> The actual reason why America is an outlier is widespread over-diagnosis.
> A typical ADHD diagnosis in America is done by a paediatrician or a family doctor in an office visit as brief as 15 minutes. The norm in Europe is an hours-long assessment by a psychiatrist.
Anecdotal evidence, but our experience is — and most people/teachers/doctors we talk to say — that most diagnosis are done via similar long tests.
I’ve not heard of doctors/teachers trying to address ADHD without a formal test being done.
Are others able to confirm that they know of diagnosis from a “15 minute doctor visit”?
EDIT: In fact, our insurance won’t even cover medication for our son without a formal checkup — every 3 months.
Sure, some may “unofficially” think or claim to have ADHD from talking to their doctor that may say something like “it’s possible you/your child has ADHD”, but I find it hard to believe that actual treatment/IEP (individual education plan) happens without a formal diagnosis.
Similar to another poster. Our 6 year old was just diagnosed with it.
The formal test was a short survey about our childs behavior in various situations. It was highly subjective with questions similar to "My child has difficulty sitting still" (Never, Sometimes, Often).
There was not example of what is considered sometimes or often and what is age appropriate for a 6 year old.
The survey was required to be answered by the parents and kindergarten teacher. That was all that was necessary to have the option of medication.
Even more surprising is that with only slight more effort we now have the option to put our child on an IEP (indivdualized education plan) where there will now be a full additional teacher in the classroom assisting her.
Overall it has been an eye opening experience. Compared to our first child, our 6 year old is more spirited, but is not violent or defiant. She is mostly concerned with her own interests and will admittedly have difficulty focusing for long periods of time. I would be very curious if her behavior is above the threshold for ADHD in other countries.
This was just our experience and it is very possible that our child was an obvious case so further analysis was not necessary. For now we have opted not to use medication. Interestingly our diagnosing pediatrician has two children with ADHD and said that they put both children on medication at 6 years old.
This is like every 6 year old lol. I bet you I would have been diagnosed with ADHD if I was tested, but in truth I was just an active kid who didn’t like sitting in a classroom chair all day.
Yes, I have such a diagnosis and can confirm this, but it was many years ago. I assume it's still the same.
I got a short quiz to see what symptoms I was complaining about and then I got asked about my drug usage and why I was seeing them.
I told them that I tried a friend's adderall once and I felt so much better immediately.
They told me drinking 2 pots of coffee a day, doing tasks out of order, "just in time laundry", and being "excitable" is actually ADHD and that I'd be better off if I took these pills every day and cut way back on the caffeine.
It took about 15 minutes.
What other questions would you have? Do you think you'd need to give me the long-form test? Lol.
I followed the advice btw. It's going well many years later and I hope RFK doesn't take the stimulants away.
In california (and i would have guessed nationally) at least you do need a long form test in order to get control prescription like adderall. But the test is more of a "video game" style that tests your attention
Adult diagnosis is weird. I’m assuming you were not a child drinking that much coffee. Adults have decades of coping mechanisms obscuring the signal, and yet just talking to an adult with ADHD for an hour will tell you whether the person has ADHD instead of being a stimulant junkie that read the DSM to present manufactured symptoms. It’s exhausting to talk to someone with ADHD for hours if you don’t have exactly the right disposition (like being a polymath or having it too).
They will still often want you to do a sleep study, because chronic lack of quality sleep or chronic stress looks a hell of a lot like ADHD. It’s also why you want the person with ADHD to write or at least copy edit your emergency procedures because they haven’t just adopted chaos, they were born in it, molded by it. They were adults before they ever saw order and to them it was just blinding. They will absolutely write a procedure that won’t skip steps or overly rely on the actors to be calm and present of mind to pull it off.
This is wild. It took me ~20 years as an adult to get diagnosed because I couldn’t get my shit together to keep going back to neuro-psychiatrists to progress through the testing pipeline.
In my ten years as a teacher, I've had just one student whose pediatrician prescribed ADHD meds, much to the alarm of my colleagues. Typically, an ADHD diagnosis is the result of either a full neuropsychological evaluation, which requires several visits with a clinical psychologist and extensive observation forms for teachers and parents to complete.
