Seeking an ADHD Diagnosis

What is ADHD and do I have it?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition which is characterised by inattention, hyperactivity and impulsivity. Many clinicians also recognise that difficulty with emotional regulation and executive functioning skills are also common features of ADHD.

You may want a diagnosis to:

• Explore what you are good at, which parts of your life may be more challenging, and to develop strategies to help yourself
• Find out whether your current difficulties are caused by ADHD and not by another condition
• Find out whether you have ADHD and another condition as well.

Self-assessing for ADHD

What does ADHD actually mean? Isn’t everybody inattentive, hyperactive and impulsive at times? Well, yes we are, and there are physical and mental health conditions that may share similar symptoms. For example, anyone experiencing stress might find it difficult to concentrate, be forgetful, impulsive or ‘always on the go’. So what would make these features stand out and be defined as ADHD?

Simply, these characteristics present in a more extreme form in those with ADHD and will have done since childhood. ADHD can be a lifespan condition and how it affects us can change as we transition from childhood into adulthood and in later life.

Referrals for ADHD assessments

The first step is to make an appointment to see your GP to explain that you would like to be referred for an ADHD assessment. Before your appointment, be as informed as you can be about ADHD and be ready to explain the reasons why you think you may have ADHD. This might include referencing traits in the Self-report scale (page 7 of the booklet), explaining the impact it has on your life, and discussing your experience as a child/adolescent.

Your GP will want to rule out any physical causes for your symptoms and may use their own screening tools at this stage. The GP will know who in your local NHS service should receive the referral for you to be screened for ADHD. The GP cannot diagnose you with ADHD, and cannot prescribe medications without the guidance of a mental health specialist trained in ADHD. Some people with ADHD may have other mental health concerns, which will also need to be understood and managed with the help of a mental health specialist.

Before your appointment with the mental health specialist, it would be useful to consider the following:

• Your medical history, including any difficulties, support and treatment you may have had for your physical and mental health. If you have any records of these, take them with you. Don’t worry if you don’t have any records, the mental health specialist can learn a lot from talking to you and taking your clinical history.
• Your experience at school and in education.
• If you feel comfortable to do this, talk with trusted friends and family members and ask for their perspective. Talk with them about what you have learned about ADHD and ask them what they think. With your permission, the mental health specialist may want to obtain information from them as part of the assessment, so it is useful to raise the subject beforehand.
• ADHD can run in families so find out if there is a family history of ADHD and/or other specific learning differences or mental health problems.

An assessment for ADHD will involve an evaluation of your developmental, mental health and medical history. This will enable the mental health specialist to gain an understanding of the impact ADHD has on your life, and guide their support recommendations.

Your assessor will then determine whether your symptoms match the clinical criteria for an ADHD diagnosis.

The clinical criteria your assessor will most likely refer to are those in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, commonly known as DSM-5 (2). There are eighteen symptoms – nine in a group entitled ‘Inattention’ and nine in a group called ‘Hyperactive or Impulsive’.

If your assessor does determine that you have enough symptoms to merit a diagnosis of ADHD, they may also discuss which subtype of ADHD you have. Within DSM-5, there are currently three presentations:

• The Combined type means that you have met the criteria in both the Inattention and Hyperactivity/Impulsivity groups.
• Predominantly Inattentive type is applied to people who exhibit mainly attention difficulties or poor impulse control and is the most common presentation in adolescents and adults (3).
• Predominantly Hyperactive type means that you have not enough symptoms in the Inattention group to be diagnosed as having the Combined type. The central difficulties experienced by individuals with a Predominantly Hyperactive type are in the Hyperactive and impulsive group of characteristics.

The journey of accessing a diagnosis

Getting a diagnosis may not be straightforward. We know there can be barriers of different kinds including accessing a diagnosis via the NHS. Here are some of your rights, and courses of action you may wish to consider.

Right to choose

The 'Right to choose' clause of the 2012 Health Act means the individual can 'insist' that their GP / local NHS funds them to get a 'timely' assessment / diagnosis in another area if there is no capacity to be seen within 18 weeks in their local service.

