ADHD and Rejection Sensitive Dysphoria Test

Is there a better way to screen for adult ADHD?

Adult ADHD expert Dr. William Dodson asks his patients 3 questions. They aren’t anything like the usual questions used to diagnose ADHD.

Dr. Dodson’s 3 Question Test for Adult ADHD

Here are Dr. Dodson’s 3 questions:

‘At any given moment in your life, how many separate thoughts do you have going at the same time?’

‘For your entire life have you always been much more sensitive to rejection, teasing and criticism?’ 

‘Look back over your life – can you remember a period time longer than about 5 minutes (and not drug induced) in which you have both been mentally and physically at peace?’

Do I Have Adult ADHD Quiz Questions

Dr. Dodson’s questions are different because he is asking about what is going on internally for an adult with ADHD.

The way ADHD (Attention Deficit Hyperactivity Disorder) has been understood, and diagnosed, is through the criteria of the DSM. The DSM criteria are based on external observations of children with very obvious signs of ADHD.

The DSM criteria were designed for diagnosing children. Initially there was no recognition that ADHD continues into adulthood.

Now there is an understanding that ADHD is a result of neurodiversity. People with ADHD have a difference in how their brain regulates many things, including attention.

An ADHD brain doesn’t go away when you become an adult, but adults often learn to manage their ADHD traits. And since our understanding of ADHD is so limited, many people never realize that their brain is different.

We also now know that ADHD exists on a spectrum, and that ADHD traits can fluctuate depending on life circumstances. So someone who managed their ADHD fine for years, can suddenly have major issues with ADHD under stress.

They never realize that what they are feeling is because they have ADHD, which can be managed well once this is understood.

Do I Have ADHD Question 1: Racing Thoughts

The DSM criteria of hyperactivity focuses on physical hyperactivity. The stereotype is a disruptive little boy running around in class.

Here are the criteria of hyperactivity/impulsivity for the DSM diagnosis of ADHD:

  • Often fidgets with or taps hands or feet, or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected.
  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
  • Often unable to play or take part in leisure activities quietly.
  • Is often “on the go” acting as if “driven by a motor”.
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed.
  • Often has trouble waiting his/her turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

There is no mention of hyperactivity of thoughts, when clearly this is an aspect of ADHD. It is the regulation of thoughts that can be an issue. You can see this in our famous distractibility, and charming but meandering storytelling.

Having many thoughts can be amazing. It can lead to creative problem solving, seeing things in new ways, coming up with out-of-the-box solutions.

We can look ahead and consider multiple possibilities, and see problems and solutions before anyone else does. Trust me I have, and I would not trade that for anything, and it turns out I’m not alone.

‘In the midst of all the chaos swirling through your brain, all the disorganization and impulsiveness, this condition (ADD) also seems to trigger a certain kind of creativity.’

David Neeleman, CEO of JetBlue

But having many thoughts can also lead to having trouble sleeping, because sometimes I can’t ‘turn my mind off‘. And under stress, it can become absolutely overwhelming and can lead to ADHD decision paralysis.

Dr. Dodson’s Adult ADHD racing thoughts test:

‘At any given moment in your life, how many separate thoughts do you have going at the same time?’ .

Dr. Dodson’s Adult ADHD question #1

Dr. Dodson finds most adults with ADHD say they have ‘three to five simultaneous thoughts’.

If we think of this as ‘hyperactivity of thoughts’, then it fits right in with the idea of ‘ADHD hyperactivity’.

Do I Have ADHD Question 2: Rejection Sensitive Dysphoria Test

Dr. Dodson’s second question for Adult ADHD is actually a test for Rejection Sensitive Dysphoria (RSD) test:

‘For your entire life have you always been much more sensitive to rejection, teasing and criticism?’ 

Dr. Dodson’s Adult ADHD question #2

Dr. Dodson says he almost always gets the answer ‘Yes’ to this question.

But no one brings it up on their own because they don’t know being highly emotional is related to ADHD and they feel so much shame about being highly sensitive in this way.

Imagine if we thought of this as ‘emotional hyperactivity’, another aspect of the hyperactivity of ADHD.

Emotional hyperactivity is part of ADHD, and always has been. The ADHD experts agree on that. Although they might call it emotional impulsiveness, emotional dysregulation, or emotional lability.

Dr. Barkley, a widely respected ADHD expert, has spoken and written about the importance of emotional regulation in ADHD many times, this lecture is a good example. He has stated that back in the 60s and 70s, all the research papers included emotional impulsiveness.