At my university I know at least one person who intentionally tested positive soley for profit - the drugs sold/sell for huge markups, especially around exam time.
No idea what all it entailed other than the fact that they're unable to screen people out when I assume there are probably quite a lot of people doing or trying to do what he did.
It's possible the process is tuned to make sure most people who need it can get it even if that means some people can abuse the system and their fellow people.
>Are others able to confirm that they know of diagnosis from a “15 minute doctor visit”?
Yes, I got mine this way. Telehealth during Covid was notorious for this, but lot of NP/PA offices now do the same thing, just with a single in person visit.
Adult me had a therapist visit for anxiety, after an hour with the first guy he said that he suspects mild ADHD, but it would need to be confirmed by someone else and it wasn’t something he would prescribe anything for in the mean time. No idea what is next but most of this is outside my budget currently so it’s on hold. Doesn’t seem easy to get a confirmation in my experience
I have two children diagnosed with ADHD. The first was acting so erratic in class that he ended up missing four weeks of school because they kept sending him home. The doctors suspected ADHD, but refused to diagnose it without going through the full process. Short-term therapy, then long-term therapy followed by a psychiatric review. Once he got medication everything went back to normal.
We just started the evaluation with our second child and it's the exact same process. Not that I doubt some doctors cut corners, but I haven't personally seen it.
This was our experience with our daughter about a decade ago. Her school required a diagnostic test that took several hours and cost several thousand dollars.
It took me 15 minutes, thank God, because seeing a psychologist and psychiatrist would have taken 18 months and cost me much more for something I obviously have.
Back in the 1970s I had a bed wetting problem. They tried a medication called Ritalin to address this problem. This medication had an interesting side effect of making me pleasant to be around for the first time in my life. Both my parents and all of my teachers remarked on how much better I was able to pay attention and be kind to other people. Then they took me off the medication and I reverted to my wild ways. I don't think many or any people had heard of ADHD back then, so it didn't occur to anyone to try to medicate me for what I clearly had. Over the decades I've learned to cope with ADHD without medication, but I can't help but wonder how much better my life would have been if I had been able to concentrate and not been so hyperactive. Maybe I would have done better in school and had friends.
Even today, I wonder if I should go through the trouble of being diagnosed and getting on medication. The last three days I wasted my time instead of doing the work my company pays me to do and got exactly nothing done. The entire time I kept thinking, "I really should do that work so I can keep my job and provide for me family" but I couldn't concentrate and procrastinated day after day.
Most of my children have ADHD. Before they could be diagnosed, they did have to go through extensive testing by a psychiatrist and there were interviews conducted with us as their parents and with their teachers. The 15 minute diagnosis mentioned in the article has not been my experience. We have regular meetings (every 6-8 weeks) with the psychiatrist to evaluate their dosage and how things are going.
> but I couldn't concentrate and procrastinated day after day
Please make sure to take care of yourself and try going through with the diagnosis. What you described is very similar to what I was going through - severe procrastination which resulted in worse and worse performance at work, eventually I had to quit my job because of it. Later I’ve learned procrastination of this magnitude is basically your subconscious screaming at you that something is not right and you should be taking care of yourself instead of forcing yourself to work.
On a side note - ADHD is hereditary so if your children have it there’s a good chance you and/or your SO have it too.
Hey! I got diagnosed with ADHD last year as an adult and getting diagnosed and medicated has been a massive improvement in my quality of life. If you have the energy to do it, I would strongly recommend it. The medication is great—I have far fewer "stare at the wall, bounce in my seat, get nothing done" days—but I also appreciate having a concrete diagnosis. Even after decades of assuming I had it, it felt good to actually hear it from a doctor for some reason.
I had a bedwetting problem too. It was awful and tormenting, when visiting friends I had to bring clothes and sleep on the floor. Male puberty solved it almost to the day. All of a sudden it was gone and what a relief that was. I think it was just training the lizard brain to hold things a little tighter during sleep, or until then the nerve pathways were not supple enough.