In any instance where an alternative provider undertakes the assessment and diagnosis, the provider retains legal care of the patient for the period after diagnosis while the clinician monitors the patients response to medication. They usually then - at the 'request of the patient' write to their GP requesting a 'Shared Care Agreement'. If granted, this means that after the period of medication monitoring (usually 3+ months while the trial getting the dosage optimised) the patient then gets their monthly prescriptions funded by the NHS (and the patients income tax of course). The patient however must get an annual 'medical review from the diagnosing clinician - so this will be an annual event for which the patient may have to pay.

Private diagnosis

Should you access a ‘paid for’ private diagnosis (even if it is done by an NHS Consultant who does this privately also) many GPs are refusing to accept a 'private diagnosis'. There is a loophole in the Royal College of GPs’ guidelines on this that make this difficult to challenge. When this is the case then the individual will end up paying substantial sums every month for a repeat prescription and the cost of the prescription medication itself - in perpetuity.

Also an ECG (electrocardiogram) and general medical history will be required by the private diagnosing consultant - some GP's provide this; others can be 'unhelpful' and some insist that while they may be legally obliged to share the medical history to a private clinician at the behest of their patient - but some refuse to undertake (and incur the cost) of an ECG.

Understanding how ADHD affects you

Living with ADHD can be a major source of anxiety for many. Daily habitual lifestyle changes to reduce your stressors are an integral part of living successfully with ADHD. Making these lifestyle changes is something you need to do gradually – but start now.

Medication can be helpful to many, but there is more to managing ADHD than simply taking medication. To understand the reason why we need to make lifestyle changes and choices that help us manage impairments related to ADHD, we need to explore how ADHD is affecting you personally.

Every person with ADHD is unique. You are a collection of your genetic makeup, your environmental influences, for example, your upbringing, school life, your family, community and your particular set of experiences. Therefore, the way in which ADHD affects you may be different from another person with ADHD who has had a very different set of experiences or family background to your own.

For some people, ADHD is also thought to be associated with physical problems such as asthma and migraines Some women experience more difficulties with ADHD because of hormonal changes.

Managing ADHD with medication

Medication is proven to be helpful for many adults with ADHD. Medications for ADHD help your brain to function better and improve your ability to focus, remember information, reduce impulsivity, help with emotional regulation and some aspects of executive functioning.

There are two types of ADHD medications: stimulant and nonstimulant medications. Your prescriber will advise you what might work best for you based on how your ADHD is affecting you and your medical history.

When starting to take medication for ADHD, the prescriber will start a process called ‘titration’. This process involves starting medication on a low dose and over a period of several months, the dose may be increased until it is working effectively for you. This will involve monitoring any change in symptoms, and any potential side effects that might appear. Your prescriber should discuss these with you at the start of titration, or if you change to another medication, so that you are aware of what to look for.

Everyone has a unique brain so comparing yourself to others who have ADHD will not be helpful. Discuss your concerns with your doctor and allow yourself time to get this right.

Medications licensed for ADHD can have effects for different lengths of time. Some are intended to be taken once a day, others a few times a day. It's important that the person taking the medication is aware of how and when to take their particular medication., so you may only need medication for a certain period each day; for most people, this will be when they are at work.

Medication is one of a range of strategies and should be used as such. You must not rely on medication alone to manage ADHD successfully. Medications may cause side-effects like dizziness, drowsiness and visual disturbances and you should be informed of these possible effects and if affected you should avoid potentially hazardous activities such as driving or operating machinery.

While you wait

Getting a diagnosis can take a long time. Whilst you wait to receive a diagnosis there are organisations working specifically with musicians that can help manage your symptoms.

We recognise that there can be long waiting times on the NHS assessment /diagnostic pathway. Whether or not you are waiting for a formal assessment, have a formal diagnosis or have chosen not to pursue a formal assessment, there is additional support you may be able to access for your mental health, and to help you to cope with the symptoms, traits and differences associated with neurodiversity.

