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If you are reading this article, you're likely contemplating to pursue an ADHD assessment. Perhaps you feel that yourself or a loved one might have ADHD. Maybe you've experienced challenges in your life with focus, attention, or impulsivity, and you're seeking clear answers. Regardless of your situation, embarking on the path to an accurate ADHD diagnosis can be daunting. This guide aims to equip you with in-depth knowledge and resources needed to navigate this effectively.
ADHD specialist services: NHS and Private
The NHS route, delays and patience
The NHS is the UK's public healthcare system, offers ADHD assessments and treatment. Since the services are divided within regional and local organisations, there is no set standard in terms of assessments length or aftercare. Usually, in this setting the assessments tend to be detailed, extending up to 3-4 hrs followed by a comprehensive report. Once a patient is diagnosed and decides to commence treatment, needs to receive specialist follow-ups every 6 - 12 months. Due to a combination of limited funding and increased demand, waiting times can be notoriously long. Sometimes, the delays can last up to many years. This is challenging for adults seeking answers. The NHS assessments are not free, they carry a significant cost, however these are covered by the National Health Service.
The Private path vast, confusing and has a price tag
The current emphasis of this type of assessments is largely around reduced waiting times. With few providers focusing on in-depth assessments. There is less consistency across the services such as: regulation, assessment length, report detail, type of professional completing the assessment or aftercare. Prices are influenced by multiple factors, most important is the assessment conducted by a psychiatrist which is a (medically qualified doctor), psychologist or another specialist. What is the length of the private assessment? What are the costs of follow-ups, shared care agreement, prescriptions, location: in-person or online meetings. Would you be able to see the same practitioner?
Online searches reveal a plethora of options, each with different marketing, offering and varying costs. Some clinics offer in-depth evaluations, while others cater specifically to streamlined assessments. The price tag can be perceived as a barrier, especially if this is the first experience accessing private healthcare. Another challenging factor is that some private medical insurance plans may not cover the treatment for ADHD. Where self-funding is available, this offers the most effective access to private care.
Ensuring an Accurate ADHD Diagnosis
Qualifications
Ensure the psychiatrist, psychologist, or specialist conducting the assessment is qualified. However, these have limitations in terms of understanding the level of expertise in diagnosis and treatment of ADHD. Some professionals may have limitations in understanding other conditions or may not be able to prescribe medication. Most practitioners obtain expertise in diagnosing and treating ADHD by completing a training course, work experience or undergoing a training programme. Read their website profile and if not sure ask questions. Look for certifications from relevant bodies:
Learn about the importance of a psychiatrist being on the Specialist Register The Specialist Register - GMC (gmc-uk.org)
General Medical Council Find a doctor’s record on the medical register - GMC (gmc-uk.org)
Royal College of Psychiatrists (RCPsych) Public members list (rcpsych.ac.uk)
British Association for Counselling and Psychotherapy British Association for Counselling and Psychotherapy (bacp.co.uk)
Nursing & Midwifery Council Search the register - The Nursing and Midwifery Council (nmc.org.uk)
Regulation
Beyond the qualifications, marketing and online reviews private services in England specialising in the diagnosis and treatment of ADHD need to be registered with the Care Quality Commission. This system of registration ensures that only those people who are deemed to be fit and are likely to provide good quality care are registered. The Care Quality Commission monitors, inspects and regulates services that provide health and social care. This includes mental health services providing diagnosis and treatment of ADHD. There are a couple of advantages for an ADHD service to be registered with the Care Quality Commission, as the assessment process already passed rigorous checks.
To find and compare the public list of CQC registered services, you can search Find and compare services - Care Quality Commission (cqc.org.uk)
Registered organisations need to meet a number of regulations. The list can be found here Regulations for service providers and managers: related legislation - Care Quality Commission (cqc.org.uk)
Note: In England, some practitioners may have exemption in registering with the Care Quality Commission. Scotland and British Isles have the equivalent, but different regulatory bodies.
Company check:
When you are accessing ADHD services through a company, you can check the Company House details. The search results will guide you to understand who the directors are, their full names, positions in the company, the nature of business, date of last accounts and many other details. The public information can be accessed for free at Get information about a company - GOV.UK (www.gov.uk)
Pre-assessments for ADHD are offered by some service providers. It is important to highlight these are not replacing or reducing the diagnosis assessment process.