> Even today, I wonder if I should go through the trouble of being diagnosed and getting on medication
Maybe talk to people diagnosed with ADHD as adults? Of my acquaintances like that, they mention an immediate improvement. The benefits were very obvious to them.
It is almost as if we should test for ADHD by just testing amphetamines in questionable situations and just seeing if people respond well?
Likely very questionable advice, but if you are a risk-taking type then maybe score something and just test it on yourself? Try to be scientific of course. And try to understand the risks (which you need to understand even if you were diagnosed by the medical system).
> A typical ADHD diagnosis in America is done by a paediatrician or a family doctor in an office visit as brief as 15 minutes.
I'm in my 30s, and in the process of receiving a diagnosis after it had been suggested to me my entire life by teachers, colleagues, and friends. I avoided diagnosis and medication mainly because I was skeptical of the safety record of medications -- probably because that's why my parents never sought a diagnosis for me when I was younger.
After doing more research the past few years, I learned that ADHD medications are the success story of medical management of psychiatric illness, and they have a strong safety record
In any case, for me so far it has involved four (4) 2-hour appointments with a clinician, having trusted colleagues and close friends fill out detailed "external rater" forms in which they rated my executive dysfunction, and (yesterday) a marathon 4-hour long testing session in which I took a sequence of standardized tests under the supervision of a clinician.
I know that diagnosis of ADHD in children is a different animal, and even for adults there are clinics that provide a diagnosis and prescription in a half hour or so -- but not everyone with ADHD is diagnosed after a single 30 minute session with a provider. And contrary to another sibling comment, there are fairly robust objective metrics for identifying the hallmark features of ADHD and executive dysfunction.
If you are truly interested, these can be found with a quick search query -- I won't do that here for you.
But you will find that ADHD is one of the most widely studied psychiatric illnesses with strong neurobiological basis and well known measurable correlates, and as I mentioned, has the highest response rates to medication for a psychiatric condition. So you should have no trouble finding out more!
> Few things agitate Robert F. Kennedy junior, America’s new health secretary, more than the rate of attention-deficit hyperactivity disorder (ADHD) among American children. And for good reason
I'm sorry, let me stop you there. What in the world are you talking about? The government's main guy looking after America's health is obsessed with ADHD diagnosis rates -- for good reason? That is absolute madness. Got nothing better to do, I guess. No infinitely long tail of the global pandemic that was ravaging the population a couple of years ago? The threat of bird flu? Dare I mention health insurance?
I can't read the article, but I can say (a) that Americans are generally much less opposed than Europeans to treating mental disorders through medication, and (b) the best available information tells us that ADHD is underdiagnosed, not overdiagnosed, even in America.
The moral hazard is pretty clear. Testing is profitable and so are the drugs. If they are wrong, there is no penalty. For the same reason an optometrist lied about my perfect vision as a child and conned my parents into glasses I never used paid for by insurance.
Remember doctors are there to advise not to command, know the hazards and be willing to say no or consider the data from your own perspective.
I like to tell people if you go to a carpenter to build a table, you'll get a wooden table. If you go to a stone cutter, you'll get a marble table. If you go to a welder, you'll get a metal table.
The trick is to know who to go to get what you want. In the USA with PPO there is generally zero friction to just making yourself an appointment with a speciality doctor and that specialty doctor will use his "toolbox" to create the outcome that you came to him and paid for. If you go to a psychiatrist, well their tool is prescription medicine, so that is what they'll use.
This sounds like common sense, but i think the population at large places too much trust in the doctor. In the US you have to be your own advocate.
An idle idea I’ve had is that the healthcare bureaucracy in the U.S. can get so bad that one wishes one can hire a lawyer-type of role to navigate it as a paperwork proxy of sorts. But perhaps greater scope is needed- a personal medical advisor who has the domain knowledge, while being independent of the incentives that drive others in the health system.
I suppose in the past that would just be your family doctor, wasn’t it.
Because what used to be a generic indicator of distracted early childhoods (whether by nutrition, environment, weird parenting) got a new name.
And it is no coincidence or surprise that brain stimulants like amphetamines dominated the first wave of treatment. People 'perform' better on amphetamines, always have. They work so long as you concentrate on the short term and ignore long term issues like increasing tolerance, increasing demand and ultimately schizophrenia from chronic deep sleep deprivation.
