Assessment for ADHD in UK and Ireland

If you’ve noticed that you experience aspects of inattention, impulsivity and/or hyperactivity, you may identify as having Attention Deficit Hyperactivity Disorder (ADHD). You may even be seeking an assessment and possible diagnosis for this neurotype. This formal recognition can be beneficial to help you get a sense of who you are, to find understanding around aspects of yourself that have seemed confusing, and to have access to supports like medication and talk therapy if you’re interested in taking these up.

If you do have ADHD (often self-described by individuals as being an ‘ADHD-er’), self-identification or diagnosis can be a positive experience, by helping you work out what accommodations and support you need, in order to get the most out of life. Having said this, the information you may read about ADHD assessment is often overly clinical, and even pathologising! Despite this, the neurodivergent (ND) community embraces neurotypes such as ADHD as different ‘ways to be’. We see neurotypes such as ADHD and autism as natural variations of the human brain; ND folk have unique strengths, and perspectives, and offer great contributions to society. We actively encourage our clients, and readers of our online material, to consider this viewpoint.

Pathway to adult ADHD assessment at an ADHD clinic - UK

Obtaining an assessment for ADHD within the National Health Service (NHS) in the UK currently involves a fairly lengthy wait. Marie Hackshall, System Programme Lead for Learning Disability and Autism at the UK’s NHS Autism Kent and Medway Trust, recently told broadcaster the BBC there has been a 700% increase in demand for ADHD services, since 2022.

There are seemingly no definitive figures detailing waiting list times; however, our research indicates the average wait in the UK for adult ADHD assessment is around eighteen months to two years, with some southern regions of the UK, such as Surrey and Sussex, holding a four or five-year wait-list.

The prevalence of ADHD in adults varies according to the figures released by the relevant country. (The UK’s ‘ADHD UK’ charity cites the UK NICE guidelines of between 3 and 4%, while Ireland’s Health Service Executive (HSE) cites 2.5% of the adult population. America’s ADDitude Magazine cites around 9% of the USA. Meanwhile, a paper in the Lancet found the figure to be between 2% and 7%, globally.)

It is possible that recent awareness in the media from celebrities who are proudly ADHD has perhaps contributed to the sharp rise in referrals that Marie Hackshall describes.

It is possible that recent awareness in the media from celebrities who are proudly ADHD has perhaps contributed to the sharp rise in referrals that Marie Hackshall describes.

If you believe you may be an ADHD-er and are seeking NHS assessment, here is the referral process in the UK:

GP consultation

(1) Consult your GP or doctor; be prepared to discuss your traits and medical history, as the doctor has to decide whether to refer you for assessment at a commissioned adult ADHD service, for those above 18.

It is useful to take along any reports or feedback from educational tutors, supervisors, workplace managers etc., as well as any notes from your lived experience, from yourself and family members. The World Health Organisation’s ADHD Self Report Scale ASRS v 1.1 (on pages 45-46 of these Royal College of Psychiatrists’ Guidelines) can be printed out and completed, and is useful to take along to appointments).

If your GP says there is no ADHD service in your area of the UK, you may consider changing GP, in case their provision is different. England, Wales and Northern Ireland follow the NICE guidelines on ADHD, which gives a right to the provision (or ‘right to choose’) of an ADHD service. (Scotland has a different guidance system and doesn’t follow the ‘right to provision’ system. The Scottish ADHD Coalition has more information). That means if there is no local provision in England, Wales and Northern Ireland, your local NHS has an obligation to fund you to receive the service elsewhere. You can access that funding through the Individual Funding Request process applicable to your region. The charity ADHD UK has more information on that option. Psychiatry-uk.com claims to be the largest provider of the right-to-choose service, for ADD and has details on it’s website.

Once you have been referred for assessment at a commissioned adult ADHD service, a psychiatrist or specialist ADHD nurse will typically conduct an assessment using their preferred screening tools, see further information below. You can discuss with the service provider at the stage of diagnosis whether you want the diagnosis itself and the care plan to be shared with your GP. (Psychologists can diagnose ADHD, but cannot prescribe ADHD medication). See ‘Assessment at an ADHD Clinic’, below.

Pathway to adult ADHD assessment at an ADHD clinic - Ireland

Ireland’s Health Service Executive (HSE) has previously described that “No fully established ADHD specific services for adults with ADHD in Ireland,” however under the Executive’s national Model of Care, a National Clinical Programme has been relatively recently developed to improve what the HSE describes as “a deficit in service provision”. (Useful information here). However, as is the case with so many health provisions at the national level, new funding for the programme is currently being sought. There is seemingly no definitive data on current waiting times for assessment in Ireland, however, our research indicates it to be anywhere between six and 24 months, on average.

As with the UK, Irish patients initially see their GP or doctor for potential onward referral. In Ireland, this is carried out by adult community mental health teams (ACMHTs) (providing the referred patient falls under a catchment area currently providing the service), where screening for possible ADHD is completed as part of an overall mental health and psychiatric assessment. Onward referral to an Adult ADHD Clinic may then be made.

