ADHD
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What is ADHD?
"Attention deficit hyperactivity disorder (ADHD) is a condition that affects people's behaviour. People with ADHD can seem restless, may have trouble concentrating and may act on impulse.
Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school.
Most cases are diagnosed when children are under 12 years old, but sometimes it's diagnosed later in childhood.
Sometimes ADHD was not recognised when someone was a child, and they are diagnosed later as an adult.
The symptoms of ADHD may improve with age, but many adults who were diagnosed with the condition at a young age continue to experience problems.
People with ADHD may also have additional problems, such as sleep and anxiety disorders.
It's also a good idea to speak to a GP if you're an adult and think you may have ADHD, but were not diagnosed with the condition as a child."
Taken from www.nhs.uk
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What are the symptoms of ADHD?
"The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into 2 types of behavioural problems:
- Inattentiveness (difficulty concentrating and focusing).
- Hyperactivity and impulsiveness.
Many people with ADHD have problems that fall into both these categories, but this is not always the case.
For example, around 2 to 3 in 10 people with the condition have problems with concentrating and focusing, but not with hyperactivity or impulsiveness.
This form of ADHD is also known as attention deficit disorder (ADD). ADD can sometimes go unnoticed because the symptoms may be less obvious.
ADHD is more often diagnosed in boys than girls. Girls are more likely to have symptoms of inattentiveness only, and are less likely to show disruptive behaviour that makes ADHD symptoms more obvious. This means girls who have ADHD may not always be diagnosed.
The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of 6. They occur in more than 1 situation, such as at home and at school.
Children may have symptoms of both inattentiveness and hyperactivity and impulsiveness, or they may have symptoms of just 1 of these types of behaviour.
Inattentiveness (difficulty concentrating and focusing).
The main signs of inattentiveness are:
- Having a short attention span and being easily distracted.
- Making careless mistakes eg. in schoolwork.
- Appearing forgetful or losing things.
- Being unable to stick to tasks that are tedious or time-consuming.
- Appearing to be unable to listen to or carry out instructions.
- Constantly changing activity or task.
- Having difficulty organising tasks.
Hyperactivity and impulsiveness.
The main signs of hyperactivity and impulsiveness are:
- Being unable to sit still, especially in calm or quiet surroundings.
- Constantly fidgeting.
- Being unable to concentrate on tasks.
- Excessive physical movement.
- Excessive talking.
- Being unable to wait their turn.
- Acting without thinking.
- Interrupting conversations.
- Little or no sense of danger.
These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.
Related conditions in children and teenagers with ADHD.
Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:
- Anxiety disorder (which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness).
- Oppositional defiant disorder (ODD) (this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers.
- Conduct disorder (this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals
depression.
- Sleep problems (finding it difficult to get to sleep at night, and having irregular sleeping patterns).
- Autistic spectrum disorder (ASD) (this affects social interaction, communication, interests and behaviour).
- Dyspraxia (a condition that affects physical co-ordination).
- Epilepsy (a condition that affects the brain and causes repeated fits or seizures).
- Tourette's syndrome (a condition of the nervous system, characterised by a combination of involuntary noises and movements (tics)).
- Learning difficulties (such as dyslexia).
Symptoms in adults.
In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.
As ADHD is a developmental disorder, it's believed it cannot develop in adults without it first appearing during childhood. But symptoms of ADHD in children and teenagers often continue into adulthood.
The way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children.
For example, hyperactivity tends to decrease in adults, while inattentiveness tends to remain as the pressures of adult life increase.
Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms.
Some specialists have suggested the following as a list of symptoms associated with ADHD in adults:
- Carelessness and lack of attention to detail.
- Continually starting new tasks before finishing old ones.
- Poor organisational skills.
- Inability to focus or prioritise.
- Continually losing or misplacing things.
- Forgetfulness.
- Restlessness and edginess.
- Difficulty keeping quiet, and speaking out of turn.
- Blurting out responses and often interrupting others.
- Mood swings, irritability and a quick temper.
- Inability to deal with stress.
- Extreme impatience.
- Taking risks in activities, often with little or no regard for personal safety or the safety of others eg. driving dangerously.
Related conditions in adults with ADHD.
As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions.
One of the most common is depression. Other conditions that adults may have alongside ADHD include:
- Personality disorders (conditions in which an individual differs significantly from the average person in terms of how they think, perceive, feel or relate to others).
- Bipolar disorder (a condition affecting your mood, which can swing from one extreme to another).
- Obsessive compulsive disorder (OCD) (a condition that causes obsessive thoughts and compulsive behaviour).
The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships and social interaction."
Taken from www.nhs.uk
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What are the treatments for ADHD?
"For children with ADHD, although there's no cure, it can be managed with appropriate educational support, advice and support for parents and affected children, alongside medicine, if necessary.
For adults with ADHD, medicine is often the first treatment offered, although psychological therapies such as cognitive behavioural therapy (CBT) may also help."
Taken from www.nhs.uk
Right to choose
If you reside in England and are covered by the NHS, you are now legally entitled to select your mental healthcare provider and team.
This crucial right empowers you to opt for alternative providers if you find the waiting time for your ADHD assessment too lengthy. Providers must offer services within the NHS in England.
The Right to Choose in Mental Health is a relatively new option, introduced in 2018, and not all patients, GPs, or clinicians may be familiar with it and its functioning. We have provided an explanation specifically designed for those undergoing the ADHD Assessment process. See below.