Experience:
Seek a practitioner with experience in diagnosing ADHD, look for information on their website or inquire during your initial contact. Before booking a consultation, private providers need to provide patients with terms and conditions, and written information about their services and fees. Up to 60% of adults diagnosed with ADHD may suffer from one or more co-existing conditions. Sometimes, a diagnosis in mental health may have limitations, and in this case the practitioner needs to perform what we call a psychological formulation. For many years, ADHD used to be diagnosed mainly by child and adolescent psychiatrists, general adult psychiatrists, paediatrician or clinical psychologists.
Currently the NICE guidelines recommend: "A diagnosis of ADHD should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in the diagnosis of ADHD". Given the wide gap of training and expertise in the approved assessors, you need to choose carefully the level of support you need.
Assessment length
The Royal College of Psychiatrists recommends "We suggest that in most cases, assessment and diagnosis of ADHD will require two to three 1h sessions. It is important to stress that this process does not need to be rushed". "Questionnaires can help with the assessment process but ADHD can only be accurately diagnosed with a comprehensive interview; a consultation-based assessment". The Adult ADHD Assessment Quality Assurance Standard (AQAS), published in 2024 suggests "It is recommended that 2 hours or more is required for an adequate assessment..."
The ADHD assessment is one of the most detailed consultations in mental health. This needs to be comprehensive, since it covers an individual entire developmental history, during pregnancy, birth, childhood, school and adult life. The information is collected from the patient, and where available an informant. The diagnosis process needs to focus on any other conditions which may mimic the ADHD symptoms or understand any present co-existing conditions. If a diagnosis of depression and anxiety can be temporarily, ADHD is a lifelong condition. Therefore, a careful consideration and detail process needs to be in place when establishing this diagnosis.
The ADHD assessment consists of understanding the pre-assessment questionnaires, neurodevelopmental history, general mental health screening and mental state examination, physical health screening, completion of a diagnosis interview questionnaire e.g. DIVA-V, diagnosis formulation, risk assessment, diagnosis psychoeducation and where appropriate a treatment plan.
To read our approach to the Adult ADHD assessment, visit Private Adult ADHD Assessment | London and U.K (adhdspecialist.com)
Specialist and patient bias
Although a vast majority of patients may be able to identify correctly the inattentive and hyperactive symptoms. Attending an ADHD assessment should be viewed as an exercise of curiosity, where this can have several outcomes: establishing a diagnosis of ADHD, not meeting the diagnosis criteria, one or more co-existing conditions or the presentation may be explained by another mental health diagnosis. Some researchers highlight the risk of repeatedly reading symptoms online, may lead to a phenomenon called cyberchondria. Although the narrative was that ADHD is underdiagnosed, we do not have access to up-to-date data for the present or the future projections. What we certainly know, is that in 2023 and part of 2024 for the first time we experienced several medication shortages due to an increased global demand and possible manufacturing issues.
Confirmation bias occurs when the assessors focus is on information that confirms their existing beliefs about ADHD. For example, a specialist who primarily encounters ADHD presentations might overlook symptoms of other mental health conditions. This bias may also apply when someone seeking an assessment does extensive reading, repeated online testing for months, sometimes years. Now, this bias may not apply to everyone, but it is something to always be mindful.
Gender bias, historically women used to be underdiagnosed compared with the "typical" presentations in naughty young boys and men. Currently, there is an emphasis from most services about adhd diagnosis in women, inattentive symptoms, masking and internalised experiences. The bias tilt can shift from one group to another in just a few years. Therefore, is important for the condition not to be over or under diagnosed and each case to be approached with curiosity. An interesting emerging area is the link between neurodevelopmental conditions, ADHD, ASD, and hormonal changes.
Socioeconomic bias may play a role in the journey of being diagnosed with ADHD. Individuals from lower socioeconomic backgrounds are likely having less access to private services or may have challenges to have comprehensive assessments. On the other hand, some assessors consider if someone has a high education achievement cannot suffer from Adult ADHD. We require far more research and resources in this area. Mental health challenges can affect anyone, regardless of age, background, education or social class.
Even the most open-minded people aren't immune to unconscious bias.
