ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder that causes persistent difficulties with attention and concentration, and/or hyperactivity and impulsivity. ADHD is a lifelong disorder. The prevalence of ADHD in the UK is 3-4%. People who have ADHD are more likely to experience other difficulties such as problems with their mental health or substance abuse.

There are 3 subtypes of ADHD:

• Inattentive ADHD - difficulties with attention and concentration

• Hyperacive/Impulsive ADHD - difficulties with hyperactivity and impulsivity

• Combined ADHD - difficulties with attention/concentration and hyperactivity/impulsivity

There is a wide variation in ADHD presentations and every persons experience of ADHD is unique. However, there are common symptoms of ADHD which can include difficulties in the following areas:

• Concentrating and paying attention to detail

• Sustaining attention

• Completing tasks

• Organisation, planning and sequencing

• Listening

• Distractibility

• Forgetfulness

• Avoidance of particular tasks

• Fidgeting/squirming

• Struggling to sit for periods of time

• Restlessness

• High levels of movement

• Interrupting/intruding

• Talking excessively

• Struggling to wait/turn take

Diagnostic criteria are set out by The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) and are as follows:

At least six (five in adults) inattention symptoms and/or at least six (five in adults) hyperactivity-impulsivity symptoms that have:

• started before 12 years of age.

• occurred in two or more settings such as at home and school.

• been present for at least 6 months.

• clearly interfered with, or reduced the quality of social, academic or occupational functioning.

• not occurred exclusively during the course of a psychotic disorder and are not better explained by another disorder such as oppositional defiant disorder or conduct disorder.

An adult ADHD assessment is £1300.

Payment can be made in full prior to the assessment or in instalments. To pay in instalments a deposit of £200 is due at booking, then 50% of the remaining balance is due after the first appointment, and the remaining 50% of the balance is due once the draft report is ready.

We pride ourselves on offering a fully face to face, in-person assessment process. We can also offer some appointments on Teams, if this is your preference.

Assessments are done at your pace and we do not specify a certain number of sessions. Sometimes, for lots of reasons, an assessment needs to be done quickly. Sometimes an assessment needs to be taken more slowly, possibly because you feel worried about the process or because you are juggling lots of competing demands. As a rough guide, assessments generally consist of 3 appointments - 2 assessment appointments and 1 feedback appointment. If the assessment needs to be done over more than 2 sessions there is no additional charge for this.

From the first assessment appointment to receiving feedback and the final report is usually less than 4 weeks.

At the moment we can offer assessments beginning within 4 weeks of your initial enquiry. Once the assessment begins (the first assessment appointment) it should be complete (feedback and final report) within 4 weeks.

Before the assessment begins we will do what is called a screening assessment. A screening assessment is a brief assessment looking for signs of ADHD. We do this because sometimes people come to us seeking a particular assessment e.g. ADHD, but it turns out that they need a different type of assessment e.g. autism. The screening assessment process helps us to decide which assessment would best meet your needs, and gives you some reassurance that the assessment is needed. We cannot make a diagnostic decision based on the screening assessments. The screening assessment is done via questionnaires and forms that will be emailed to you. We also need to seek information from someone who knows you well, preferably since childhood (called an informant). You can complete the forms online and submit them. We will review the information and get back to you with feedback about which assessment would best meet your needs.

The next stage of the assessment is to meet. The first appointment can be done in person or on Teams. We will complete what we call a developmental history - a detailed review of your background and history, and your current difficulties. It is really helpful if someone who knows you well (again, preferably since childhood) can come to this appointment too.

The next appointment is done in person. We will do a QbCheck which is an online ADHD test. It is completed on a laptop and takes 20-30 minutes.

After the 2 assessment appointments we can discuss how you would like to receive feedback. Some people want to hear the outcome of the assessment as soon as possible, and so brief feedback can be given over the phone before the report has been prepared. Other people might like to wait to receive the report so that they can read through the whole assessment, findings and recommendations. The report will be ready 2-3 weeks after the final assessment appointment.

