ADHD assessment and treatment – 

• We undertake the entire process of ADHD Assessment and Treatment in keeping with the latest evidence based and National Institute of Clinical Excellence (NICE) Guidelines. The fee structure for ADHD assessment is a minimum of £1000.00 plus follow-up reviews – details can be found here.
• A full developmental and clinical/social history is acquired at the initial meeting alongside a Mental state examination to rule out other psychological problems which may manifest similarly.
• Consideration is given to academic performance, liaison with school teachers as appropriate (done with your consent) 
• Use standardised SNAP, SDQ or Vanderbilt ADHD Questionnaires alongside the above. We use our secure online systems to deliver ADHD questionnaires.
• At times additional tests may be required, e.g. QB check computerised continuous performance tests. At First Step Clinics we offer the QB Check for ADHD where it is needed rather than as a routine considering there is an additional cost (please check the fees section for more detail). By providing this in-house, we aim to make the ADHD Assessment & Treatment swift and timely.
• If there is a doubt about a child’s learning or cognitive ability, a WISC or similar (for IQ) check may be needed. In case there is a likelihood of Autism Spectrum Disorders, further formal assessments will need to be undertaken separately. These are done independently at additional costs, sourced from other providers by you.  
• Occasionally we may require blood tests / ECG prior to trial with medication. These need to be arranged separately either via your GP or privately.
• Medication information, initiation, monitoring – it would be safe to assume that in the first one to three months after initiation of medication treatment of ADHD, the treatment will need private prescriptions. Once the dose of medication is stabilised, we will send a formal request to your GP so that they can provide repeat prescriptions in keeping with our well documented shared care protocols. We are unable to influence the time-scale at which GPs accept to start prescribing and in rare situations, a GP may decline to provide refill prescriptions. In such situations, we are reliant on you contacting us to re-initiate a request for our clinical services.
• Once settled on an optimal dose, follow up reviews tend to happen once every 12 months under a shared care agreement with the GP or when the dose needs to be reviewed or when the GP recommends a specialist review. The onus on scheduling the yearly review before end of 12 months rests with you, without this the shared care will be deemed null and void and the patient considered to be discharged from our care.
• Please factor in external costs that are not charged by this clinic. This can include the following: 1. If your child is prescribed medication by our consultant and until these available as NHS prescriptions via your GP (which is usually the case until the GP agrees for shared care only after the dose is stabilised), we can give you private prescriptions. These are outside the normal NHS exemptions for free prescriptions and you buy the medication from community pharmacies at your own expense. 2. specialist medical checks by private consultants such as Cardiology or Neurology. These may be required to support the diagnostic process or medication treatments.

Read on to find out more about ADHD Assessment and Treatment:

ADHD is a relatively common condition affecting 2 – 5 % of children and adolescents. The incidence and prevalence vary depending on which clinical criteria (ICD 10 or DSM) are used. 

Presentation:

Those affected display symptoms in four areas – hyperactivity, difficulty sustaining attention and impulsive behaviours. The fourth area of concern often overlooked is executive functions. The latter include emotional regulation, problem-solving, time management, organisational skills, and multi-tasking effectively.

A certain number of these features need to be present to meet the diagnostic threshold and the difficulties noticed across at least two settings i.e school and home. A variant, Attention Deficit Disorder (ADD) is also recognised, here the symptoms relating to overactivity/impulsivity are not dominant. Such presentations where difficulty relating to inattention is the main problem tends to be seen more in girls and being less obvious likely to be missed and less reported.

Causal factors: 

A variety of theories spanning bio-psycho-social factors have been considered by researchers. Family history tends increase chances of getting the condition as do problems during pregnancy including drug use. Inconsistent parenting may often be part of the equation.

Diagnostic process: 

This will typically involve a clinical interview spanning the early development, ruling out medical and social causes (childhood abuse) as if these explain the presentation better, ADHD may not be diagnosed. Corroborating the findings by acquiring information from school is vital and often done by direct communication / school observations (if need be) and use of specialised questionnaires which are also completed by parent/s and the young person unless too young. 
Though the diagnosis can be made at a relatively early age of around 6 it is very common in my practice to see teenagers who have not been diagnosed until very late, in some cases as late as late teens or in young adulthood (adult ADHD is now increasingly recognised). 

Preschoolers under 5 may be assessed for probability of a diagnosis, firm conclusions may be deferred until a child is close to age 6 or above. 

Treatment: 

ADHD is best understood as a neurodevelopmental condition wherein the evolved frontal cortex (larger thinking brain at the top) is not sending down sufficient dampening signals (chemicals such as dopamine) to quieten the lower primitive brain structures from where random behaviour, inattention, and impulse arise. 
Treatment in milder cases and pre-school children involves helping the child train itself to use the regulatory control of the larger thinking brain more. This is complemented hugely by parents learning the right skills by attending individual or group parenting sessions. 
Medication is used above the age of 5 and in moderate-severe conditions or where the above efforts have not yielded sufficient benefit. The medication used may be stimulant (first choice) or non-stimulant variety and would supplement the deficient chemicals such as dopamine when used in clinical doses thereby producing a clinical benefit. 

Why is it important to treat ADHD? 

Prompt ADHD Assessment & Treatment is vital as left untreated, these children tend to by virtue of their lack of regulatory control get in trouble due to their behaviour and poor academic performance. This leads to being “told off” by adults who are in a position of authority and in time may get worse leading to exclusion from mainstream schooling for periods of time and at times permanently. Such experiences, other than imparting a negative sense of self lead to an antagonistic attitude towards adults and presents as Oppositional Defiant Disorder which may eventually acquire a flavour of Conduct Disorder leading to anti-social behaviours and contact with the legal system. Young people may end up drug-taking as a way of sensation seeking (a common need seen in those with ADHD) and at times self-help. The consequences of not treating ADHD thus can be significant in terms of potential for poor long term outcomes.

Further reading on subtle nuances in the diagnostic process – click here

To find out about the non-pharmacological ADHD coaching / CBT based psychological approaches to treating ADHD

Click here to read about Pharmacological treatment of ADHD