The Art (and Imperfection) of Diagnosing ADHD with Dr. Amie DeHarpporte
Imagine this: one person spends ten minutes with their doctor, walks out with a prescription, and calls it an ADHD diagnosis. Another spends an entire day in a psychologist’s office, testing memory, attention, and executive function, only to arrive at the very same conclusion. Which one is “real”? Which one counts?
In this episode, Pete Wright and Nikki Kinzer talk with psychologist Dr. Amie DeHarpporte, who has spent her career living at the intersection of these contradictions. Once a high school teacher and now a specialist in ADHD assessment, Dr. DeHarpporte has seen how elusive—and yet how desperately needed—a clear diagnosis can be. She explains why ADHD is simultaneously overdiagnosed and underdiagnosed, how TikTok has blurred the boundaries of what people think ADHD looks like, and why the process is as much art as it is science.
But the story isn’t just about tests and checklists. At its heart, a diagnosis is about validation—about someone finally saying, yes, what you’ve been experiencing all these years is real. Dr. DeHarpporte takes us inside her practice, showing how thorough assessment can unravel years of shame, rewrite self-narratives, and reveal strengths hidden in plain sight.
What you’ll discover is that ADHD diagnosis isn’t a binary. It’s a lens, a way of telling the story of your life with more clarity. And sometimes, that clarity is the most important prescription of all.
Links & Notes
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Pete Wright
Hello, everybody, and welcome to Taking Control, the ADHD podcast on TrueStory FM. I'm Pete Wright, and I'm here with Nikki Kinzer. Hello, Nikki.
Nikki Kinzer
Hello. Hello, everyone. Hello, Pete.
Pete Wright
Kind of leaning into a wrestling kind of a thing.
Nikki Kinzer
Right.
Pete Wright
Nikki Kinzer.
Nikki Kinzer
With Pete Wright.
Pete Wright
We're doing something we have never talked about—what it actually takes as an adult to get diagnosed for realsies. And so we're gonna do that today. I can't believe it's taken us quite so long to have...
Nikki Kinzer
I think we have talked about it. Not like today, but we have talked about it.
Pete Wright
Not like today we haven't.
Nikki Kinzer
I...
Pete Wright
I think we've talked adjacent to it. Adjacent to it.
Nikki Kinzer
Yeah, maybe adjacent to it.
Pete Wright
Because I know I've never talked about my specific diagnosis experience.
Nikki Kinzer
Because I remember we had like... no, um...
Pete Wright
Not after that psychologist told me I have ADHD and that I should talk to him about it.
Nikki Kinzer
Right. Right. That's true.
Pete Wright
Yeah.
Nikki Kinzer
No, but I do remember us talking about like the comorbid conditions and how like doctors have to...
Pete Wright
We did talk about comorbids, yep.
Nikki Kinzer
...kind of, you know, really figure out what are the layers. Is it depression, anxiety, ADHD, like those kinds of things.
Pete Wright
Yes.
Nikki Kinzer
That's what I'm thinking about.
Pete Wright
Yes, that is true.
Nikki Kinzer
But not the actual testing and what it looks like and all of that. Our guest is gonna inform us on what that is, which is exciting.
Pete Wright
Totally. And I think it's really important because I think the word "diagnosis" has gotten all tossed and twisted and tossed up, and now it can mean anything from a fifteen-minute TikTok video to, you know, fifteen minutes with your primary care physician and suddenly you have ADHD, which may be all you needed to know, which is fine. But if you really want a diagnosis, what does it really, really, really take? And so that's what we're going to talk about today. But first, you know the drill. If this show has ever helped you understand your relationship with ADHD in a new way, we're asking for your support on Patreon. Starting at just five bucks a month, you help us keep the public show free for everyone while you continue to get bonus content in the very personal Patreon member feed that you get access to, which includes Jibber Jabber up front, questions with our guests at the end, stuff that the public feed does not have. And it helps us, of course, keep investing in our community and offering fun extras. We count on it to keep the servers hot. Visit patreon.com/theADHDpodcast to learn more. And, you know, speaking of things that you'd like to take control of, our book, Unapologetically ADHD, is finally—I don't know if it's "finally." I think "right on time"—is coming out in paperback on October the 28th.
Nikki Kinzer
And it's not apologizing for it.
Pete Wright
No, we're not apologizing for anything.
Nikki Kinzer
It's like... no.
Pete Wright
No, no.
Nikki Kinzer
Uh-uh.
Pete Wright
It arrives top hat and tails right on time. You can pre-order it right now where you get your books and get the new edition right on release day. So if you've been holding off on the hardback, you know, no judgment there either. But now we have the full set. We have the paperback coming in October. We've got the audiobook, we've got the hardback. We have not done a live reenactment of the book or like a diorama. Those probably are gonna have to wait on those, but we definitely have all the key formats. So check those out. Yeah, we're gonna do a movie. We're gonna do a movie anyhow.
Nikki Kinzer
You mean it's not coming out in a movie anytime soon? I wonder who would play you and who would play me. Hmm, we'll have to think about that.
Pete Wright
Brad Pitt and Reese Witherspoon.
Nikki Kinzer
Oh, nice.
Pete Wright
There you go. Nailing it.
Nikki Kinzer
Okay.
Pete Wright
Just crushing it. Yep. Finally, connect with us on TakeControlADHD.com.
