symptoms? If you show that you're thinking of the future, and that you want to work with your psychiatrist to achieve the same results (e.g. less self-harm), you can approach it from a collaborative standpoint rather than a potentially combative one (not that you advocating for yourself is combative, just that sometimes things can get tense if a mental health professional and their patient have different priorities/points of view).

Overall, remember that you know yourself better than anyone else does, and that one psychiatrist's opinion isn't going to change who you are or what you've been through. If he ends up being supportive and takes your concerns on board, fantastic! But if he doesn't, or if you have to fight for a diagnosis/treatment, that doesn't mean you're wrong or difficult or making excuses. Your brain's wired the way it is, regardless of what any psychiatrist or anyone else might say. I hope your appointment does end up going well, and that you feel heard and respected by your psychiatrist. If you're up to it, you're welcome to post an update after the appointment, I'd be interested to see how it pans out. Best of luck with it all.

[Stacey]

Hey Eli,
Everything that Charlie said I agree with. I actually just went through this with my partner. I was noticing behaviours with him that were frustrating for both him and me and recommended bringing it up with his family doctor. They did some of the assessments that you can find here.

While I don't recommend going to your psychiatrist and being like "here's the assessments I found on the internet and used to diagnose myself" I do recommend doing them yourself and pinpointing the areas that you find that you have the most difficulty. That will allow you to go into your appointment with a clear idea of the areas that you need to emphasize and you can prepare to have examples of how each of those areas of functioning are impaired, having a negative effect on your quality of life/relationships, etc.

Additionally, this youtube channel has amazing information on ADHD and was helpful for my partner.

If you ever need to talk, feel free to send me a message on discord, while I don't have the direct experience of having ADHD, I just went through, and am still going through in a lot of ways, all this with my partner so I may have some insight. I hope all goes well at your appointment.

[Celyn]

I second everything that Charlie said.

I don't know how it works where you are but I'm wondering if you could look into finding a psychiatrist or psychologist who does specialise in ADHD, or neurodivergence in general?

The problem with mental health systems is that they are very good at detecting mental health, but neurodivergence isn't classed as mental health so ADHD and autism tend to get missed completely, or misdiagnosed. For example, some women who have been diagnosed with Borderline Personality Disorder find out that they are autistic and realise BPD was a misdiagnosis. Similarly, it can be difficult to tease out what might be ADHD from other disorders, such as being impulsive and perhaps gambling, could be ADHD or it could be Bipolar. (Of course, it's possible to have BPD or Bipolar and be autistic/adhd at the same time). It's also a bit more complicated if you have a history of trauma as sometimes trauma reactions can mask underlying autism/adhd or in some cases, some might get told they have what could be a trauma reaction/trauma related diagnosis, but some professionals may be unaware that the same outward behaviour could be autism/adhd. The difference is in the underlying cause of behaviours (for example, spacing out 'dissociating' could be trauma related or it could be due to sensory/social overwhelm).

But as Charlie says, what matters is that you can find evidence that you've had traits of ADHD going back to childhood (and if possible/relevant, before trauma so that you can prove not everything is trauma related) and that its impacted your life as well. If you have family members with autism or adhd that might add to your case as well since autism can at times be genetic and autism and adhd can sometimes be co-morbid.

It's good to do some background reading too but be aware that you may come across some terms online that aren't used by professionals. For example, Rejection Sensitive Dysphoria seems to be quite common when reading online about ADHD but it's a new term coined by the online communities (I think) that even professionals might not be fully aware of.

I went through some time over the last few years where I analysed almost every memory and part of my personality, behaviour, emotions that I could think of. Except I took it a little too far and pretty much broke everything about me down based on the things I had read....and I felt like I had literally reduced myself to nothing more than a bunch of criteria and symptoms. So while it's definitely good to get help, get a diagnosis to help explain things and understand yourself more and potentially get medication as well, it can also get a little heavy when you can't figure out what might be adhd, what might be mental health, trauma and what makes you, you. Talking to someone you trust, who knows you well, or even just us on TeenHelp might help to keep your perspective as well.

