#127🔍 The Full Psychiatric Assessment You Actually Need

“I just need an ADHD assessment” is almost never true

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Part 6 of the Things I Wished I Knew Sooner Series

🦋 The Takeaways

Belief: I just need an ADHD assessment.

Reality: Anxiety and depression can also be present and need to be treated before assessing for ADHD in adults.

Action: Request a full psychiatric assessment, not just an ADHD screen.

⭐️ Introduction

Welcome back to Things I Wished I Knew Sooner. Over the past few weeks, I’ve been talking about what happens after you get diagnosed with ADHD as an adult.

But today I want to step back and talk about something that happened before my diagnosis: what you’re actually getting assessed for.

I sat down with Cheryl Cooke, PhD, DNP, PMHNP-BC, a psychiatric mental health nurse practitioner, to discuss what an ADHD assessment should look like. What she told me made me rethink my own assessment experiences.

When I went to get assessed, I thought I was just getting an ADHD evaluation. But Dr. Cheryl explained something crucial: “When you come in to say, ‘Oh, I just need an ADHD assessment,’ you are not looking at the entire picture, particularly in adults. You need a full psychiatric assessment.”

It’s never just one thing when it comes to ADHD.

😵‍💫 The Belief - I Just Need an ADHD Test

When you’re struggling with focus, procrastination, or time management, it’s easy to point to ADHD as the culprit. You’ve read about it online. You’ve taken the self-assessment quizzes. You see yourself in the symptoms.

So you go to a provider and say, “I think I have ADHD. Can you assess me for that?”

It seems straightforward. You have a specific problem. You want a specific diagnosis. You want to get treated and move on.

I did the exact same thing. My marriage was struggling. A therapist asked if I’d ever been assessed for ADHD. So I found a psychiatrist and said, “I need an ADHD assessment.”

I wasn’t thinking about anything else. I just wanted to understand why certain things were so hard for me. I wanted a simple explanation for a complex problem.

🤝 The Reality - ADHD Rarely Shows Up Alone

Here’s what Dr. Cheryl explained: ADHD is rarely the only thing going on.

“You may also be experiencing anxiety or depression. Both impact your ability to focus and concentrate. Lack of focus or concentration are symptoms of many psychiatric conditions. In fact, it’s an early symptom for anxiety: inability to sleep, lack of concentration, lack of focus.” (I’ve struggled with sleep for the last 17 years.)

Anxiety and depression can look exactly like ADHD. You can’t focus. You procrastinate. You forget things. You feel scattered.

But the underlying cause—and therefore the treatment—is completely different.

Dr. Cheryl’s approach:

“I tend to think that anxiety shows up first for most people, and then they get depressed because they’re tired of being anxious. And if we don’t clean that up, the focus and concentration issues don’t improve.”

She doesn’t prescribe ADHD medication until she completes an assessment for anxiety, depression, or other psychiatric illness. “Once I get that settled, then I work on concentration and focus. If we’ve treated your depression and anxiety, and you’re feeling pretty good but still scattered, then I start looking at ADHD.”

Think of it like layers you have to unravel:

1. Anxiety and depression (if present) - assess and treat these first

2. Substance use (if present) - address this alongside or before mood disorders

3. ADHD - only after addressing conditions that mimic ADHD symptoms

You can’t see what’s actually ADHD until you’ve addressed the other issues that mimic it.

My own experience:

When I moved from my first provider to my second provider, I learned I also have OCD traits. What I thought was ADHD rumination was OCD and required a different treatment approach. Having that language allowed me to get better care.

If I’d only been assessed for ADHD, I would have missed a crucial piece.

I define anxiety as being able to imagine all the ways something can go wrong, even before you do anything. It often stops me from doing anything.

🛠️ The Action - Ask for a Full Psychiatric Assessment

1. Request a comprehensive evaluation, not just an ADHD screen.

Don’t say “I need an ADHD assessment.” Say “I’m experiencing [symptoms], and I’d like a comprehensive psychiatric evaluation.”

This signals you’re open to discovering what’s actually affecting you, not just confirming what you think you have.

2. Be prepared to discuss more than focus.

A proper assessment covers:

• Mood and energy levels

• Sleep patterns

• Anxiety and worry

• Substance use (alcohol, marijuana, caffeine)

• Trauma history

• Family mental health history

Be honest about all of it.

3. Expect treatment to be layered.

Treat anxiety and depression first, then see what remains. If you’re still scattered after mood disorders are addressed, then ADHD could be at play.

This might feel frustrating if you’re convinced you have ADHD. But treating the wrong thing first wastes time.

4. Understand medication is just one part of the treatment plan

Dr. Cheryl calls it “wraparound services”—the need for a comprehensive, interdisciplinary plan to manage symptoms:

• Primary care for general health

• Psychiatrist for medication management

• Therapist for trauma and mental health

• Coach for behavior change

• Close attention to managing exercise and sleep routines

“Medication is a part of the picture. Our best evidence is that medication and non-pharmacological treatments are best at addressing mental health conditions. That is why therapy is so important—this can help you identify and work on behavioral change or habits that are not working to improve your health.”

Dr. Cheryl asks every patient:

• “How do these symptoms affect your life?”

• “What’s going to change because I prescribe an ADHD medication?”

If you can’t answer clearly, you might not need medication. You might need different support.

✨ Conclusion

Getting diagnosed with ADHD as an adult isn’t as simple as taking a quiz and getting a prescription. It’s a process of unraveling layers to understand what’s actually happening.

When you go in for an assessment, you’re not just checking a box. You’re starting a conversation about your mental health that might reveal things you didn’t expect.

That’s not a bad thing. It’s actually the whole point.

Because the goal isn’t to get diagnosed with ADHD. The goal is to understand yourself well enough to get the right help.

👩‍⚕️ About Dr. Cheryl Cooke

Dr. Cheryl L. Cooke is a Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) with more than 40 years of nursing experience. She earned her PhD in Nursing Science and a Doctorate of Nursing Practice in Psychiatric Mental Health Nursing across the lifespan. She maintains a private practice serving clients with ADHD, anxiety, and other mental health needs. Learn more at cooketherapy.com.

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