We are not taking new patients at this time, sorry.
There are appointments for medicolegal reports.
What is ADHD?
Many of us have problems with attention, hyperactivity or impulsiveness at times. In people with ADHD these problems are there most or all of the time, and have a substantial impact on ability to function in multiple ways. ADHD is classed as a neurodevelopmental condition. Put simply, it is thought that parts of the brains of people with ADHD have developed a bit differently and work a bit differently. Genes that affect how dopamine works in the brain are known to play a role. But there are probably many different genes that can be involved (over 100 at the last count). This could explain why the condition shows itself differently in different people. It could also explain the overlap with other neurodevelopmental conditions such as autism, dyslexia and dyspraxia (developmental coordination disorder). People with ADHD are more prone to develop problems with anxiety and depression, low confidence or start to use street drugs or gamble. There has been recent research about how people with ADHD are more likely to sustain fractures, crash their cars, develop diabetes and startlingly, die on average 7 years earlier than people without ADHD. The hope is that treatment will begin to address these impairments. The good news is that overall, ADHD responds better to treatment than just any other mental health disorder you can think of.
Who gets ADHD?
ADHD tends to run in families and heritability is about 70%. It shows itself by age 12 usually, and affects 3-5 % of people of school age (up to 1 in 20). Of people who have this condition as a child, around half will still have it as a young adult. If a person has ADHD, it will almost always be present from childhood. But sometimes it is not picked up until adulthood – especially if the problem is more inattentiveness than hyperactivity. Historically, more males have been diagnosed with ADHD than females – but it may show itself differently in women and get missed. Nowadays, many adult adhd clinics are seeing more new women patients than men.
How is ADHD diagnosed?
There is no blood test or brain scan that can diagnose ADHD. The diagnosis is made by a careful assessment of symptoms and how they affect the person. It takes a couple of hours, and information from people who know the person well is needed. Often structured assessments such as DIVA (Diagnostic interview in Adults in ADHD) are used. The DIVA5.0 is s structured diagnostic assessment based on the DSM5 criteria. You may have seen postings on websites such as Reddit about DIVA. It is helpful to newer clinicians to ensure that all areas are covered. Really scales such as DIVA are just a collection of standardised questions about symptoms. The current version of DIVA contains some errors (compare it ite by item to DSM5) and some questions with a very complicated structure. For example ” Do you often not follow through on instructions and often fail to finish chores or duties in the workplace?”. Follow that first time? Nor did I. And are we really happy about saying “failure”? A talk with your clinician about what you struggle with day to day is much more informative than reading out this stuff, whatever the people on Reddit say. Unfortunately, so much buzz and emphasis on DIVA has made appointments longer than needed, and is one of the reasons that waiting lists are so long. It takes an additional hour or so. It’s useful if you need a higher level of diagnostic certainty – for example for an Occupational Health or legal report, if the clinical picture is complicated or if the clinician is inexperienced. The DIVA might be needed if you want shared care (but very few GPs around Wales offer this) or if you might want someone else to take over your treatment in future (but whether private or NHS, they are likely to want to do their own assessment). For many patients whose priority is to start treatment by a cost-effective route, a DIVA is not needed (and the NICE guidelines do not specify use of the DIVA is required). A detailed clinical interview with an experienced clinician covering all the important areas is fine in most cases. It doesn’t take 3 hours to diagnose Schizophrenia, OCD or Alzhiemer’s – so why ADHD?
Many NHS and private clinics send out pages and pages of forms, and they won’t see you unless you fill them all in. We think this is really silly because people with ADHD are mostly not good with long forms (Secret – a lot of the forms don’t get read at the NHS Clinic when they are sent back!). Most of our patients have already done forms and lots of research by the time to they look for a private appointment.
What about QbTest? This has been introduced in some NHS clinics including Cardiff (as well as in private clinics) as a screening tool. In basic terms, you look at dots on a computer screen while a web cam tracks your eye movements to see how well you are concentrating. It would be great to think that a computer could diagnose ADHD reliably, without all that talking. But a 2023 meta-analysis (number-crunching of data pooled from published research) concluded that QbTest was only “acceptable” at telling if someone did or did not have ADHD. The study concluded that QbTest “should not be used as stand-alone screening or diagnostic tool, or as a triage system for accepting individuals on the waiting-list for clinical services”. So, we don’t offer QBtest. If you want good a screening test before booking an appointment, the ASRS-5 has just 6 questions and was developed for the World Health Organisation. It is quick, free and is surprisingly accurate (Sensitivity 91%, Specificity 96%, according to the admittedly limited research).
Who can diagnose ADHD?
The NICE guidelines say “A diagnosis of ADHD should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise”. The NICE Guidelines also recommend medication over other non-medical treatments in adults who are impaired by ADHD. GPs do not start medication for ADHD so it will usually be a Psychiatrist who starts medication (but some Nurses and Pharmacists can prescribe too, Psychologist don’t). Unless you are sure that you don’t want medication, you might want to find someone who is both experienced in diagnosing ADHD, and who can prescribe.
Is ADHD Over-diagnosed?
It is certainly diagnosed a lot more than it used to be. All of us at some time are restless, inattentive or impulsive. So it can be easy to convince yourself you might have ADHD. Haven’t we all wished we could concentrate for longer, get better grades,or be more organised? Yes! Does this mean we all have ADHD? No! If you have never lost your keys or phone, or been late for work or lost track of what someone is saying – well done! Most of us have done these things now and again, but it does not mean we have ADHD. People with ADHD experience the symptoms often, and in more than one setting. Importantly, there must be “clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.”(DSM5TR). It is important to understand this, because some patients come to an appointment convinced they have ADHD, and can be disappointed – even cross – to be told the doctor is not convinced they have it. That said, for people who do have ADHD, the condition can restrict many aspects of life – work, study, relationships, family, leisure, health and more. Treatment can be life-changing.
ADHD Treatment
Medication can be very effective – even life-changing- for adults with ADHD. This is particularly so with moderate to severe ADHD. In mild ADHD effects can be small or negligible. Almost always, medication requires specialist input. In theory, a GP will take over prescribing when the patient is on an effective dose of the right medication, as long as there is continuing specialist review – so called shared care. But many GPs in South Wales won’t do this – even when an NHS specialist has made the diagnosis. I suspect they are holding out for money.
ADHD coaching is also popular and there are some great self-help materials and support groups. There are forms of CBT (cognitive behavioural therapy) that have been adapted for helping with ADHD.
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