Do you think you have undiagnosed ADHD?

If you have wondered whether you might have a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) you are not alone. We are finding increasing numbers of patients are keen to discuss whether this might apply to them.

 

This is a diagnosis which, by definition, is present from childhood, so typically we would expect most cases to have been identified at school: teachers have, for many years now, been trained specifically to identify and flag up children who they suspect might have this.

 

If you feel that you have symptoms consistent with ADHD, or someone who has been working with you (e.g. an educational learning support advisor) has suggested that you should consider seeking a formal diagnosis of ADHD, please read the information below which will help you to navigate what may be a long process.

 

How is attention deficit hyperactivity disorder (ADHD) diagnosed and treated?

ADHD is usually diagnosed by a psychiatrist with a special interest in this condition.

 

Although there is no cure for ADHD, it can be managed with appropriate educational support, advice and support for parents and affected children, alongside medicine, if necessary.

 

Medicine is often the first treatment offered to adults with ADHD, although psychological therapies such as cognitive behavioural therapy (CBT) may also help.

 

Typical symptoms of ADHD in Adults

As ADHD is a developmental disorder, it cannot develop in adults without it first having appeared during childhood.

 

By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives.

 

The symptoms in children and teenagers are sometimes also applied to adults with possible ADHD; but some specialists say 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 get worse as the pressures of adult life increase.

 

The following symptoms are often 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 – for example, driving dangerously

 

Please see this link for the full ICD-11 diagnostic criteria for ADHD.

 

I think I have undiagnosed ADHD. What is the process if I would like to be referred for further assessment?

 

We can refer patients who meet certain criteria to a psychiatrist for further assessment.

 

Before booking an appointment with your GP to discuss this, there are a few key steps which you can take to make the process more straightforward.

 

Complete the patient referral questionnaire. If you click here ADHD Referral - Part B.docx then you will open an online form which you can save and send to us (see email address below). The Community Mental Health Team (CMHT) will not accept a referral without this form, there is no way to bypass this step, even if you find filling in forms difficult. If you are having trouble you may wish to ask a family member or friend to help you complete it.

 

Write as much as you can (at least 2-3 sentences) for each of the questions in the form, in your own words. Give some real examples of challenges you face which have led to question why you might have ADHD and the restrictions you feel this has placed on your day-to-day activities. Be honest and open about any problems you have faced.

 

Please take your time to explain fully what the impact is on your day-to-day life as this is crucial to the referral and without this your referral may well be rejected by the specialist team (CMHT).

 

Fill in ALL the boxes. If any area is thought to be lacking in information the CMHT might reject your referral.

 

Email this information to birchwood.practice@nhs.net with “Request ADHD Referral” in the subject line. This will then be saved to your record and passed to reception to progress to the next steps.

 

Please note that the process of getting a referral is likely to take some time. The target is for the assessment to be started within 18 weeks (4 months) although currently this at least a year if not more.

 

Prescribing of stimulant medication used to treat ADHD is currently done under a “Shared Care Agreement” with your psychiatrist. This requires that you remain under the care of the CMHT – if you are discharged from their care then we can no longer prescribe your medication as it would no longer be “shared” care. Your medication (if appropriate) should be initialised and stabilised by the CMHT and then at this stage they can ask us to prescribe the medication directly. The CMHT are still responsible for physical monitoring and medication reviews so if your review (usually annual) is delayed we may not be able to continue prescribing your medication (you would need to get it directly from the CMHT if they were willing to prescribe it for you). It will be your responsibility to ensure you remain under the care of the CMHT and that your scheduled reviews take place in a timely manner.

 

Childhood ADHD and Autistic Spectrum Disorder (ASD)

 

If you believe your child may suffer with ADHD or ASD, it is vital that this is first discussed with the child’s school. The school can then make a referral to Community Paediatric or Child and Adolescent Mental Health Services (CAMHS). The school are required to prepare a detailed report.

 

This usually includes things like:

 

• School reports about learning, behaviour and attention

 

• Observations of your child in the classroom and playground

 

• Any support plans, SEN support, or EHCP information

 

• Relevant safeguarding or pastoral concerns

 

Right to choose

 

You may have heard that you can choose to seek a referral via companies which are affiliated with the NHS (Right to choose providers), rather than being referred to the local CMHT, CAMHS or Community paediatrics.

 

This is correct, although you will still need to email us the relevant information as per steps above. Please complete this form and email it to us before any referral can be sent.

 

If you do wish to be referred to a ‘Right to choose’ provider, please make this clear in the email you send us.

 

If you would like your child seen by a ‘Right to choose’ provider, the school will still need to prepare us a report. Please attach this report with your email.

 

For more information on the ‘Right to choose process’ please click on the link below:

Right to Choose - ADHD UK

 

Private assessments

 

Understandably, some patients and guardians may wish to seek a diagnosis privately.

 

It is important to note that we will only consider ‘shared care agreements’ with private providers who are also ‘right to choose’ providers.

 

For ‘shared care’ medications to continue the patient will be required to have annual consultant reviews with their chosen private provider.

 

For patients who have sought a private diagnosis there is no facility for NHS Dorset CAMHS teams, paediatrics and CMHT services to monitor patients prescribed ADHD or ASD medications unless they are referred to the service by standard referral processes. In these cases, CAMHS teams, paediatrics or CMHT services will need to complete the standard assessment process and can only provide treatment if the patient is found to meet the services criteria.