Nikki Kinzer
I don't know. You kind of look like Ben Affleck to me. Sorry. You kind of look like Ben Affleck. I could see him doing that with you.
Pete Wright
This may be the most ADHD intro you've ever allowed me to do.
Nikki Kinzer
I know, I know, sorry. All right, back on track.
Pete Wright
Finally, please connect with us at TakeControlADHD.com for episodes and our mailing list. Jump into the ADHD Discord community at TakeControlADHD.com/discord and find us on the socials at Take Control ADHD.
Picture this. You're scrolling through TikTok at 2 a.m. You're watching someone explain how losing their keys is actually a profound neurological condition, and you think, "Wait, that's me! Could I have ADHD?" I didn't even know when I wrote that that it rhymes, but I'm very proud. Meanwhile, across town, a family doctor is prescribing Adderall after a fifteen-minute chat, while in another office a woman who's struggled for decades is being told her symptoms are just anxiety again. Welcome to the contradictory world of adult ADHD diagnosis in 2025, where we're simultaneously over-diagnosing and underdiagnosing at the same time.
Today we are joined by Dr. Amie DeHarpporte, a licensed psychologist who specializes in ADHD assessment—basically a detective for brains. What makes her fascinating is that she spent over a decade as a high school teacher before becoming a psychologist. So she's seen ADHD from both sides of the classroom door. She's here to help us talk about the ins and outs of assessment and diagnosis and testing and all that great stuff as an adult. Dr. DeHarpporte, welcome to the ADHD podcast.
Dr. Amie DeHarpporte
Thank you very much. Glad to be here.
Nikki Kinzer
Welcome.
Pete Wright
I apologize for all that fiddlefaddle up front. That was just too much. It was too much.
Dr. Amie DeHarpporte
All good. I'm intrigued by the question of who would play you, Pete.
Nikki Kinzer
Right?
Pete Wright
Do you have an opinion just right off the dome?
Dr. Amie DeHarpporte
No, I'm just gonna take a pass on that one.
Pete Wright
So Ryan Reynolds, you say.
Dr. Amie DeHarpporte
I fear if Ben Affleck isn't good enough for you, anything I say might be an insult.
Pete Wright
Excellent. I'll take that.
Nikki Kinzer
Well, it might not be good.
Pete Wright
No. No, no, no.
Nikki Kinzer
Yeah. He wants Brad Pitt.
Pete Wright
Ryan Reynolds is fine. It was Brad Pitt, now it's Ryan Reynolds. I've already changed my mind.
Dr. Amie DeHarpporte
Okay, that's fair.
Pete Wright
Okay, here we go.
Nikki Kinzer
Okay.
Pete Wright
What is going on with the diagnosis space in ADHD, and particularly for our prospective adults?
Dr. Amie DeHarpporte
Well, I think you named it really well—that there are tensions. I think there are dilemmas for the psychologist where we don't want to overdiagnose, but we don't want to underdiagnose. And there are groups of people, there are individual stories of people who have struggled for a long time and who have... life has been harder than it needs to be and it has not been recognized. And they've banged their head against the wall for a long time saying "What's wrong with me? Why is this not being recognized?" And then at the same time, there are challenges in being accurate with diagnosis when we are faced with a lot of people seeing traits that all humans have and recognizing themselves in them and assuming that it's ADHD when in fact what they're behaviorally demonstrating isn't necessarily outside of what would be kind of part of the normal distribution of human traits. So the question is where do you draw the line? How do you draw the line? How do you do that when you have incomplete information and when you're trying to separate out what a person's individual experience is versus how that compares to what would be diagnostic?
Pete Wright
That's fascinating. You just said something that I find potentially triggering. What is the impact of social media on shrinking—I say shrinking sort of presumptively—the general sort of common knowledge of what is the normal distribution of human traits?
Dr. Amie DeHarpporte
I mean it's a good question. There are emerging research coming out about social media and TikTok in particular. I'm not up on the specifics of it, but I will say there's been a lot of informal talk among psychologists of folks coming in with assumptions and sometimes a lot of surety about "This is the diagnosis that I qualify for" and telling reasons why, and sometimes those reasons can be traced to really inaccurate assumptions. So I'll give you an example of one. I had a client come in and say, "I cricket my feet..."
Pete Wright
I could just want to do it.
Dr. Amie DeHarpporte
"So I must be on the spectrum." And apparently she had seen a TikTok video where someone, an autistic person, was describing their experience and they were talking about...
Pete Wright
I know it's...
Dr. Amie DeHarpporte
...rubbing their feet together in bed at night before they fell asleep and they labeled that as an autistic trait. And so the client said to me, "Ah, that's me," and that was kind of part of what really inspired her to seek out diagnosis.
Pete Wright
And that would be part of what I'm saying.
Dr. Amie DeHarpporte
And it was kind of hard for me to say, but I said, "You know, I just need to let you know that that's not actually in the official symptom list of autism spectrum disorder." And so there's some inaccurate information out there about what a diagnosis really entails, what the criteria are, and it can be painful, I think, for people who feel like their individual experiences are being recognized in a wider community. And yet when they go to get the quote-unquote official, you know, something that makes them feel like they're actually legitimate, they're being gatekept. And so it's hard as a psychologist to be the one to say no when someone doesn't meet the full criteria because our job is to not kind of just put the rubber stamp on people's perceptions or assumptions coming in. That's why we have an assessment process. That's why we go through all this testing. That's why we sometimes take a full day doing all this because a lot of things can sound like one thing on the surface, but actually have another cause. Just because someone's coughing doesn't mean it's necessarily COVID. It could be bronchitis, it could be pneumonia, it could be something caught in your throat. There are a lot of symptoms that look very similar on the surface but have different causation underneath. And that's the psychologist's job is to sort that out. And that can sometimes be a really complex process.