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> A typical ADHD diagnosis in America is done by a paediatrician or a family doctor in an office visit as brief as 15 minutes. The norm in Europe is an hours-long assessment by a psychiatrist.
Anecdotal evidence, but our experience is — and most people/teachers/doctors we talk to say — that most diagnosis are done via similar long tests.
I’ve not heard of doctors/teachers trying to address ADHD without a formal test being done.
Are others able to confirm that they know of diagnosis from a “15 minute doctor visit”?
EDIT: In fact, our insurance won’t even cover medication for our son without a formal checkup — every 3 months.
Sure, some may “unofficially” think or claim to have ADHD from talking to their doctor that may say something like “it’s possible you/your child has ADHD”, but I find it hard to believe that actual treatment/IEP (individual education plan) happens without a formal diagnosis.
The formal test was a short survey about our childs behavior in various situations. It was highly subjective with questions similar to "My child has difficulty sitting still" (Never, Sometimes, Often).
There was not example of what is considered sometimes or often and what is age appropriate for a 6 year old.
The survey was required to be answered by the parents and kindergarten teacher. That was all that was necessary to have the option of medication.
Even more surprising is that with only slight more effort we now have the option to put our child on an IEP (indivdualized education plan) where there will now be a full additional teacher in the classroom assisting her.
Overall it has been an eye opening experience. Compared to our first child, our 6 year old is more spirited, but is not violent or defiant. She is mostly concerned with her own interests and will admittedly have difficulty focusing for long periods of time. I would be very curious if her behavior is above the threshold for ADHD in other countries.
This was just our experience and it is very possible that our child was an obvious case so further analysis was not necessary. For now we have opted not to use medication. Interestingly our diagnosing pediatrician has two children with ADHD and said that they put both children on medication at 6 years old.
This is like every 6 year old lol. I bet you I would have been diagnosed with ADHD if I was tested, but in truth I was just an active kid who didn’t like sitting in a classroom chair all day.
I got a short quiz to see what symptoms I was complaining about and then I got asked about my drug usage and why I was seeing them.
I told them that I tried a friend's adderall once and I felt so much better immediately.
They told me drinking 2 pots of coffee a day, doing tasks out of order, "just in time laundry", and being "excitable" is actually ADHD and that I'd be better off if I took these pills every day and cut way back on the caffeine.
It took about 15 minutes.
What other questions would you have? Do you think you'd need to give me the long-form test? Lol.
I followed the advice btw. It's going well many years later and I hope RFK doesn't take the stimulants away.
Adult diagnosis is weird. I’m assuming you were not a child drinking that much coffee. Adults have decades of coping mechanisms obscuring the signal, and yet just talking to an adult with ADHD for an hour will tell you whether the person has ADHD instead of being a stimulant junkie that read the DSM to present manufactured symptoms. It’s exhausting to talk to someone with ADHD for hours if you don’t have exactly the right disposition (like being a polymath or having it too).
They will still often want you to do a sleep study, because chronic lack of quality sleep or chronic stress looks a hell of a lot like ADHD. It’s also why you want the person with ADHD to write or at least copy edit your emergency procedures because they haven’t just adopted chaos, they were born in it, molded by it. They were adults before they ever saw order and to them it was just blinding. They will absolutely write a procedure that won’t skip steps or overly rely on the actors to be calm and present of mind to pull it off.
No idea what all it entailed other than the fact that they're unable to screen people out when I assume there are probably quite a lot of people doing or trying to do what he did.
So the process can't be especially rigorous.
Yes, I got mine this way. Telehealth during Covid was notorious for this, but lot of NP/PA offices now do the same thing, just with a single in person visit.
It may be personal, and you don’t have to answer, but this is the general question I have to these 15-minute diagnosis.
We just started the evaluation with our second child and it's the exact same process. Not that I doubt some doctors cut corners, but I haven't personally seen it.
Even today, I wonder if I should go through the trouble of being diagnosed and getting on medication. The last three days I wasted my time instead of doing the work my company pays me to do and got exactly nothing done. The entire time I kept thinking, "I really should do that work so I can keep my job and provide for me family" but I couldn't concentrate and procrastinated day after day.