(I'm not a professional nor an expert but I do have a Masters in Child and Adolescent Mental Health, where I focused on autism but have briefly come across adhd and have spent time thinking about whether I have one or both of these, but haven't gone for a diagnosis yet).

Take care and feel free to keep us updated if it helps

Thank you all for your responses. They were very helpful, and I used them in my preparation notes for talking to my psychiatrist. Unfortunately, he shut the idea down before I could even really get into my concerns or why I was asking, even though I told him it was my therapist who had encouraged me to ask him. He simply said "no" the second I mentioned ADHD and said it was "over-diagnosed." Needless to say I felt very upset after the appointment.

Thankfully my case management appointment was about thirty minutes after that, so my poor case manager got to listen to me rant. Luckily he was a kind and compassionate listener, and we decided to try and find me another provider. The problem is I have Medicaid, which is like government insurance here in the U.S. The problem is that not many providers take it because it doesn't offer as much financial return as private insurance, plus it's much more paperwork, apparently. Finding a provider is already stressful enough, but my limited options will make it more difficult.

I just don't know what to do. The way my brain works is really affecting my self-esteem, and I didn't even have the chance to convey that to my psychiatrist before he shut me down. He says it's probably anxiety or a mood disorder causing my symptoms, not ADHD, but then all he does for my anxiety is up my Vistaril to two times a day. Like dude, that's not going to do anything. It's just so frustrating when I've been complaining about anxiety or maybe ADHD or whatever for months and he does nothing. It makes me want to scream.

[Stacey]

I'm sorry to hear that Eli, that's very frustrating but unfortunately not an uncommon problem in the diagnosis of ADHD, especially in adults. Unfortunately, the biases about ADHD that became prevalent in the 90s about the overdiagnosis of it is still ingrained in our medical system despite having much more and much better research on the topic now.

I'm glad your case manager is going to work with you on hopefully finding a new provider, despite the limitations. Medication is helpful for many, but ADHD actually responds really well to different behavioural therapies like ACT/CBT as well as lifestyle changes, so if you had someone you could discuss those things with that isn't your psychiatrist you could maybe consider giving those a try in the meantime. There's a lot of reliable information out there about this. Like this article.

There are also really great books you can read, The Happiness Trap by Russ Harris is aimed at depression/anxiety but it teaches the principles of ACT which are very helpful in ADHD. There are a number of CBT workbooks as well. If you find you have access to a therapist that does CBT/ACT therapy at all, it may be something to consider.

I hope that everything works out and that you find a new provider that is willing to listen to your concerns instead of brushing them off. Having that kind of response from a healthcare provider can be incredibly discouraging. I'm glad you have the support of your therapist and case worker though.

Here is a great website that you may find helpful too, they have a great resource and support page:
https://chadd.org/

[Celyn]

I'm sorry to hear your psychiatrist completely shut it down before you could even explain. I'm glad your case manager listened to you though and I hope that you are able to find another provider.

Even though we tend to discourage others from self-diagnosing and that only a professional can diagnose, I do think there should be a caveat for neurodiversity. Personally, I think that if you feel you might have ADHD then it's worth looking for techniques that work for you or talking to others who have ADHD to see what helps them. ADHD-alien is a good resource for relatable comics and tips on how to cope. Sometimes, it's also about letting go of expectations of how you should be and accepting more of who you are. It's not a replacement for medication, I understand, but it can still help a bit while you try to get a diagnosis and potentially medication.

[Storyteller.]

I'm so sorry it didn't end up going well, and that you were dismissed so quickly. I agree with Stacey and Holly that it might be helpful to look into resources and tips for ADHD people anyway; even though medication isn't an option at the moment, you may be able to better understand the way your brain works with this new framework of potentially having ADHD, and that can help find ways to deal with the problems you're facing in the meantime. I really hope you're able to find a better provider, because you deserve to get the right diagnosis and support.