Nikki Kinzer
Oh, I can imagine because there's so many overlaps of characteristics and symptoms of things that I can see where it could... yeah, you have a tough job for sure when Pete said—I don't know if he called you a private eye or an investigator—but I can see that fitting very well.
Pete Wright
Oh yeah.
Dr. Amie DeHarpporte
For example, anxiety and ADHD do have a lot of overlap. If you just look at the symptom criteria, some of the symptom criteria of having your mind racing and rumination of irritability, of restlessness, difficulty with sleep. Well, those all sound really familiar to folks with ADHD, right? Those are literally in the symptom criteria list for anxiety. So there's a lot of overlap in symptoms. And the question is what's the cause—like what's the wellspring underneath the surface? We don't always know that right away.
Pete Wright
One of the things that we've long sort of hung our hats on for this show, if you look at the show's sort of ideology, it's that, you know, we're talking to adults with ADHD, to college students with ADHD. And we're talking about the tools and strategies that can help you wrangle your ADHD whether or not you have a diagnosis because you know what, like sometimes all of those sort of commonalities that you experience like cricketing your legs just for one example. If you feel like you have a bucket of these experiences and the tools and strategies help you. Why not use them? Go ahead, right? That's fine. You cannot have ADHD. And a lot of the things we talk about on this show are bangers for just life hacks, right? They're things that will help you live your life.
Dr. Amie DeHarpporte
I love that. I completely agree. And I would say I do a lot of recommendation, even for folks who... you know, sometimes the diagnosis that is given is not necessarily an ADHD clinical diagnosis, but it is subclinical symptoms of ADHD. Like there, yes, there's a reason why you came in. Yes, you are experiencing that. Yes, this is real. Absolutely. And you don't necessarily reach the threshold of symptom criteria that would be needed for an official diagnosis, but you're definitely struggling with this constellation of things and all of the strategies that work for someone with ADHD are going to work for you. So look into them and use them. You don't have to meet some official criteria list for this to be useful for you.
Pete Wright
Well, that gets to one of the things that I want you to help us do today, which is, you know, because we talk to people all the time about should I get a diagnosis? What is the importance of getting a diagnosis? So I want to talk about diagnosis and what goes into a diagnosis. Like if I want to be official, whatever that means, what does it take? Right? I don't understand who I have to talk to, what they're gonna ask me to do. And I was hoping that you could just document for us podcastally what does it look like if I have a sense that I may have these traits to make it official? What does a testing day look like?
Dr. Amie DeHarpporte
Well, it kind of depends on who you go to. So there are a lot of different people who can diagnose ADHD and there's some misassumptions in people assuming that they need to go get what they sometimes call "neuropsych testing," which is actually a misnomer because neuropsychologists have specific training in psychology that make them experts in things like organic brain disorders like Alzheimer's or epilepsy. You don't actually have to have a neuropsychologist diagnose ADHD. So within the realm of psychology, any psychologist can do it. But also so can a master's level clinician. So in my state, at least in many states, a psychologist is a doctoral level clinician, someone who has their PhD or their PsyD. But master's level clinicians can also diagnose ADHD with a diagnostic assessment, it's called. It's usually the first time you meet them. They ask you, "So what brings you in?" And you have a conversation. That can be enough to put a diagnosis down on the chart. ADHD is no different than anxiety or depression or any other mental health disorder that any mental health clinician can diagnose. You can also go to a doctor, a physician. And like you said, often that's a very brief conversation. And I've talked to a lot of folks who will get started on medication after one brief conversation. Is that an official diagnosis? Yeah, it's... if we think about a diagnosis and what it is, it's actually coding that allows insurance to reimburse for the time spent with the professional. So if a doctor is coding that session, and they're prescribing medication, they're going to code it under ADHD. So they've given a diagnosis. Now, that's a different level of thoroughness. And a one-hour diagnostic assessment with a therapist is a different level of thoroughness than going in for a psychological assessment with a psychologist who's gonna spend half a day or a whole day doing a whole battery of testing. Now the question is, is that necessary? And I think actually a lot of folks in the field, we're talking about, you know, are we over-testing? Is that really necessary to do that much testing to come up with the diagnosis when there are other ways of doing it that are a lot more efficient and not as expensive and maybe it's self-serving of psychologists to be requiring jumping through all these hoops when a lot of the tools we have honestly are kind of flawed and the certainty that we have after half a day of testing is not necessarily that much greater in order to justify the time and expense, as it would be going to a therapist or talking to the therapist you've been seeing for, you know, anxiety or whatever other struggles you've had and they know you well. And maybe they say, "Hey, you know, some of these things you're saying, they sound kind of like ADHD. Let's go ahead and make it official."
Nikki Kinzer
I have a question because what is the difference... Like I know you were talking about who can diagnose, but I'm curious, like, if I go to a talk therapist, and that person says, "Oh, it kind of sounds a little bit like you have ADHD." Can that person make that diagnosis? A therapist?