Most of my children have ADHD. Before they could be diagnosed, they did have to go through extensive testing by a psychiatrist and there were interviews conducted with us as their parents and with their teachers. The 15 minute diagnosis mentioned in the article has not been my experience. We have regular meetings (every 6-8 weeks) with the psychiatrist to evaluate their dosage and how things are going.
Please make sure to take care of yourself and try going through with the diagnosis. What you described is very similar to what I was going through - severe procrastination which resulted in worse and worse performance at work, eventually I had to quit my job because of it. Later I’ve learned procrastination of this magnitude is basically your subconscious screaming at you that something is not right and you should be taking care of yourself instead of forcing yourself to work.
On a side note - ADHD is hereditary so if your children have it there’s a good chance you and/or your SO have it too.
Maybe talk to people diagnosed with ADHD as adults? Of my acquaintances like that, they mention an immediate improvement. The benefits were very obvious to them.
It is almost as if we should test for ADHD by just testing amphetamines in questionable situations and just seeing if people respond well?
Likely very questionable advice, but if you are a risk-taking type then maybe score something and just test it on yourself? Try to be scientific of course. And try to understand the risks (which you need to understand even if you were diagnosed by the medical system).
I'm in my 30s, and in the process of receiving a diagnosis after it had been suggested to me my entire life by teachers, colleagues, and friends. I avoided diagnosis and medication mainly because I was skeptical of the safety record of medications -- probably because that's why my parents never sought a diagnosis for me when I was younger.
After doing more research the past few years, I learned that ADHD medications are the success story of medical management of psychiatric illness, and they have a strong safety record
In any case, for me so far it has involved four (4) 2-hour appointments with a clinician, having trusted colleagues and close friends fill out detailed "external rater" forms in which they rated my executive dysfunction, and (yesterday) a marathon 4-hour long testing session in which I took a sequence of standardized tests under the supervision of a clinician.
I know that diagnosis of ADHD in children is a different animal, and even for adults there are clinics that provide a diagnosis and prescription in a half hour or so -- but not everyone with ADHD is diagnosed after a single 30 minute session with a provider. And contrary to another sibling comment, there are fairly robust objective metrics for identifying the hallmark features of ADHD and executive dysfunction.
What are they?
But you will find that ADHD is one of the most widely studied psychiatric illnesses with strong neurobiological basis and well known measurable correlates, and as I mentioned, has the highest response rates to medication for a psychiatric condition. So you should have no trouble finding out more!
I'm sorry, let me stop you there. What in the world are you talking about? The government's main guy looking after America's health is obsessed with ADHD diagnosis rates -- for good reason? That is absolute madness. Got nothing better to do, I guess. No infinitely long tail of the global pandemic that was ravaging the population a couple of years ago? The threat of bird flu? Dare I mention health insurance?
Remember doctors are there to advise not to command, know the hazards and be willing to say no or consider the data from your own perspective.
The trick is to know who to go to get what you want. In the USA with PPO there is generally zero friction to just making yourself an appointment with a speciality doctor and that specialty doctor will use his "toolbox" to create the outcome that you came to him and paid for. If you go to a psychiatrist, well their tool is prescription medicine, so that is what they'll use.
This sounds like common sense, but i think the population at large places too much trust in the doctor. In the US you have to be your own advocate.
I suppose in the past that would just be your family doctor, wasn’t it.
Amphetamine salts (generic for Adderall) cost less than $20 a month. Generic atomoxetine is $15.
The medication for ADHD is _cheap_. A pharmacy will likely get more profit from a bottle of ibuprofen.
The gross margin on amphetamine salts even at $20 must be insanely high. We're talking about what, a couple grams of active amphetamines in a month?
And it is no coincidence or surprise that brain stimulants like amphetamines dominated the first wave of treatment. People 'perform' better on amphetamines, always have. They work so long as you concentrate on the short term and ignore long term issues like increasing tolerance, increasing demand and ultimately schizophrenia from chronic deep sleep deprivation.