The process is slightly different in Ireland than in the UK, as the ADHD assessment is typically carried out by a team. More emphasis is seemingly placed on a holistic view of the patient. Adult Community Mental Health Teams (such as Psychiatrists and Occupational Therapists) work collaboratively to support a person, also aiming to support other co-existing mental health problems the person may have, such as depression and anxiety, which can co-occur with neurodivergence.

Assessment at an ADHD Clinic

If you are one of the lucky ones that have made it to an assessment clinic, via the NHS or the HSE, the clinicians will use their chosen diagnostic tool(s) – the ones typically used at assessment include –

·       The Diagnostic Interview for Adult ADHD (DIVA)

·       QbCheck and QbTests (computerised tests)

·       ADHD Rating Scales such as the Adult ADHD Self-Report Scale (ASRS) and the Conners' Adult ADHD Rating Scale (CAARS).

·       Behaviour Checklists such as the ADHD Rating Scale-IV (ADHD-RS-IV) or ADHD Symptom Checklist.

·       Cognitive tests and neuropsychological assessments, i.e., measures of attention, working memory, inhibition, and cognitive flexibility.

The assessing clinician(s) will ideally carry out a post-assessment discussion with you, and if a diagnosis is offered, a care plan will be outlined, including recommendations for ADHD-specific medication. This can be prescribed by a psychiatrist, or prescription-qualified specialist ADHD nurse. If medication is recommended, it is advised that your GP should perform some medical tests like your blood pressure and cardiovascular functioning, to make sure they’re suitable.

(Not everyone diagnosed with ADHD chooses to take medication; for some individuals, a diagnosis can be more about self-governance, affirming identity and autonomy, and gaining documentation that means employers and education settings can offer more targeted accommodations, adaptions and support. It is always your choice.)

The care plan may also include signposting for talk therapy, or coaching. In addition, supports may be signposted to the person in areas such as the workplace, where employers have a responsibility to protect employees and potential employees from discrimination and harassment and to make reasonable adjustments to assist them to do their jobs. (The non-profit organisation EmployAbility offers individuals advice and support in this area, for example).

Private assessment for ADHD

If you are privileged enough to have the funds, then private assessment for ADHD can be a more streamlined and easy option than navigating the waiting times and catchment areas of the NHS or HSE. Do check that the diagnosing clinicians are recognised members of the General Medical Council in the UK, or the Medical Council of Ireland, however. It is also worth liaising with your GP to ensure your provider will accept a ‘Shared Care Agreement’, meaning they will accept the findings and administration from your provider, and take on the prescribing of medication under your national healthcare provider (as opposed to costly private prescriptions!) The following resources may be useful regarding lists of private ADHD assessment clinics:

UK – compiled by the UK Adult ADHD Network (UKAAN)

Ireland – compiled by occupational therapist Susan Madigan

While you’re waiting for the assessment

While waiting for your ADHD assessment, you can take steps to manage any challenges you’re experiencing more effectively. These can include seeking support from ADHD-focused charities and support groups, exploring self-help resources, as well as connecting with neurodiversity-informed therapists and coaches. (The website aadduk.org has a useful list of supportive resources that includes the UK, Ireland and Europe.)

Thriving Autistic has a dedicated global directory where individuals can search for neurodivergent, neuro-affirming providers such as therapists, coaches, psychologists, relationship support advisors, and many more, at https://neurodivergentpractitioners.org/

The ‘ADHD in Adults’ National Clinical Programme, in partnership with charity ADHD Ireland and the UCD School of Psychology, has developed the Adult ADHD App. It’s available to download from Apple and Google app stores. The app provides self-care and signposting information regarding adult ADHD.

Children and young people

In both the UK and Ireland, children and young people seeking assessment for ADHD are referred to the relevant child and adolescent mental health service via their GP or education setting. The clinicians may be a specialist child psychiatrist, paediatrician, or appropriately-qualified healthcare professional with training and expertise in ADHD. Assessments typically include a physical examination, the consideration of interviews or reports from other significant people, such as parents and teachers, evidence of ADHD traits in two different settings, and six or more symptoms of either inattentiveness, or hyperactivity and impulsiveness.

Common ADHD traits and experiences

Inattention: this somewhat clinical term is actually often experienced as a lack of focus or attention on things the individual is less interested in. However, there can be hyper-focus on experiences that are enjoyable, or keep the person in creative ‘flow’. If this ‘trait’ applies to you, you may become easily disracted, and could struggle to manage time. However, you may also find yourself to be hyper-productive when in your ‘flow’, with the intense capability to absorb and immerse yourself in meaningful activities and subjects.

Hyperactivity: you may experience excessive restlessness, and a need to regulate the body through movement. Whilst this can for some individuals create challenges when stillness is desired, this trait can manifest as lots of physical energy which can be beneficial in the sporting field, as well as ingenious creativity, or hyperactivity in one’s creative thinking.

Impulsivity: you may experience impulsive behaviours when you act very quickly with (what can seem to others), little thought to the consequences. However, this trait can equate to fast problem-solving abilities and instinctive entrepreneurial tendencies.

Other useful resources and information

ADHD and autism often co-exist. For anyone self-identified or formally diagnosed as autistic, Thriving Autistic offers free, monthly online meet-ups for adults.