Dr. Amie DeHarpporte
Yes, they can. Yes, it's no different than anxiety or depression or anything else.
Nikki Kinzer
Okay.
Dr. Amie DeHarpporte
Often what they will do is often they will refer out for testing. And part of the reason for that is because the onus is a little higher with ADHD because one of the favored treatments for ADHD is medication.
Nikki Kinzer
Right.
Dr. Amie DeHarpporte
And so to...
Nikki Kinzer
And they can't do the medication.
Dr. Amie DeHarpporte
They can't do the medication. But a lot of them I think want to ensure that if someone is getting medication, that there's been a thorough diagnostic process that happens because there are side effects of medication and there can be costs associated with that in terms of, you know, if someone has anxiety, putting your central nervous system on a stimulant can actually make things worse. So there's, you know, obviously potential for abuse. So there's I think some wanting to be reassured that their instinct is accurate. They'll refer someone out for more thorough testing, especially if the presentation is maybe a little bit more complicated with comorbidities or things like that. But they could actually diagnose someone. The tricky thing is that one of the reasons—and I know we're talking about adult diagnosis, but for children at least, in order to get accommodations in schools... Sometimes it depends on the state, but in many states there are only professionals that hold certain degrees are allowed to make diagnoses that qualify to open the door for an IEP. And so, for example, a psychologist diagnosis of ADHD is required in order to start the IEP process. Or not to start the IEP process, but to qualify under Other Health Impairment. Or a medical doctor. So that's why sometimes we'll get someone who has been diagnosed by a therapist be referred to us to sort of make official that diagnosis that then can be shared with the school for accommodation reasons.
Pete Wright
That was one of the things that I found so interesting. I mean, we're talking about these short conversations that can end in a diagnosis when the battery of testing that we had to undergo for our kids was extraordinary. It took days, it took people, you know, it took all of the collateral information gathering from others, from peers, from parents, from teachers. It took the standardized testing and rating scales to align to, you know, DSM criteria. Like it was a significant thing. And I'll never forget the therapist that was performing the testing came out of the room in 15 minutes and I said, "So what do you think?" He said, "Oh, no, definitely. We know exactly what this is." As if to imply we don't need to go on. We're doing it pro forma. We just have to check a lot of boxes. I don't hear a lot of adults going through that same sort of rigor and I'm guessing it's because there are fewer barriers. There's no, you know, you can't get accommodations unless... once you're out of school. I don't hear people saying that at work. You have to have a 10-hour diagnostic evaluation. Any letter from your therapist is gonna do kind of a thing.
Dr. Amie DeHarpporte
Right. I think the process is not codified in the same way for adults as it is for, you know, under special education law for children.
Pete Wright
Right.
Dr. Amie DeHarpporte
And so there isn't kind of the same hoops to jump through. And you're right that there are a lot of data gathering and performance testing and a lot of times it involves IQ testing, memory testing, computerized test of attention, executive function testing, there are a whole lot of things that we do. And you know, I know I just said earlier I'm not sure that that is justified in terms of time and expense compared to, you know, in obvious cases, what a therapist could pick up on in an hour, a well-trained therapist would be able to make that judgment and like, "Oh yeah, obviously, you know, that's not a question." I think where testing is really useful is in cases where it's more complicated. Where I think about arrows kind of pointing in different directions. And every piece of data that I get in an evaluation, whether it's from a rating scale, from a teacher, or a self-report from the structured interview with the person themselves or a rating scale from a spouse or a test of attention. Each one of those I think of as an arrow pointing in one direction or another. Sometimes the arrows all point in the same direction, and then it's really obvious. Sometimes they don't. Sometimes they point in different directions. Sometimes they point toward anxiety. Sometimes they point toward sleep. Sometimes they point toward history of a head injury. Sometimes they point toward depression. And sometimes they point at multiple things simultaneously. And so then what you need is someone to really, like you said, be a detective and put their detective hat on and slow the process down, take the time to gather the timeline of events. Because if we think about ADHD as a neurodevelopmental disorder that shows signs before age 12, there should be symptoms across the life course. And so if someone comes in as an adult and says, "Oh, I've really been struggling with deadlines at work." And this is the first time that's happening to them, and it's corresponding with a divorce, right? That maybe is a different story than someone who has struggled throughout their life but has never been picked up on and they had poor grades, but it was attributed to low motivation or to, you know, maybe they just weren't cut out for school, but you know, they always thought maybe something was going on, and then they come in because something's happened, maybe demands have increased in their life and now they're motivated to come in. I just had an adult that I diagnosed recently where she sort of had this history of job hopping. She had this history of... she had, I think, went to three different colleges. She had been, you know, at school told she was really smart, but she, you know, just wasn't motivated enough. And she finally got to a point in her adult life where she was kind of tired of feeling stupid or inadequate and wanted to know. And I kind of said to her, a little bit of what you said, Pete, of like, because on the phone, I talk to people on the phone before they come in for testing. And because we don't take insurance, you know, this is a pretty significant out-of-pocket outlay. So I do a lot of actually counseling people against getting testing, which is a terrible business model. But some of what I'll say is like "Read the books on ADHD, listen to the podcasts, you know, those tools that work for people. They can work for you. You don't necessarily need to come in, you know, and do this half day of testing if you have all these things going on in your life. Act as if." And you can get to the same point whether or not you have this official stamp or not, because it's not gonna get you accommodations like it would, you know, in school. And she said, "No, I just want to know." And she said "I've had therapists who have told me over the years, like, oh maybe it's ADHD, but they don't really know." And it's not really... they haven't really looked into it and it seems like they're just kind of guessing and I want to go to someone who really is an expert in this. Can you help me out?" And so we sat down, we put together her whole chronology of life and what was happening at different times and when the symptoms were there and were the symptoms there prior to when she was having these other things going on in her life, you know, prior to when she started using cannabis, was she struggling or did it only come with the, you know, I mean...