Is the assessment approved?
Regardless of where you are seeking to book your assessment and treatment, there is no list of NHS recognised ADHD assessments. A simple checklist to follow is assessor qualifications and professional registration, enquire if the assessment is conducted to NICE guidelines and enquire about service provider registration. Having a comprehensive ADHD assessment is a very important decision, as the assessment report is proof of your diagnosis for many years to come.
Perhaps in the history of mental health there was no other mental health diagnosis to be challenged as much as ADHD. In the future, the person with an established diagnosis is likely to change address, specialist, their GP or country of residence. Therefore, the diagnosis report needs to be comprehensive as this helps during your journey in life, the clinician taking over your care, or other institutions requesting a proof of diagnosis.
ADHD Assessment and Treatment Costs
Seeking diagnosis and treatment for ADHD can be a financial burden, but at the same time offers opportunities towards improved quality of life, education, career development or better relationships. Although the NHS is far from perfect, in particular when it comes to funding, can offer free care. In this situation the person would need to cover the subsidised cost of the medication, and in some cases, this may also be provided entirely for free. The assessment costs, follow-ups and medication refills are mostly covered by the National Health Service. Some NHS organisations may have contracts with third party providers via the Right to Choose Program, which may be a separate topic.
Private care for ADHD should be emphasised on quality of care, positive outcomes and sustained improvements for years to come. However, this comes at the cost of the ADHD assessment, this can range from hundreds to thousands. Followed by covering the costs of follow-ups and cost of medication until the shared care agreement is in place. Since ADHD is a chronic long-lasting condition, there is a need for continuity of care. In order for the shared care agreement to be valid, a specialist follow-up appointment is required every 6-12 months.
Long-term, living with ADHD
We are still in the early phases when it comes to the understanding of the origins of ADHD. An area of interest is how someone suffering from this condition can have the best quality of life for many years to come. Some recent research articles indicate that individuals with ADHD are nearly twice as likely to develop at least one cardiovascular event, compared with non‐ADHD.
Some suggest that a person with ADHD is part of a higher-risk group for experiencing injuries and may be at a higher risk to develop physical health conditions in adulthood. A very recent study released in February 2024 suggests that the treatments for ADHD may reduce hospitalisation episodes, mortality or risk of injuries. We have well established data in the literature about the relationship between addictions and ADHD.
Closing words
Mental Health is not a one size fits all, and in most cases is more of a marathon rather than a sprint. We all have symptoms of certain conditions; however, these may not always meet the diagnosis threshold of a condition. Whether you choose the private assessment route or the NHS, the most important factor is finding a qualified and experienced professional. The ADHD diagnosis is not the end, but a valuable beginning towards a better quality of life. Attention Deficit Hyperactivity Disorder is a condition which can be managed effectively. Compared with other mental health conditions, when this is diagnosed accurately, it has one of the best treatment outcomes. In most cases, ADHD is present by itself, however in some individuals may also be accompanied by co-existing conditions. A qualified specialist will be able to answer your questions and provide you with clarity.
Find understanding: ADHD Assessment
Living in London or the U.K. and suspect you might have ADHD?
Read our approach to the ADHD assessment, if it aligns with your needs, we'd be happy to assist you.
References
DIVA Foundation - DIVA-5 - Use of DIVA-5 (divacenter.eu)
Overview | Attention deficit hyperactivity disorder: diagnosis and management | Guidance | NICE
Attention deficit hyperactivity disorder (ADHD) - Diagnosis - NHS (www.nhs.uk)
Is cyberchondria specific to hypochondriasis? - ScienceDirect
Unconscious Bias among Health Professionals: A Scoping Review - PMC (nih.gov)
Confirmation bias | Definition, Examples, Psychology, & Facts | Britannica
Research: How Bias Against Women Persists in Female-Dominated Workplaces (hbr.org)
Pictures source Pexels.com Free Stock Photos, Royalty Free Stock Images & Copyright Free Pictures · Pexels
Disclaimer: The information is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional. Information about mental health topics and treatments can change rapidly and we cannot guarantee the content's currentness. For the most up-to-date information, please consult your doctor or qualified healthcare professional. For more information, you can check the Royal College of Psychiatrists (rcpsych.ac.uk)
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