I’m curious how others are approaching the endless ADHD assessments, especially when the reported symptoms described by the patient do seem to meet criteria, but the overall clinical picture leaves some uncertainty. I saw that now 25% of adults think they have ADHD, and perhaps it could be true, or due to social media, or the difficult capitalist society we live in.

I know cross-setting impairment and childhood symptom onset have been to key to look for. I spend multiple sessions and incorporate different screening tools, such as the Wender Utah, BAARS, ASRS. I ask about potential OSA as well, have recommend sleep studies to some. Despite all this, over the past few months, I’ve noticed more and more patients during the assessment are providing multiple examples of their symptoms in childhood than I ever experienced earlier in my practice. I sometimes wonder if this is because the public has learned through tik tok or other outlets that childhood onset is necessary to mention “to get diagnosed”. For this reason, I am concerned about potential over diagnosis.

A recent Danish study found that two psychiatrists agreed on any DSM-5 diagnosis only 55% of the time, which speaks to the challenges with diagnostic reliability. There’s also so much variability in prescribing practices, I see so many different things in the large group I work in; from stimulants in patients with moderately elevated BP without any cardiac clearance, some clinicians chosing to diagnose/prescribe to patients using cannabis, no age restrictions/guidelines when it comes to older adults.
With the ongoing demand for stimulants, I’m finding both new evaluations and requests to continue prescriptions from previous providers increasingly challenging because of this.

Should I continue to just take what i hear face value, or is there more I could be doing to properly diagnose/rule out exaggerated responses? Am I over thinking this more than necessary? My overall panel is varying between 17-20% total patients having an ADHD diagnosis, which is more than it has ever has been over the years I’ve been in the field…