Pete Wright
Okay, that's a... is that a red flag? I don't know.
Dr. Amie DeHarpporte
Well, maybe, but also we know that people with ADHD have a higher rate of substance use.
Pete Wright
Maybe. Yeah, that's what I mean, right?
Dr. Amie DeHarpporte
So yeah, yeah, the red flag in that way, right.
Pete Wright
Yeah. Yeah. Right.
Dr. Amie DeHarpporte
So chicken and egg, right?
Pete Wright
Yeah.
Dr. Amie DeHarpporte
So it could be that, because also the long-term effects of cannabis use can mimic a lot of ADHD symptoms. So it could be an after effect, but it could also be a reason why she's self-medicating. So we sat down and looked at all of it and it became clear through looking at the chronology that no, these symptoms were there from the time that she was a young kid and I talked to her mom. And her mom told me all the stories that teachers would tell about her. And it was like, "Oh, this is someone who is just overlooked for years." And that was very validating to her, I will say. Like she got a little teary when I talked to her in the feedback session. She said, "Oh, this makes so much sense."
Nikki Kinzer
It sounds like that's what she needed was the validation, right? Because as humans, we want to be seen, we want to be heard, and we want to be taken seriously. And I think that sometimes doctors have a way of being in such a rush that they don't take your concerns, you know, very seriously. And it's interesting because I had a doctor's appointment recently and I was so impressed with what she said. Because I was telling her this issue, I was having this pain in my leg. And we were kind of talking about different things that it might be. And she goes, "I don't want to discount this. And I want, you know, I'm not discounting this. So let's just, you know, wait and see what happens. And then if it's still going on, I want you to contact me. Da-da-da." And I really appreciated her saying, "I'm not discounting you."
Dr. Amie DeHarpporte
Mm-hmm.
Nikki Kinzer
You know, I think there's something about that that, you know, we need... until she said it...
Pete Wright
So you didn't even know you needed to hear it until she said it. Yeah.
Nikki Kinzer
And then it made me realize like, "Oh, right. I just want her to take this seriously because I'm worried with my own anxiety that I have a blood clot and I'm gonna die."
Dr. Amie DeHarpporte
Right. And one of the things that...
Nikki Kinzer
Right? Like that's what I'm thinking.
Dr. Amie DeHarpporte
One of the things I do, I feel like is my job is to tell someone's story.
Nikki Kinzer
Yeah.
Dr. Amie DeHarpporte
So I write all this up if you've ever gone through a psychological evaluation for ADHD, if you're going to someone who is thorough and really takes their time and is interested in... I mean the question for me when someone comes in is not ADHD or not, the question is what is going on here? Tell me about your experience and help me understand. What it's like to be you. And there are going to be things that are hard for you, and there are gonna be things that are amazing strengths. But there's a reason why you're coming in. Let's understand it. Let's put it all together in a story that helps you understand it. So ideally when I do my feedback sessions, which are two hours long after all of this process of gathering all this information. There should be no surprises. Everything I say to the person, they should nod along. I know I'm on track because they're like, "Yes, exactly. That's right." And of course, it's nothing new, right? It's everything that they've told me or people that they care about or who care about them have told me about them or things I've observed about them. But my role is to put it together in a way that makes it make sense together so that they can make sense of their own experience. Like, "Oh, you mean that experience with, you know, the boyfriend, that experience with the job, that experience with the parenting. Like that's all part of the same thing. Oh, that makes sense. I feel heard. I feel seen." Yes. So it's their own experience. Just... I think about a New Yorker cartoon of someone in a therapist's office and the thought bubble above their head was this kind of tangle of yarn and then the therapist's speech bubble is a yarn in a ball, like a nicely wound ball, and the person's smiling. It's like, okay, I'm gonna take this big tangle, I'm just gonna organize it for you and give it right back to you in a way that hopefully is empowering. And that helps you make sense and move forward.
Pete Wright
What I'm hearing so much is that you know, you may not need, subjectively, you may not need a diagnosis. You may know in your heart of hearts exactly how you live in the world. What you're paying for with this admittedly expensive process of getting a thorough test is you're paying for patience. You're paying to take the time to do the whole job and you're paying to be heard at a level of thoroughness that you don't get just about anywhere else.
Dr. Amie DeHarpporte
I think that's true. I think that's true. And I would say additionally, you know, you're paying for objectivity. So one thing that's, you know, yes, therapists can make the diagnosis, but it can be fraught a little bit if there's someone, if you've been seeing a therapist for a long time, or you know... So a testing psychologist is someone who, you know, you don't go to therapy with them afterwards, probably. They kind of fly in, fly out. And so they can sort of put together the whole process and then give you the honest assessment without fearing what the repercussions will be for the relationship because they are gonna tell you the truth. And I think that that also involves the looking at other things that might be going on. So when we're talking about adults especially, adults have a long time to accumulate a lot of experiences and a lot of things that can go on in their lives that can lead to symptoms in various realms. So again when we're talking about like the cough of COVID versus bronchitis. Is that ADHD? Or could there be anxiety going on? Could there be depression going on? How about after effects of a concussion or sleep issues? Chronic sleep is a huge issue.
