What should I tell an ADHD assessor if I think my focus problems are actually OCD?

Say you are worried it may be OCD

Start by saying this plainly at the beginning of the history: "I am wondering if my focus problems may be OCD rather than ADHD, or both." That helps the assessor ask the right follow-up questions instead of treating all concentration problems as simple distractibility.

A Canadian ADHD assessment is supposed to look at other explanations and coexisting conditions, not just count ADHD symptoms. CAMH’s adult ADHD assessment guidance and the Canadian ADHD Practice Guidelines from CADDRA both describe a structured assessment that includes comorbidities, developmental history, functional impairment, and differential diagnosis. In other words, this is relevant information, not a side issue.

• When your concentration problems started
• Whether they are constant or come in episodes
• What is happening in your mind right before you lose focus
• Whether anxiety relief behaviours take up time
• Whether the issue is unfinished tasks from distraction or getting stuck in checking, reviewing, repeating, or avoidance

If your thoughts include self-harm, suicide, severe anxiety, depression, or substance use concerns, say that directly. If you need help now, call or text 9-8-8 in Canada, or call 911 in an emergency.

Name the clues that sound like OCD

The most useful details are the ones that show an obsession-compulsion pattern rather than ordinary distractibility. The assessor is listening for intrusive thoughts, urges, images, or doubts that create distress, followed by actions or mental rituals meant to reduce that distress.

• Intrusive thoughts: unwanted thoughts, images, or urges that feel hard to dismiss and keep interrupting what you are doing
• Obsessions about contamination, harm, mistakes, morality, symmetry, relationships, health, or whether you did something wrong
• Checking rituals, such as re-reading messages, checking locks, appliances, schoolwork, forms, or body sensations repeatedly
• Mental rituals, such as reviewing events, counting, praying, replacing a “bad” thought with a “good” one, or trying to feel completely certain
• Reassurance-seeking, including asking others if things are okay, if you offended someone, or if you are safe
• Repeating or restarting tasks until they feel “just right”
• Avoidance of triggers because they set off obsessive doubt or rituals
• Losing large chunks of time to rumination, checking, confessing, researching, or trying to get certainty

This kind of description gives the assessor a clearer history than saying only “I cannot focus.”

Explain how it differs from ADHD distractibility

The key question is why your attention breaks. In ADHD, attention often shifts because of boredom, competing stimuli, poor task initiation, weak working memory, or difficulty sustaining effort. In OCD, attention may narrow onto a distressing thought or doubt, and the loss of focus happens because the person is busy neutralizing, checking, avoiding, or trying to feel certain.

Some people have both. They may be distractible in a broad ADHD way and also get stuck in rituals or obsessional loops. If that seems true for you, say so. The assessor is not looking for a perfect one-word explanation. If you need help now, call or text 9-8-8 in Canada, or call 911 in an emergency.

If trauma reactions seem relevant too, see how clinicians tell ADHD from PTSD in adults who have concentration problems.

Bring examples from real life

Concrete examples are often what make the difference. Pick two or three recent situations and describe them step by step, including the thought, the feeling, the behaviour, and how much time it took.

• Work or school: “I re-read one email for 25 minutes because I was afraid I sounded harmful, rude, or irresponsible.”
• Driving or leaving home: “I go back to check the stove or door multiple times even when I know I already checked.”
• Parenting or relationships: “I ask for reassurance repeatedly that I did not say the wrong thing.”
• Studying: “I restart notes until they feel right, so I fall behind.”
• Technology: “I keep searching symptoms or mistakes online to feel certain, then I cannot get back to the task.”

Also say whether these patterns happened in childhood, the teen years, or started later. ADHD usually begins earlier in life, while an obsession-compulsion pattern may become more obvious at certain stress points. Timing alone does not settle it, but it matters in the history.

If a teen is being assessed, a parent can describe what they see without trying to force a label. For youth ages 12 to 17, Finding Focus offers assessment only in select provinces through licensed Canadian clinicians working with the clinic. Consent and family involvement depend on the young person’s circumstances, maturity, applicable law, and clinical judgment.

Bring a short symptom list and questions

A short written summary can keep the assessment focused. One page is enough. It should help the clinician compare obsession-compulsion clues with ADHD-type distractibility during history taking.

1. Write your top 3 focus problems in plain language.
2. Under each one, note what happens just before it starts.
3. Mark whether the interruption is a fear, doubt, image, urge, boredom, noise, forgetfulness, or task overload.
4. List any rituals or mental acts you do afterward.
5. Estimate time lost and how often it happens.
6. Note what causes impairment, such as lateness, unfinished work, conflict, exhaustion, or avoidance.

Useful questions to ask include: “Does this sound more like intrusive thoughts and compulsions than ADHD distractibility?”, “Could both be present?”, and “What information would help you tell the difference?” If broader alternative explanations are on your mind, what red flags make an assessor think it may not be ADHD after all? may help you prepare.