Once the report has been received a feedback appointment can take place to review the report together, including recommendations.

If further support is desired we can discuss consultation or post-diagnostic work.

The standards for assessment of ADHD are set out by The National Institute for Health and Care Excellence (NICE). The guidance is summarised here:

• 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, on the basis of:

  • a full clinical and psychosocial assessment of the person; this should include discussion about behaviour and symptoms in the different domains and settings of the person's everyday life and

  • a full developmental and psychiatric history and

  • observer reports and assessment of the person's mental state

• A diagnosis of ADHD should not be made solely on the basis of rating scale or observational data. However, rating scales such as the Conners' rating scales and the Strengths and Difficulties Questionnaire are valuable adjuncts, and observations (for example, at school) are useful when there is doubt about symptoms.

• ADHD should be considered in all age groups, with symptom criteria adjusted for age-appropriate changes in behaviour.

• In determining the clinical significance of impairment resulting from the symptoms of ADHD in children and young people, their views should be taken into account wherever possible.

For a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or inattention should:

• meet the diagnostic criteria in DSM‑5 or ICD‑11 (hyperkinetic disorder; but exclusion based on a pervasive developmental disorder or an uncertain time of onset is not recommended) and

• cause at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation in multiple settings and

• be pervasive, occurring in 2 or more important settings including social, familial, educational and/or occupational settings.

As part of the diagnostic process, include an assessment of the person's needs, coexisting conditions, social, familial and educational or occupational circumstances and physical health.

People often look at the symptoms of ADHD and feel that they ‘fit’. It is true that all people will struggle with some of the difficulties associated with ADHD, particularly when they are tired or stressed, or experiencing difficult periods or transitions in life such as loss, relationship breakdown, parenthood or changes to jobs or living situations. People may also have other conditions or disorders which mean they experience these difficulties such as autism, memory difficulties, or physical health problems.

People with ADHD have persistent problems with the above symptoms, meaning that symptoms have been present since childhood and impact them significantly in a number of ways and in different settings.

Not everyone who has ADHD needs or wants additonal support. People have often developed good ways of living with ADHD. However, some people might want help to think about their ADHD and the impact it has on their life. The following treatment options are available:

• Therapy - ADHD can often lead to secondary difficulties including depression and anxiety. Therapy can help with these secondary difficulties.

• Post-diagnostic support - often people seek an assessment of ADHD already feeling very strongly that they have ADHD and so the diagnosis is expected. Some people seek an ADHD assessment as part of a wider assessment to answer questions about their experiences, and a diagnosis can come as a surprise. Post-diagnostic support is a short-term process which can help you to:

  • learn about ADHD and how it might impact on you as an individual

  • work though any feelings you might have following your diagnosis

  • explore what wider support may be helpful to you at work or home

  • think about who to tell about your diagnosis and how to explain ADHD to others

• Coaching - coaching is an increasingly popular tool to help people live well with ADHD. Coaching supports you to recognise your individual experience of ADHD and how this might help and hinder you in your life. Coaching is useful to help develop practical strategies to live with ADHD.

• Medication - there are medication options for ADHD. These should be discussed with a qualified health professional such as a nurse prescriber, pharmacist, GP or psychiatrist. If

  you would like to consider medication we have links with a medication service who can prescribe, titrate, and where appropriate support shared care agreements. You can find more information about this service at www.clearlyfocusedadhd.co.uk.

Find out more about consultation and post-diagnostic support services we offer at NeuroNest Psychology.

As Practitioner Psychologists we are not able to prescribe medication. Medication can be prescribed by Psychiatrist's, GP's, and other healthcare professionals with specific training in ADHD such as Specialist Nurses and Pharmacists.

We have links with a private clinic specialising in ADHD medication titration services, more information can be found at www.integrapsychiatry.com

You can also speak with your GP about what options are available via the NHS, including medication. More information is available here.