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What is the best way to get an ADHD assessment in England?

Updated: 7 days ago

I think because of my unique(ish) position of being an ADHDer whilst also working part-time in an NHS neurodevelopmental service pretty much every week I get asked

"What's the best way to get a diagnosis".

Firstly I want to make it clear, despite what the media may portray, getting an assessment does not equal getting a diagnosis. The purpose of an assessment is to formulate with you and to explore your experiences to see if an ADHD diagnosis fits and that your experiences can't better be explained by an alternative.


The below are my personal opinions and are written specifically about England as some of these options are not available in other parts of the UK.


Should I go for an assessment?

  • During the assessment, the clinician is looking for impact in daily life. A diagnosis will require there to be an impact on two areas of your life. So if you are looking for assessment just for curiosity and you feel things are great in all aspects of your life, an assessment process isn't going to give you the outcome of a diagnosis. Having said that, if you are reading this chances are you have thought long and hard about the effort it takes to "hold it all together" and there might be invisible struggles others don't see, be clear as to what these are during the assessment, a good clinician will be exploring with you impact on mental health , relationships and day to day functioning in activities.

  • Some people worry about going for an assessment because, what if "I am making a big thing out of nothing", "maybe I am just" "lazy", "unmotivated" , "flakey", "stupid". This is something clinicians hear every day, we work with you to work out what the barriers are to you meeting expectations or doing the things you want to be doing.



Who can do an assessment?

  • An assessment is usually done by a psychiatrist, a psychologist or a specially trained allied health professional. Within the NHS the process varies but it is often a clinician that will do the narrative assessment and then refer to psychiatrist if medication is required.

  • A lot of private assessments are offered by psychologists however, something that is a psychologist can't prescribe medication and if you do receive a diagnosis and it is not from a psychiatrist then you may need to get a new assessment from a psychiatrist. It is also worth noting that in some areas of the UK if you have a private diagnosis it will be an exclusion criteria meaning that you can't access NHS assessment and treatment services. When I initially went for an assessment I had no intention of trying medication, I had tried various antidepressants and anxiety meds in the past and none had been a positive experience for me. But when the psychiatrist said "Sarah would you like to be able to finish a sentence" I thought that did sound rather tasty and enticing. ADHD medication can have a significant positive experience for some. Its something like 70% of adults experience benefits on it - which is pretty impressive outcomes compared to other psychiatric medication. So do factor in, if you are told you are ADHD, will you want to know if medication can make a difference for you. If you choose to go privately can you afford the prescription costs and regular reviews? (My prescription costs me about £105 a month but at various points over the last two years it has been as low as £45 and as high as £190 a month.

  • Before getting an assessment is worth asking your GP who they will be willing to do a "shared care agreement" with. Some medications such as the ones often prescribed by ADHD need a specialist overseeing and reviewing them. A shared care agreement means that the GP is able to take over repeat prescriptions but if there are concern's or a review needed you return to the psychiatrist. Medications that require "shared care" include Methylphenidate, Lisdexamfetamine, Dexamfetamine and Guanfacine.


What are my options for Gaining an assessment?



Option

Pros

Cons

GP to refer to local NHS services

The GP will usually be familiar with the referral route and will be confident in agreeing to a "shared care agreement".


 

You should be feeling confident that the assessment will be following NICE guidelines.


 

There is often a range of freepost-diagnostic support available.

Long waiting lists (although this varies between areas so it is always worth asking.)


 

A lack of choice and control. Whilst you will always be entitled to ask to change clinician you will not have chosen who to see.

GP to refer to a right to choose provider. Right to choose is your choose to ask for an alternative NHS provider. This could be a service in a different area or it is often a private company that is contracted to offer an NHS service.

These often have shorter waiting lists than local NHS services. The charity ADHDUK keeps a list of current waiting lists


 

Most will offer titration (medication)


 

They are funded through the NHS

There may be an unadvertised wait between your first appointment and medication. They might not offer none medication post diagnostic support


 

If the provider loses its NHS contract you may be left without support.


 

GP's are not always aware of the referral option and you will need to go to the appointment with your GP with all the information. This letter is useful.


 

You may be discharged if you miss an appointment.