But the DSM specifically decided to not include emotions in the diagnostic criteria of ADHD, and listed it as an associated problem in some people. But it is clearly a core feature.

With ADHD you have emotional hyperactivity and impulsiveness. People with ADHD have normal emotions but they feel more extreme because it is harder for people with ADHD to self-regulate. We can’t moderate our emotions as well.

This can mean being easily excitable, feeling passionate about your interests, sharing your excitement in a way that gets other people excited too. It can be a beautiful thing.

But this can also show up as a quickness to anger, having a low frustration tolerance, and being easily irritated.

And at its worst, it can show up as an unbearable sensitivity to rejection and criticism. Adults with ADHD consider this the most debilitating aspect of having ADHD.

This is the Rejection Sensitive Dysphoria (RSD), a specific term that Dr. Dodson came up with, for this aspect of ADHD (and likely autism as well). I don’t think it is excessive to say that RSD has cost lives.

Do I Have Adult ADHD Question 3: Restlessness

Overwhelmed. Restless. Irritated. This can be what it feels like to have undiagnosed adult ADHD.

The adult with ADHD is desperately trying to hold everything together, wondering why it seems so easy for everyone else.

And the symptoms of ADHD are not static, they get worse with stress, and during menopause for women.

By symptoms, we are talking about the regulation of emotions, thoughts and actions, not just distractibility and impulsiveness/hyperactivity.

People with ADHD are more likely to use alcohol and other drugs. To ‘self-medicate’ without even knowing this is what they are doing.

Dr. Dodson’s Adult ADHD restlessness test:

‘Look back over your life – can you remember a period time longer than about 5 minutes (and not drug induced) in which you have both been mentally and physically at peace?’

Dr. Dodson’s Adult ADHD question #3

Dr. Dodson says that many adults with ADHD answer ‘No! My mind is never at peace’.

Do I Have Adult ADHD?

Dr. Dodson’s questions get to the core of how it feels to have ADHD as an adult, not how it looks when a child has ADHD in a classroom.

The DSM criteria is not designed for adult ADHD diagnosis. This is so well known that a non profit group, the DIVA foundation, has designed and validated interview questions with examples of how the DSM criteria for ADHD can present in adults.

It also draws a line in the sand, the DSM says you either have ADHD or you don’t. This is a problem because we now know that ADHD is a brain difference that exists on a spectrum.

And this is the crime, there are so many people out there with ADHD or ADHD traits who don’t know it.

Interested in another quick informal test for adult ADHD?

Read how ADHD entrepreneur Will Henshall got diagnosed by Dr. Ned Hallowell with another 3 simple questions!

Or formal tests? Here is my review of medically validated ADHD assessment tools.

Who don’t realize how amazing things can be if these traits (VAST – Variable Attention Stimulus Trait, is the new term for ADHD traits) are well managed.

They don’t realize that over-focusing or hyperfixation is a part of ADHD, and learning how to control hyperfixation can turn a curse into a superpower. (What’s hyperfixation? Definition here.)

There are people out there who think they are just a ‘highly sensitive person’, or ‘too emotional’, or ‘too much’. Who get diagnosed with anxiety, depression, or borderline personality disorder, when the main issue is that they have ADHD and regulation of emotions is part of ADHD.

There are physicians and researchers out there who do not understand ADHD. That it isn’t just about distractibility, impulsivity and hyperactivity. That ADHD is about regulation.

Think about Dr. Dodson’s questions. They ask about the thoughts, emotions and the sensation of restlessness in an adult with ADHD.

We know that our thoughts, our emotions and our actions are intertwined. So use this knowledge when thinking about ADHD, because ADHD is about the regulation of all three.

The hyperactivity and impulsivity that you see physically also applies to our thoughts and emotions. And treating ADHD can treat all these symptoms. Someone with ‘refractory depression’ may have ADHD and finally respond to ADHD medications.

There are safe and unbelievably effective medications for rejection sensitive dysphoria.

The physical restlessness and dysregulation may manifest as body focused repetitive behaviors such as cheek biting or skin and scalp picking. Most people are too ashamed to seek treatment for this, but there are lots of options to treat skin and scalp picking, including – ADHD medication!

It is time to get serious about this, because this confusion is affecting many lives. As someone with adult ADHD I am passionate, irritated and really angry about this lack of knowledge about ADHD.

If that makes you want to call me ’emotionally dysregulated’, that’s fine. As long as you finally realize that ’emotional hyperactivity’ is a part of ADHD.