Areas › Focus, starting, and ADHD › Getting assessed and diagnosed
Both people will tell you they were up for three nights. The useful question is what they did with those hours: driven and busy points one way, wired and wrecked points another.
In mania the need for sleep falls away and the activity has a purpose behind it, however unrealistic that purpose looks from outside. In ADHD the night simply runs late, the person is still tired, and the next day is worse for it. So ask about the following morning as well as the night. Where you can, ask someone who lives with them too, because the account from inside and the account from outside are often not the same account.
Qur’an and Sunnah
'Do not rush to recite before the revelation is fully complete but say, Lord, increase me in knowledge' (Quran 20:114). Slowing down for one more question is its own small way of asking to know more.
فَتَعَٰلَى ٱللَّهُ ٱلۡمَلِكُ ٱلۡحَقُّۗ وَلَا تَعۡجَلۡ بِٱلۡقُرۡءَانِ مِن قَبۡلِ أَن يُقۡضَىٰٓ إِلَيۡكَ وَحۡيُهُۥۖ وَقُل رَّبِّ زِدۡنِي عِلۡمࣰ ا
exalted be God, the one who is truly in control. [Prophet], do not rush to recite before the revelation is fully complete but say, ‘Lord, increase me in knowledge!’
Qur’an 20:114read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
The long follow up of the multimodal treatment study of ADHD found that symptoms persisted into young adulthood for a substantial number of those children, and that self report and informant report diverged. That divergence is the practical point for adult assessment: one account is often not enough. It was a follow up of a trial rather than a test of any interview method, so it argues for collateral information without telling you how to gather it.
Swanson JM, Arnold LE, Molina BSG, Sibley MH, Hechtman LT, Hinshaw SP, Abikoff HB, Stehli A, Owens EB, Mitchell JT, Nichols Q, Howard A, Greenhill LL, Hoza B, Newcorn JH, Jensen PS, Vitiello B, Wigal T, Epstein JN, Tamm L, Lakes KD, Waxmonsky J, Lerner M, Etcovitch J, Murray DW, Muenke M, Acosta MT, Arcos-Burgos M, Pelham WE, Kraemer HC, MTA Cooperative Group. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression.. Journal of child psychology and psychiatry, and allied disciplines doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
Two people can lose the same hours of sleep for opposite reasons, and what they did with the time is what shows which.
When not to
If there is any hint of a manic episode with risk attached, that goes straight to psychiatric assessment rather than into your formulation.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
Hyperactivity and impulsiveness almost never turn up alone. When restlessness appears with no attention difficulty beside it, that is a reason to ask what else might be going on.
Alongside diagnoses, ask how relatives died. Falls from roofs, crashes, deaths with the safety gear left on the ground: these recur in some family lines and they say something a list of diagnoses cannot.
Run a short anxiety and depression screener alongside the ADHD measure at every intake, not only when someone mentions their mood.