Adult ADHD assessments - importance of chart review?

[cara susanna]

Hi all,

For those of you who do ADHD assessments with adults, how much do you take into account chart notes that suggest no presence of childhood symptoms? Like, for example, past mental health intakes where the patient denied having behavioral problems in childhood, denied learning problems, denied having bad grades, etc. If you need context, I'm in the VA so for me this is usually from military records or C&P reports.

Would especially love input from neuro folks.

Thanks!

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[singasongofjoy]

disclaimer: not my area of expertise. But someone with inattentive ADHD who is very motivated and bright might have done fine in school but still not as well as they could have done, and/or might have accommodated by spending twice as much time studying etc.- working twice as long to get the same amount of work done can allow someone to get on just fine in life... until suddenly they aren't able to do that anymore, can't stay late at work anymore because now there's a kid in the picture, other competing demands, and then the wheels start to fall off the bus because that strategy doesn't work anymore.

 

[WisNeuro]

It's tough, especially in the VA. In their early experiences in the system, Vets may tend to just say no to everything. In terms of the military records, we often had cases where they denied any MH issues or symptoms, and then when they are vets and we are getting collateral info, we learn about things like suicide attempts in adolescence. Hard to know what's accurate and what isn't.

I will note these chart notes and point out discrepancies in the report (or would back when I still did these). Also, try and get around to asking about early school grades and experiences outside of the context of the ADHD sx. Work this into the general background interview if you can.

 

[PsyDr]

The adhd section of the DSM5 says that individuals self report is unreliable and that collateral is necessary. It phrases it a way that leaves out the idea of malingering, while still giving a standard.

 

[futureapppsy2]

Collateral, collateral, collateral—both from childhood and adulthood if possible.

 

[PikminOC]

Too much secondary gain to get stimulants.

 

[psych.meout]

It's tough, especially in the VA. In their early experiences in the system, Vets may tend to just say no to everything. In terms of the military records, we often had cases where they denied any MH issues or symptoms, and then when they are vets and we are getting collateral info, we learn about things like suicide attempts in adolescence. Hard to know what's accurate and what isn't.

I will note these chart notes and point out discrepancies in the report (or would back when I still did these). Also, try and get around to asking about early school grades and experiences outside of the context of the ADHD sx. Work this into the general background interview if you can.

Yeah, it's more complicated for veterans than other populations. There's such pressure and coaching from recruiters, peers, NCOs, and others to underreport or lie about mental health history prior to service because it would be disqualifying or result in them getting medically separated that you can't interpret denials in their medical records the same way as you would for other populations.

 

[thebalmofhurtminds]

In addition to how common it is for veterans to say no to most previous evals, I'll also say that when I was at the VA, I ran into a lot of issues with providers putting down "denied" when they did not ask explicitly, but simply because the veteran did not volunteer that information.

 

[AcronymAllergy]

In addition to how common it is for veterans to say no to most previous evals, I'll also say that when I was at the VA, I ran into a lot of issues with providers putting down "denied" when they did not ask explicitly, but simply because the veteran did not volunteer that information.

Yes (and not necessarily unique to VA). Or they'll carry it over from prior notes (theirs or others') without verifying or updating. Which is why I appreciate when someone actually writes "did not report" instead; at least then I know they probably just didn't ask about it.