Nikki Kinzer
Well, and autoimmune diseases too, because my husband has MS and my daughter has an autoimmune disease that we're still trying to figure out what it is. But like a lot of the ADHD symptoms come from that too, right?
Dr. Amie DeHarpporte
Autoimmune, yes, absolutely.
Nikki Kinzer
Like yeah.
Dr. Amie DeHarpporte
Thyroid is another one. And... You know, I'm not a doctor, so I try to stay in my lane. I'm not gonna go down the road of medical diagnosis, but what I can do is I can refer people to, you know, could this issue you have with listening to directions and not being able to, you know, discern what people are saying to you in a crowded room, could that be auditory processing disorder? Well, I'm not going to diagnose that, but I'm going to send someone to an audiologist because I can tell you it's not ADHD. And if it's not, I can still say you have this pattern of strengths and challenges. And the challenges are real, even if you're not getting the diagnosis of ADHD. People come to us for a reason. They're struggling in their lives. It's not just for funsies, right? And so my job is to, even if I'm not giving an ADHD diagnosis, to say, yes, this is real and there are people who can help you.
Pete Wright
The fascinating thing for me in all of this is my assumption would have been that the complexities of some cases, the complexities of the cases where folks are not just ADHD, right? You're talking about those arrows pointing in different directions. Teasing out the complexity there would come with a longer-term relationship with your regular therapist. But what I'm hearing is through this sort of critical evaluation process, you can tease out what is depression, anxiety disorders, what is trauma-based experiences. What is learning disorders and sleep disorders and substance use disorders? Like you can tease all of those things out as a part of this overall diagnostic experience?
Dr. Amie DeHarpporte
Sometimes.
Pete Wright
To what level of confidence, I guess.
Dr. Amie DeHarpporte
Right. Yes. I think that's a great question. I think the longer I have been in this field, the more humble I am. And the more I talk with people about holding it lightly, you know, I kind of use this metaphor of like just hold it lightly. Because whether it's a diagnosis or a non-diagnosis or pointing in another direction. There's still information that's going to be gathered over time. And we know that people... ADHD the course of ADHD fluctuates. Like the update to the huge MTA study, the multimodal study of ADHD, longitudinal study, actually found that in 64% of people, their symptoms waxed and waned over the life course. Which is kind of a big deal because we've thought traditionally of ADHD as sort of this neurodevelopmental diagnosis that is static over the course of the life cycle. And that's not necessarily true. And you know, environmental factors play a huge part and stressors and all sorts of different... And interestingly, in between-individual comparisons, they found that individuals who have more stressors, greater demands on them, actually end up showing greater resolution of ADHD symptoms than individuals who don't.
Nikki Kinzer
It doesn't surprise me.
Dr. Amie DeHarpporte
Which is... it's counterintuitive.
Pete Wright
Whoa, yeah.
Dr. Amie DeHarpporte
So this is counterintuitive. So in between-individual comparisons, people who have more stressors, they show fewer ADHD symptoms in adulthood. Probably because they've had to develop coping mechanisms, right?
Nikki Kinzer
Exactly. And they're under that pressure and adrenaline that is forcing them to get things done, right? Like they have that external factor that is...
Dr. Amie DeHarpporte
The urgency.
Nikki Kinzer
pushing them... the urgency, yeah, right. That's why like... I mean if you look at like first responders and you know how many of those people have ADHD, I bet it's a pretty high percentage.
Dr. Amie DeHarpporte
And if you think about kind of ADHD also in the sort of neurodiversity lens of the mismatch between the person and the environment. It may be that people with ADHD need high demand, high novelty, high stimulation jobs, right?
Pete Wright
Yes, right.
Nikki Kinzer
Right.
Dr. Amie DeHarpporte
So, but then if also if you look, here's the other counterintuitive piece, if you look at within-person comparisons, so like a person compared to themselves over the life cycle, greater stressors lead to more ADHD symptoms. Right. Which also makes sense in the sense that at times of stress, when we're flooded and overwhelmed, we can really struggle more than when we can just take a break and...
Pete Wright
Yes, yeah, that also makes sense. Yeah, even more flooded.
Nikki Kinzer
Shut down. Yeah.
Pete Wright
Yeah.
Dr. Amie DeHarpporte
...gather ourselves, right? So there's some interesting, conflicting, and yet to be determined non-conclusive information of what we're learning about people with ADHD in these long-term studies.
Pete Wright
So...
Dr. Amie DeHarpporte
But one of them is that it's not stable and it doesn't always look the same at every single point in time. And so that leads to some humility for me in terms of what I see walking into my office at any point in time. I do my very best and I do have the luxury of time because I work in private practice and I think just as a person I'm really curious and I seek to understand and I'm really trying to show up for this person to help them make sense of what they're going through and I have imperfect tools that have a lot of flaws and there's, you know, there's no such thing as an ADHD test. We have no single instrument that is predictive of ADHD. And anyone who thinks that you can take a computerized test of attention or an IQ test or anything else and have it say, you know, thumbs up or thumbs down to ADHD is vastly overestimating what's going on behind the curtain. It's really much more of an art than a science. I hope that I'm bringing some value to the table and that I mean my clients tell me that. They thank me and they say, "Oh, this makes so much sense to me." But I also tell them in a lot of cases, like this is where you're at today. This is the snapshot of you in time, understanding you in light of your history, but your future has yet to be written and we'll see what happens from here.