Private assessment

Usually the shortest wait for an appointment and you have control over who you see.

Costs can vary and are significant and can be ongoing if you choose to pay for treatment. You might need to do your homework about ongoing expenses. Ask if the assessment cost includes a report, if it includes titration, what the follow up costs are. Costs can include paying the psychiatrist to write the prescription, paying for medication, paying for appointments to review medication. Cost of additional therapy or groups


 

Sadly not everyone is honest. Check your professional is a registered psychiatrist, psychologist or allied health professional.


 

Your GP may not agree to have shared care with a private psychiatrist. Check first.



Who do you recommend?


I am often asked who I think well of. Please note that some of these may be personal endorsements whilst others are ones that other professionals or clients have had a positive experience of accessing. I do not take payment for advertising or making referrals. I can't guarantee your experience will be the same as the previous positive experiences.

Dr Baskind is based in Leeds

Xcelsa Health are based in Warwick but also offer online.

Affirm Diagnostics are a neurodivergent led assessment service. Please ntoe they are psychology and OT so cannot offer prescriptions as treatment but they are a great option for an autism assessment.


For right to choose, if you can do online appointments and lots of paperwork before hand, psychiatry UK and problem shared are both OK.


What can I expect from an assessment?


To prepare to speak to your GP about referral for an assessment complete this screening tool and prepare a few points on why you think an ADHD assessment will be helpful and what the impact on your daily life is. Your GP or private clinic will let you know if you need to complete other forms as that varies between clinics but they should be following NICE guidelines. An appointment could be between 1 and 3 hours. It could be between 1 and 3 appointments. Some clinics use a QB Test or will ask you and or someone who knows you well to complete some questionnaires, they may ask for school reports (if you have them) . Most clinics will do an interview based on an assessment tool called the DIVA (great name right). I have never had a QB test or administered one so I will be interested to hear your experiences if you have one as I have some personal views and assumptions about it and I would find it interesting to learn more. You will be asked questions from childhood and adulthood, the clinician might be writing down things as you talk to make sure they capture what you are saying. If they give you a diagnosis they should talk to you about treatment options and next steps. There is no "best" medication, the prescriber will work with you to let you know potential benefits, adverse effects and support you in finding what helps you be at your optimum.



What are my other options for support?


Often the most useful part of an ADHD assessment is the validation and time to understand how your brain works. A therapist who is interested and skilled in ADHD or an ADHD coach can also explore with you your thinking style and strategies that will work for you.


This can be something you access privately or access to work can sometimes fund coaching (you do not require a formal diagnosis as it is about your support needs.)


As an occupational therapist my focus is on how we can use your values and skills to help you find ways of doing the things you find meaningful, reducing the overload and burnout or feelings of inadequacy. I would always strongly recommend you ask a person their understanding of ADHD.



I do not view ADHD as a disorder but that it can be disabling when you have faced judgement for not doing or being a particular way and you are in a society that expects you to do tasks that are not aligned with your strengths. Rather than trying strategies that work for most people we explore your profile and get curious about what is important to you. The last thing an ADHDer needs is another person telling them "have you tried to make a list".



Are there any other resources you recommend?


My best advice is listen to other ADHDers.


Because of my love of comedy I really like neurodivergent moments podcast

How to ADHD has been going for a long time

This is a powerful ted talk on a life as an undiagnosed woman


I have a love hate relationship with Additude website. It sometimes has really informative talks and information on and sometimes it is pedalling "snake oil" aka take this expensive multivitamin.


I am yet to find the perfect book, (Also if you can read a whole book I envy you)


I have heard good things about this unmasked book

ADHD 2.0 has some useful chapters in helping understand ADHD. It introduced me to reading more on the neuroscience of Default Network Mode and Task Postive Network There advise on exercise and diet I view as slightly unhelpful as it doesn't take into account individual need and it feeds into diet culture.


Gabor Mate can be controversial at times and I really struggle with some of his ideas on ADHD as he does see it as a disorder rather than a natural human variation. I also find he conflates truama with ADHD. This book can be useful for those who have had trauma in their lives.


If you find a website, blog, podcast or book that has been helpful to you,  let me know so that I can add to my resources.






Sarah Meharg is a neurodivergent occupational therapist.



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