ADHD
ADHD (Attention Deficit Hyperactivity Disorder)
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** After a review and careful consideration, the Practice is no longer accepting any new Adult (16+) shared care monitoring requests for ADHD. This applies to all NHS, NHS "Right to Choose", and Private agreement requests. Your care will need to remain with the specialist team. Not all providers are able to offer ongoing care and prescribing, so please consider this before embarking on any referral pathway.
Any existing ADHD shared care agreements remain unaffected and any agreements for children will continue to be assessed in an individual basis. **
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What is ADHD?
ADHD stands for Attention Deficit and Hyperactivity disorder which, as the name suggests, is usually associated with some level of difficulty in concentration, with or without physical overactivity.
In fact, ADHD can present with many symptoms such as poor focus, being easily distracted, feelings of restlessness, being impulsive, and being poorly organised. It is not unusual to have some changes to mood. The symptoms can be wide ranging.
It is very common to experience some or all of these symptoms at different times in life without this being due to a diagnosis of ADHD.
It is estimated that 3-4% of the UK population have ADHD, though many of those will be undiagnosed at present. It is usually diagnosed in childhood and around 15% of those retain the full diagnosis by the age of 25 years, and a further 50% in "partial remission".
The symptoms must have started in childhood and persist into adulthood. The symptoms must also be pervasive i.e meaning that they impact in several areas of your life. This could mean that they impact on relationships, social interactions, and education or employment. For a diagnosis to be made, the impact of the symptoms must also cause a moderate to severe impairment.
Even if you recognise some of the symptoms described above, if they are only having a minimal impact on your life then a referral would not be indicated.
ADHD is often seen at a high rate in people with other significant clinical problems including substance misuse, unstable mood states, anxiety, depression, forensic cases and emerging or developed personality disorder. It is important to discuss any of these that affect you with your GP.
We are currently seeing an increase in adults seeking an assessment for diagnosis of ADHD and this is likely to be due to an increase in the information available about it. Sadly, we are waiting for services to catch up as there are limited resources available for making assessments and the current waiting list in Sheffield is very long.
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What do I do if I think I have ADHD - How can I access a referral?
If you are concerned that you may have ADHD you should make a routine appointment to speak to your GP to discuss your concerns. It is a complex area and you will need a full appointment to discuss the areas needed. This cannot be dealt with in the same consultation as another issue you may have.
Currently all diagnoses of ADHD are made by specialists (a consultant psychiatrist) and if your GP feels you need further assessment they will be able to make a referral. You will also need to decide which route you wish to be referred into for a formal assessment. The options are:
- SAANS (Sheffield Adult Autism and Neurodevelopmental Service) - This has a long waiting list (several years)
- NHS "Right to Choose" provider - The list of these providers changes, as does their waiting times, so we suggest that you do the research on which services is right for you. More information on this can be found below and a list of available providers is available at the ADHD UK Right to Choose website.
- Private referral - You would need to research the options available to find a provider that will meet your needs and the cost of these services varies.
If you have been referred for an assessment please be aware that your GP cannot influence the waiting time for your appointment and you must contact the service provider you have chosen with any queries about this.
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What is the "Right to Choose" referral pathway?
The Practice is able to refer patients for an ADHD assessment on the NHS via a pathway called "Right to Choose". This means that the assessment would be done by a provider that this commissioned to provide this service in a different area to the one where you live. This has been introduced to reduce waiting times, but it does mean however, that your assessment is likely done remotely (i.e by video consult) rather than in person. The waiting times for these services have also increased recently.
We would not recommend a remote assessment for children and young people under the age of 16. The diagnostic process is unlikely to be robust enough for any diagnosis made to be accepted by the NHS.
Even though the "Right to Choose" providers are commissioned to provide NHS services in other areas of the country, there has been some concerns raised regarding the quality of their assessments provided remotely (not "in-person") and the Sheffield Integrated Care Board (ICB) are currently reviewing this provision.
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Treatment options for ADHD
Treatment for ADHD should form part of a comprehensive management plan set out by the specialist team. It should address psychological, behavioural and educational/occupational needs. In some instances medication may be suggested.
Medication cannot be started by the GP Practice, even with a formal diagnosis.
The psychiatry team would be responsible for assessing which, if any, medication may be of benefit. They will prescribe the medication and follow a process of 'titration' (slowly increasing the dose of medication) until they feel that the medications are effective and well tolerated. Once medications have been stable for several months, the specialist team may write to a GP to ask them to take over prescribing using a shared care agreement.
Read more about Shared Care Agreements on the page here.
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Useful resources
(With thanks to the University Health Service)