Attention deficit conditions were once thought to occur only in children, but it is now recognized as continuing into adulthood in many people. In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.
Some specialists say that 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 pressure of adult life increases. Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms.
The following symptoms may be 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
- 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
Although the exact mechanism is unknown, a number of associated neurochemical and structural abnormalities have been observed. This disorder can negatively affect the educational, social, and occupational lives of those who suffer from its symptoms. It interferes with the ability to establish and maintain close relationships.
Additional problems 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 conditions is depression. Other conditions that adults may have alongside ADHD include:
- personality disorders: conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others
- bipolar disorder: a condition that affects your moods, 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, social interaction, drugs and crime. Some adults with ADHD find it hard to find and stay in a job.
Healthcare On Demand (HoD) offers a comprehensive assessment service for adults where there are questions around whether Attention Deficit Disorders (ADDs, including ADHD) may be an underlying problem.
We accept referrals from GPs, other healthcare professionals, also individuals and families may self refer, as wished. Our preference is always to work in close collaboration with GPs and others, as this is the best practice, and is the approach most likely to ensure you get optimal care.
Please consider seeking a referral from your GP to the HoD clinic for an assessment of a suspected attention deficit state, if at all possible. It is in your best interests to do so, however we will not turn you away if this is not possible, for whatever reason.
The practitioner(s) you consult may well seek your consent to keeping your GP informed of any diagnoses or treatment being undertaken, whether you enter the service via a GP or self referral. Please remember that if you do decide to take up screening or diagnositic testing, and are confirmed as having one of these conditions, the mainstay of treatment is drug treatment alongside a talking therapy. Your GP is very likely to need to be involved in the ongoing prescription of these medicines, so it is important, and courteous, to involve them from the start wherever possible.
Why seek a diagnosis of possible Attention Deficit in Adult life?
Getting a formal diagnosis of attention deficit conditions may help you to understand why you may experience certain difficulties and what you can do about them. This is particularly the case where:
- you weren’t diagnosed with ADHD as a child, but your symptoms began during childhood and have been ongoing since then
- your symptoms can’t be explained by a mental health condition
- your symptoms have a significant impact on your day-to-day life – for example, if you’re underachieving at work or find intimate relationships difficult
- You may with to consult a specialist at the HoD clinic if you had ADHD as a child or young person, and your symptoms are now causing moderate or severe functional impairment.
See also NICE Guidance on diagnosis and management of Attention Deficit Conditions throughout the lifespan by clicking HERE.
Your Options regarding Next Steps
Healthcare on Demand is committed to ensuring that individuals and families do not pay for services that they do not need, or that they could access freely from the NHS. Following the preliminary screening, clinician recommendations can be provided via the clinic coordinator. Therefore you will receive appropriate guidance on the correct next steps for you.
Step 1: Initial Screening
- If you are not sure what you are looking for, or even whether a full Attention Deficit Assessment is indicated, you may request a preliminary screening step (Step 1), at a modest cost, before deciding whether to proceed with a full medical diagnostic step.
- This initial review takes two to two and a half hours and is carried out by an Assistant Psychologist using standard questionnaires such as the Diagnostic Interview for ADHD in adults (DIVA) plus the Strengths and Difficulties Questionnaire (SDQ; Adult version). This can be done with only the individual with suspected Attention Difficulties or, ideally, with their family member(s) too, as is appropriate.
- The consultation will include a discussion of the difficulties that make you think an attention deficit condition may be present, including anything in your history that may be significant, from childhood through to the present day. Your family history may also be thought to be relevant, as will your education and employment history. You will be asked to complete an Abbreviated History Form to provide key information.
- The Assistant Psychologist will have a general discussion with you, and will summarise the nature and range of difficulties experienced.
- The questionnaires SDQ and the DIVA will be administered, and will be scored after the consultation to give you an indication of potential findings/ scope for diagnosis.
- After the session, the Assistant Psychologist will write up the report, including all items addressed plus the formal SDQ and DIVA questionnaire results information.
