Item — HN Reader

> 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.

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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.

> My child has difficulty sitting still

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.

There is definitely a difference between ADHD not sitting still and normal kid not sitting still.

My kid was continuously falling off his chair because he was creating a tension bridge between his chest on the edge of the table and his feet on the seat of his chair.

It was driving his kindergarten teacher crazy lol.

Related: it was a 15 minute doctor visit for us, but both me and my wife have ADHD so the doctor looked at the survey and said "boy howdy, I think you guys know what you are talking about"

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

This? https://www.youtube.com/watch?v=WqoMrCLl14E

Feels kind of reductive.

If I played too many video games so now I don't get to have my meds, I'm going to be pretty sad.

> drinking two pots of coffee a day

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.

Correct. In my experience it's the reason many kids don't have medication. The parents can't afford the testing.

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.

So the process can't be especially rigorous.

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.

Barely. I am diagnosed and it is difficult to get. If there is a shortage I just get the shaft. If I try to renew early I get put on a list. The amount of appointments and follow up calls required is like putting stairs in front of a wheelchair store.

>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.

But did the diagnosis result in any sort of ongoing treatment (e.g. medication, formal school/work adjustments, etc.)?

It may be personal, and you don’t have to answer, but this is the general question I have to these 15-minute diagnosis.

Not parent, but yes I got medication. The work adjustments were me meeting deadlines, not procrastinating, being able to focus on one task at a time, etc. Absolute game changer. For some of us, it's completely obvious. Some, less so.

Yeah I got a prescription. IMO, these are pill farms. Everyone talks about how the medical industry is so driven by money, but somehow when it comes to mental health, people seem to shrug off the fact that everyone from the pharma companies down to the doctors office stands to make money by diagnosing and prescribing.

I think tribal and political social media discourse has exacerbated this effect, by which I mean, blanket acceptance of the ADHD diagnosis process and medication is now left-coded.

Conspiracy theorist anti-vax types exhibit "Big Pharma" skepticism, so media and pundits take great care to remind people of this. They want them to believe that they're picking a side in tribal politics.

edit: Another way it becomes left-coded is exhibited in this thread: victimization and grievance politics.

Anecdote - I'm in no way antivax or auth right but I still have a very strong skepticism to big pharma and corruption in general. I think about Purdue pharma often and how they showed just how much money you can print with some bribery and a sociopathic disregard for human life. Killing Americans is big (and shockingly safe) business if you cut the right folks in and do it at large scale!

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

Adult assessments take 4+ hours and cost $2500. It kinda sucks, but hopefully you have insurance.

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.

$1k/hr? Was it on a private jet?

Heh, welcome to the US

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.

It’s the click on the letter test supervised by a psychiatrist for my diagnosis.

Formal diagnosis is a joke.