(Additionally, we offer a downloadable support letter for individuals whose GP initially declined their request.
Further information can be accessed through the NHS link on NHS choices: https://www.nhs.uk/using-the-nhs/about-the-nhs/your-choices-in-the-nhs/)
Adult Pathway
Patients have the Right to Choose when the following conditions are met:
- the NHS practice is in England (different rules apply for Scotland, Wales and Northern Ireland)
- the General Practitioner has agreed to make a clinically appropriate outpatient referral
(Of note: The decision to make a referral is the GPs responsibility and separate from the Right to Choose. Right to Choose is a patient’s right to decide where that referral is to).
The above is designed to be wide-ranging in its application to patient choice. However. there are certain restrictions on a patient’s Right to Choose that you should be aware of. Patients cannot use Right to Choose if they are:
- already receiving mental health care following an elective referral for the same condition.
- referred to a service that is commissioned by a local authority, for example, a drug and alcohol service (unless commissioned under a Section 75 agreement). If a person has self-referred to a service, this is fine.
- accessing urgent or emergency (crisis) care.
- accessing services delivered through a primary care contract.
- in highly secure psychiatric services.
- detained under the Mental Health Act 1983.
- detained in a secure setting. This includes people in or on temporary release from prisons, courts, secure children’s homes, certain secure training centres, immigration removal centres or young offender institutions.
- serving as a member of the armed forces (family members in England have the same rights as other residents of England).
There are restrictions on who the patient can direct their care to. Patients cannot refer to just any provider. The provider must:
- have a commissioning contract with any Clinical Commissioning Group (CCG) or NHS England for the required service.
- have the service and team led by a consultant or a mental healthcare professional.
Common GP queries include:
- does an IFR (Individual Funding Request) need to be in place? It does not.
- does the CCG need to be asked for permission? It does not.
Right to Choose Providers – ADHD Assessments
We are aware of the following Right to Choose providers.
If you are aware of any more then please let us know.
Accepting new referrals:
ADHD 360 provide both Right to Choose and Private ADHD Assessments.
They started providing their Right to Choose service in mid-2021.
April 2024 Update: They are open for Right to Choose bookings. We are being told the wait is the following:
- Private adult assessments: 7 days
- Private child assessments: 3 weeks
- NHS: 2 weeks (contracted activity)
- Right to Choose (RTC): 11-14 weeks
ProblemShared is “a practitioner-led, CQC-regulated online mind health provider, working with a community of expert practitioners to broaden access to the highest quality care for people across the UK.
We work in partnership with institutions such as the NHS, insurance companies and universities to deliver NICE-informed therapy, neurodevelopmental assessments and post-diagnostic care for adults,
children and young people.
Our post-diagnostic support includes ADHD medication, where appropriate. We are also very proud to be the first Right to Choose provider in the UK to offer psychoeducation workshops. Our psychoeducation workshops are a space for clients and their families to learn more about themselves and their diagnoses“.
April 2024 Update: Their wait time is estimated to be 6 months.
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Psychiatry-uk.com may be the largest provider of right-to-choose ADHD assessments in the UK. Their assessments are predominately done by video call,
which has become commonplace since the start of the pandemic.
April 2024 Update: The current wait list for diagnosis for new adult patients is estimated to be over 18 months. If you opt for medication, then there is a secondary queue that is estimated to be over 6 months although this is subject to change due to the ongoing medication shortages.
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Dr J and Colleagues provide both Right to Choose and Private ADHD and Autism Assessments. They are a small provider and tell us that means they can work through the funding provision from the NHS particularly quickly.
April 2024 Update: We are currently accepting Right to Choose bookings for both ADHD and ASD assessments and treatments, with an estimated waiting time of 8 to 12 weeks for either service.
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Clinical Partners provide both Right to Choose and Private ADHD and Autism Assessments.
It is important to note that Clinical Partners provide an ADHD Assessment Service but they do not offer a medication titration service.
This is, therefore a great fit for individuals who want an ADHD Assessment but know that medication isn’t something they want to pursue.
To those thinking about the option for an Assessment with Clinical Partners and titration/medication elsewhere, you need to be aware that we are not aware of any NHS Right to Choose providers, or private providers, who offer a titration-only service. We only know of providers who require undertaking their Assessment before offering titration as an option.
April 2024 Update: For patients who submitted new referrals after January 1st, 2024, the current waiting period remains approximately 30 weeks, roughly equivalent to seven months. Patients whose referrals were received before this date can expect to hear from us shortly with further information.
For children and young people’s ADHD assessments, we are not currently accepting new referrals. We ask that anyone with an existing referral contact us directly at rtc@clinical-partners.co.uk or 0203 761 7029 for more information.
For up-to-date waiting time information, please contact 020 3761 7029, or email rtc@clinical–partners.co.uk
We do not currently offer medication titration.
However, this is something we’re looking at introducing in the future.
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Evolve Psychology has two clinics based in Harrogate, North Yorkshire and Huddersfield, West Yorkshire. They offer Right To Choose assessments for ADHD and Autism (or both as a combined neurodevelopmental assessment) for children/ young people up to the age of 19 who are in education.
They do not have a Right to choose service for adults (although they do have a private adult service for ADHD and Autism Services). They can accept referrals England-wide. They prefer face-to-face assessments but might be able to offer online assessments depending on individual circumstances if the team feel it would be appropriate.
April 2024 Update: They are at 24-month waiting times. Due to high demand, they are only able to take referrals for 0-19-year-olds but do take private and Insurance referrals for adults.