Pete Wright
You said that the testing might be a little bit extreme for... you know, are we doing a real service with the thoroughness of the diagnostic experience? What would you like to see if you could, you know, wave your magic wand and just change the diagnosis experience for folks? What do you feel like, you know, so you just said it's more of an art than a science. How would you craft the perfect diagnostic experience for someone?
Dr. Amie DeHarpporte
I do think that thoroughness is a benefit. I think when we're talking about briefer testing processes, it's usually because of the pressures of insurance and affordability and accessibility. And so within our field we're talking about can we take these pieces out? It's in service of expediency and of access. And access is important. I mean I think there's a real ethical issue when insurance only reimburses, you know, a limited number of units for testing of ADHD. And so the folks who take insurance are trying to cram all that testing into a very short time and they end up kind of just churning it out and not able to really take the time to give people a thorough experience. So I do think that the move toward trying briefer evaluations is in service of that, which I don't think is a great thing. So I do think a really accurate and thorough ADHD evaluation experience should involve IQ or cognitive testing. It should involve memory testing. It should involve executive functioning testing. It should include a computerized test of attention, even though those are flawed, but they have some what we call incremental validity, which means that they add on something. They're not enough on their own to stand alone, but as one more layer they can be helpful. Should include self-report and a really thorough diagnostic interview with the individual. So when I do intake interviews, I do at least an hour and a half. I actually block two hours out on my calendar because it often goes to that. Because I really want to understand kind of the experience of someone walking in my office, especially again in light of their timeline, and gathering collateral information, so from a spouse or a roommate or a colleague or a best friend, because one thing we've found is with externalizing disorders like ADHD. People aren't always the best judge of their behavior in comparison to others, right? Internalizing disorders like anxiety and depression, the person experiencing it only knows what's going on within themselves the best. But in externalizing disorders that show up behaviorally, the people around them are actually in some ways better at saying, "Yeah, the amount you lose your keys, that is outside of what is normal." Like, yeah, people lose their keys, but when you are running around like a chicken with your head cut off constantly, when you...
Pete Wright
Right. Yeah.
Nikki Kinzer
Every day, yeah.
Dr. Amie DeHarpporte
...every day are having trouble meeting this deadline at work, like that's out of the range of what's typical. So gathering information from people around the individual and especially people who knew them when.
Nikki Kinzer
Yeah.
Dr. Amie DeHarpporte
So this is tricky sometimes for adults because they don't always have great relationships with parents or sometimes parents have passed away or you know there's trauma there or things like that. But if we really want to establish that this is ADHD, one thing we know about ADHD is its presence of symptoms before the age of 12. And so we want to look at, you know, again, adults have had a lot of things happen to them and a lot of things going on.
Pete Wright
Right.
Dr. Amie DeHarpporte
Maybe they experienced a major depressive episode and have ongoing persistent depression in adulthood and they have symptoms in adulthood, how can we distinguish between those two things? Well one thing we can do is we can look back before your first depressive episode hit. What was going on? Were you having trouble with organization? Were you having trouble with, you know, et cetera, et cetera? Then we can get some comparison points. And so early information is really helpful. I will often talk to people about transcripts, grades, teacher comments, things like that from elementary school. I would love to have that data.
Pete Wright
Even for adults.
Dr. Amie DeHarpporte
Yeah.
Pete Wright
Yeah. Yeah.
Dr. Amie DeHarpporte
Especially for adults.
Pete Wright
Especially for adults. Yeah.
Dr. Amie DeHarpporte
Because it... right, we're looking for the pattern.
Nikki Kinzer
You're looking for that pattern.
Dr. Amie DeHarpporte
And one thing we know about people generally is people generally are not great reporters. They're not great reporters currently. They're also not great reporters of the past. Our recollection of the past is made in the present. It's colored by who we are today. It's not a snapshot. It's not a one-to-one correlation.
Nikki Kinzer
Well, especially with someone with ADHD, right?
Dr. Amie DeHarpporte
So...
Nikki Kinzer
Like when you think about what executive functions are requiring you to look in the past like it is going to be skewed and something that I know from working with so many ADHDers is they're incredibly hard on themselves so...
Dr. Amie DeHarpporte
Right. Yep, I was just going to say that.
Pete Wright
I definitely actually got...
Dr. Amie DeHarpporte
So actually there are... people who qualify for diagnosis of ADHD actually tend to underreport their symptoms.
Nikki Kinzer
Yeah, yeah.
Dr. Amie DeHarpporte
There is a concern about overreporting of symptoms. Some people who don't qualify for a diagnosis will over-report and they'll say, "Oh, I've really, you know, I've..." Kids not uncommonly when I diagnose like college students who will say like "Oh I'm really, really struggling, I'm doing terribly in my classes" and you request their transcript and it's all A's. And so yes, they're struggling for them, but compared to others, it's not pathological, it's not out of the range of what's neurotypical.