• BAPAM have a range of resources, education programmes and events, centred around healthy practices for performers. BAPAM might also be able to offer a short-term therapeutic intervention via their mental health service. For more information about how to apply for mental health support, visit Mental Health Support at BAPAM
• Help Musicians also offer direct mental health support via Music Minds Matter, including a 24/7 telephone service staffed by accredited counsellors, peer-led support and self-care sessions. The Help Musicians Health and Welfare Team may also be able to provide more general advice and support, tailored to your individual need and circumstances.
• Attitude is Everything run the Next Stage network for Artists and the Beyond the Music Network for Professionals. Joining either network enables you to connect with others facing similar barriers and access learning and career development opportunities.
• MU Disabled Members Network is a space for MU members who identity as disabled and/or neurodivergent to meet and discuss issues that impact their communities, shape MU policy, and change the music industry and the MU for the better. Find out more and join the network.

Managing ADHD with Cognitive Behavioural Therapy (CBT) and coaching

When looking for a therapist to help you, ensure you check they are appropriately trained, qualified and experienced practitioners who are registered with a professional body. You must also ask them about their knowledge and experience of working successfully with clients who have ADHD.

For some people, simply having a trusted ‘critical friend’ who can give you genuinely honest objective feedback to help you make the changes you want in your life may be enough to support lifestyle changes.

Cognitive behavioural therapy, dialectical behavioural therapy, coaching and group coaching may all be helpful in enabling you to start making the lifestyle choices you need to make, as part of successfully managing ADHD.

Thriving with ADHD – the good news!

While ADHD can affect us in different ways, once we understand why it is we have been struggling, we can start to explore the many different approaches to managing it and living with ADHD successfully.

For many adults who realise late in life that they have lived with ADHD, it can be both a relief but also a source of sadness as they reflect on how different life might have been if they had known sooner. Criticising yourself or others, blaming others for not knowing why you were struggling will not help. What matters is what YOU do NOW.

This is your opportunity to take control of your ADHD, and learn how to become responsible for managing it so you can get on with the business of living, going to work and pursuing your life goals and interests.

Living with ADHD can be difficult; but the good news is that when we employ these strategies and lifestyle changes, we will start to notice how much better we are feeling, and we will grow in confidence about our ability to manage our day to day lives.

A positive solution focussed attitude is something that we learn – and it takes time. Be patient with yourself, be kind to yourself, cultivate a sense of humour, appreciate the people and things in your life that mean something to you.

It may help you to explain to those close to you, why you might struggle with some things and what you are trying to do to manage it effectively. Ask for their understanding and support. Remember that support of family and friends will help you as make these adjustments to your life – but the responsibility to manage ADHD is yours. A prescriber can offer medication, but the lifestyle changes are up to you.

These changes will take time to become habits. You will still make mistakes; you will continue to struggle with some things and you will find new ways to help you better manage. When you have learned to manage your ADHD successfully you may begin to realise that there are ways in which your ADHD may help you:

• Hyperactivity can be viewed as being energetic, having drive and enthusiasm.
• Impulsivity can also be viewed as decisiveness – willing to take a chance, seize an opportunity.
• Inattention and mind wandering can be viewed as having an imagination that is looking for ideas, inspiration, new experiences and curiosity.

ADHD does not define you; it is an explanation about how your unique mind works. It is an insight into how you interact with the world you live in, and how you interact with and relate to the people who inhabit your world.

Remind yourself that you are doing your best. Celebrate those achievements and the progress you make. Go to www.borntobeadhd.co.uk (initiated and funded by Takeda) and www.adhdfoundation.org.uk for more information!

Reasonable adjustments at work

If you are experiencing barriers in the workplace that are likely to be linked to neurodiversity, you do not have to wait for a formal diagnosis to request reasonable adjustments.

You should have a conversation with your employer, engager, or pace of study about your individual needs and what reasonable adjustments you think would work. Find more information about reasonable adjustments at work.

The contents of this page was provided by ADHD Foundation.