- You will be provided with a copy of the report after the consultation
- Depending on the outcome of the interview and testing you may wish to consider progressing to the medical ADD/ADHD diagnostic assessment (Step 2) for a definitive diagnosis.
The cost for Step 1 – Screening Consultation,which takes two and a half hours, including written report provision is £300.
Screenings will be conducted by Natalie Bidad in association with Margot Heurtematte. You can learn more about Natalie by clicking on her picture below:
It is important to note that the screening step provides important indicators for your consideration, but it is not in itself a diagnostic process. It gives you an indication of whether it is likely that you may meet the thresholds for diagnosis. You need to progress to Step 2 – if appropriate and wished – to establish a full, positive diagnosis.
It is in Step 2 with a medical review with a Consultant Psychiatrist that the firm diagnosis is established, and further recommendations on treatment and other forms of support can be made.
Step 2: Medical Diagnostic Assessment
This medical diagnostic review (also referred to as Step 2) includes consultation with an Adult Psychiatrist, with:
- review of complete Step 1 findings – data and the report
- full mental health and social assessment
- history and examination in association with the General Practitioner including:
- assessment of history of exercise syncope, undue breathlessness and other cardiovascular symptoms
- heart rate and blood pressure
- family history of cardiac disease and examination of the cardiovascular system
- referral for an ECG if there is past medical or family history of serious cardiac disease, a history of sudden death in young family members or abnormal findings on cardiac examination
- risk assessment for substance misuse and drug diversion.
- discussion of diagnosis and treatment options.
If a treatment option such as Cognitive Behaviour Therapy is decided, a referral to a psychologist working with the Healthcare on Demand can be made.
If it is decided to initiate medications, the psychiatrist will make recommendations to the GP. Further follow up will be needed to assess your progress and stabilise the dosage.
As the medications may have physical side effects such as on blood pressure, heart rate and weight, the psychiatrist will assure/advise the GP that these are monitored regularly
Full report within 10 days, including recommendations for therapy, advice on support groups, implications for education/ employment, social factors and family implications
Clinic letter to GP
Face to face feedback session with the individual and partner/ family member as appropriate and agreed
The practitioners who offer full adult ADHD assessments are:
Costs of the Step 2 diagnostic review where the Step 1 screening data have already been established are £300 for an hour’s consultation. Subsequent follow up appointments are £150 for a half hour review.
The practitioner will then contact you to discuss any questions you may have, prior to the assessment consultation.
In rare instances, there may be unexpected findings that require a further consultation with the Adult Psychiatrist. This service, which is beyond the standard Attention Deficit assessment is available by arrangement at additional cost.
Interested in exploring the Assessment Options further? Please contact us by emailing info@HealthcareOnDemand.org.uk
Further Useful Links
Living with ADHD
This website has been developed to support those who come into contact with Attention Deficit Hyperactivity Disorder (ADHD) – parents/carers and teachers – and also provides resources for children and teenagers themselves, to help them understand and manage the condition. www.livingwithadhd.co.uk
add+up was set up to bring families together, to guide parents in the right direction to find the practical help they need for their children and to promote both public and professional awareness of ADHD. http://www.addup.co.uk
ADD / ADHD Online Information
ADDISS, The National Attention Deficit Disorder Information and Support Service
The ADHD Foundation https://www.adhdfoundation.org.uk/
A website for children with ADHD and those who support them https://www.ukadhd.com/support-groups.htm
ADHD Voices brings the perspectives and experiences of children into international debates around rising child psychiatric diagnoses and the increasing use of drugs in child psychiatry. These voices contribute to an empirical evidence base that helps to inform ethical debate, clinical judgment, and national policy. VOICES is a Wellcome Trust funded research project based at the London School of Economics and Political Science. www.adhdvoices.com
Wrong Planet http://www.wrongplanet.net/ – a web community designed for individuals (and parents / professionals of those) with Autism, Asperger’s Syndrome, ADHD, PDDs, and other neurological differences