Pete Wright
Yeah.
Dr. Amie DeHarpporte
But people with ADHD tend to underreport symptoms.
Pete Wright
But...
Dr. Amie DeHarpporte
And so you'll ask them, "So how did school go for you when you were young?" "Oh, it's fine. It was good." But then you look at the transcript and they're all these teacher... "I can't pay attention in class," you know, "struggles with deadlines," all these things.
Pete Wright
Yeah.
Dr. Amie DeHarpporte
But for them that was just normal. That was just life, right? They didn't know that there was a different way to do it.
Nikki Kinzer
Or is there any difference?
Dr. Amie DeHarpporte
They just thought that school is terrible for everyone.
Nikki Kinzer
No.
Dr. Amie DeHarpporte
They didn't know that they were struggling in a system that was not built for them.
Pete Wright
I would love to hear, let's just say you and I have been working together and you've done my assessment. What is your general advice for new adult diagnosis? What do you tell me as I walk out of your office?
Dr. Amie DeHarpporte
I think it really depends on what the constellation of strengths and challenges are that we found during your evaluation and especially about what your self-narrative is. Everyone comes in with a story of who they are. And, you know, for some people they're really hard on themselves. And if they're coming in feeling like they're stupid, feeling like they're not good enough, feeling like everyone else can do it and they can't, well then that's what I'm gonna focus on. And "Okay, what this diagnosis means is a reprieve for you from that narrative." And now the future looks like recognizing your strengths and recognizing that the story you've been telling all this time was you being hard on yourself for something that was beyond your control and also not recognizing the amazing parts of you that is the flip side of that coin. And you just take that for granted and you're looking all the time at the ways that you don't measure up and you don't even recognize these amazing things that you have going for you that you just assume is like, "Oh well anyone can do that." No, anyone can't. That's actually pretty remarkable. So I mean that might be one focus. For someone else, it might be something completely different. So again, for me, it's not about "diagnosis, yes or no," just knowing like, "Okay, this is someone newly diagnosed with ADHD. What does this mean for them?" I couldn't tell you. What I would need to know is what is everything that's gone on to bring... that's happened to bring them into my office and helping make sense of that for them. What does that mean for them going forward?
Pete Wright
Well, in any case, you unlock a dictionary of new language and new ways to think about yourself and how you relate to the world, and that is a massive gift.
Dr. Amie DeHarpporte
Well, one thing I say is I say look at the resources out there. Look at the podcasts, look at the books, look at, you know, the...
Pete Wright
Yeah.
Dr. Amie DeHarpporte
Look at, you know, there's so many resources. And it's almost like permission, you know, for you... "I can take it that applies to me. That could make sense for me." Yep. It absolutely... So, you know, I sometimes feel like I'm kind of like Dorothy, like click your heels. You know, you've had the power all along.
Pete Wright
Mm-hmm.
Dr. Amie DeHarpporte
But sometimes people feel... they feel like they need that permission to say like "Yes, yes."
Pete Wright
Yes.
Dr. Amie DeHarpporte
This is you.
Pete Wright
Yeah.
Dr. Amie DeHarpporte
And yes, you can take advantage of these resources.
Pete Wright
It's beautiful. Amie, thank you for doing this with us.
Nikki Kinzer
Thank you so much.
Pete Wright
I sure appreciate your wisdom.
Dr. Amie DeHarpporte
Absolutely, it was a joy. Thanks for having me, both of you.
Pete Wright
Where would you send people to learn more about the work that you do?
Dr. Amie DeHarpporte
Well, I am a testing psychologist in Eden Prairie, Minnesota. My practice is called Portage Psychology, and we are at portagepsych.com. So anyone who's interested in seeking out testing with me is certainly welcome to go to our website. We have a contact us form. But you know we...
Nikki Kinzer
And do they have to be in Minnesota or can they be... they do, okay.
Dr. Amie DeHarpporte
Yep. Yep. So I was gonna say that's gonna be a very, very narrow segment of your audience.
Nikki Kinzer
Yeah.
Pete Wright
I was gonna say...
Nikki Kinzer
Yeah.
Pete Wright
Very narrow niche, yeah.
Nikki Kinzer
Yeah.
Pete Wright
But you know, I will say visiting the website will help you see the patterns of things you should be looking for for a testing clinician in your area.
Nikki Kinzer
Yeah, agree.
Pete Wright
So if you want a template, there's a lot of great information there.
Dr. Amie DeHarpporte
Yep. I will say that there's a lot of variation in kind of the approaches that clinicians take, and we do try to fall on the more kind of thorough and...
Pete Wright
Yeah. Yeah.
Dr. Amie DeHarpporte
...humanistic side of things I would say. So if you're interested in looking at what that looks like, yeah, you can go to the website.
Pete Wright
Perfect. Perfect. Perfect.
Dr. Amie DeHarpporte
Thank you both very much.
Pete Wright
Well, thank you. Thank you, Amie. And thank you, everybody, for downloading and listening to this show. We appreciate your time and your attention. Don't forget, if you have something to contribute to the conversation, we're heading over to the Show Talk channel in the Discord server. You can join us right there by becoming a supporting member at the Deluxe Level or Better. Patreon.com/theADHDpodcast. On behalf of Nikki Kinzer and Amie DeHarpporte, I'm Pete Wright, and we'll see you right back here next week on Taking Control, the ADHD podcast.
