ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder that causes persistent difficulties with attention and concentration, and/or hyperactivity and impulsivity. ADHD is a lifelong disorder, and the prevalence of ADHD in the UK is 3-4%. People who have ADHD are more likely to experience other difficulties such as problems with their mental health or substance abuse.

There are 3 subtypes of ADHD:

• Inattentive ADHD - difficulties with attention and concentration

• Hyperacive/Impulsive ADHD - difficulties with hyperactivity and impulsivity

• Combined ADHD - problems with attention/concentration and hyperactivity/impulsivity

There is a wide variation in ADHD presentations and every person’s experience of ADHD is unique. However, there are common symptoms of ADHD which can include difficulties in the following areas:

• Concentrating and paying attention to detail

• Sustaining attention

• Completing tasks

• Organisation, planning and sequencing

• Listening

• Distractibility

• Forgetfulness

• Avoidance of particular tasks

• Fidgeting/squirming

• Struggling to sit for periods of time

• Restlessness

• High levels of movement

• Interrupting/intruding

• Talking excessively

• Struggling to wait/turn take

Diagnostic criteria are set out by The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) and are as follows:

At least six (five in adults) inattention symptoms and/or at least six (five in adults) hyperactivity-impulsivity symptoms that have:

• started before 12 years of age.

• occurred in two or more settings such as at home and school.

• been present for at least 6 months.

• clearly interfered with, or reduced the quality of social, academic or occupational functioning.

• not occurred exclusively during the course of a psychotic disorder and are not better explained by another disorder such as oppositional defiant disorder or conduct disorder.

A child ADHD assessment is £1300.

We pride ourselves on offering a fully face to face, in-person assessment process. We can also offer some appointments on Teams, if this is your preference.

Assessments are done at your pace and we do not specify a certain number of sessions. Sometimes, for lots of reasons, an assessment needs to be done quickly (for example for an EHCP application or appeal). Sometimes an assessment needs to be taken more slowly, possibly because your child feels worried about the process or because you are juggling lots of competing demands. As a rough guide, assessments generally consist of 3 appointments - 2 assessment appointments and 1 feedback appointment. If the assessment needs to be done over more than 2 sessions there is no additional charge for this.

From the first assessment appointment to receiving feedback and the final report is usually less than 4 weeks.

At the moment we can offer assessments beginning within 4 weeks of your initial enquiry. Once the assessment begins (the first assessment appointment) it should be complete (feedback and final report) within 4 weeks.

Before the assessment begins we will do what is called a screening assessment. A screening assessment is a brief assessment looking for signs of ADHD. We do this because sometimes people come to us seeking a particular assessment for their child e.g. ADHD, but it turns out that they need a different type of assessment e.g. autism. The screening assessment process helps us to decide which assessment would best meet your childs needs, and gives you some reassurance that the assessment is needed. We cannot make a diagnostic decision based on the screening assessments. The screening assessment is done via questionnaires and forms that will be emailed to you. We also need to seek information from someone who knows your child well, preferably from school (often your child’s class teacher or SENCO). The forms are completed and submitted online. We will review the information and get back to you with feedback about which assessment we feel would best meet your childs needs.

The next stage of the assessment is to meet without your child. The first appointment can be done in person or on Teams. We will complete what we call a developmental history - a detailed review of your childs background and history, and their current difficulties.

The next appointment is done in person with your child. We will do a QbCheck which is an online ADHD test. It is completed on a laptop and takes 20-30 minutes. Your child will be asked to watch the screen and respond when they see a particular target symbol.

After the 2 assessment appointments we can discuss how you would like to receive feedback. Some parents understandably want to hear the outcome of the assessment as soon as possible, and so brief feeback can be given over the phone before the report has been prepared. Sometimes parents might like to wait to receive the report so that they can read through the whole assessment, findings and recommendations. The draft report will be ready 2-3 weeks after the final assessment appointment.

Once the report has been received a feedback appointment can take place to review the report together, including recommendations.

If further support is desired we can discuss consultation or post-diagnostic work.

The standards for assessment of ADHD are set out by The National Institute for Health and Care Excellence (NICE). The guidance is summarised here:

• A diagnosis of ADHD should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in the diagnosis of ADHD, on the basis of:

  • a full clinical and psychosocial assessment of the person; this should include discussion about behaviour and symptoms in the different domains and settings of the person's everyday life and

  • a full developmental and psychiatric history and

  • observer reports and assessment of the person's mental state

• A diagnosis of ADHD should not be made solely on the basis of rating scale or observational data. However, rating scales such as the Conners' rating scales and the Strengths and Difficulties Questionnaire are valuable adjuncts, and observations (for example, at school) are useful when there is doubt about symptoms.

• ADHD should be considered in all age groups, with symptom criteria adjusted for age-appropriate changes in behaviour.

• In determining the clinical significance of impairment resulting from the symptoms of ADHD in children and young people, their views should be taken into account wherever possible.

For a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or inattention should:

• meet the diagnostic criteria in DSM‑5 or ICD‑11 (hyperkinetic disorder; but exclusion based on a pervasive developmental disorder or an uncertain time of onset is not recommended) and

• cause at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation in multiple settings and

• be pervasive, occurring in 2 or more important settings including social, familial, educational and/or occupational settings.

As part of the diagnostic process, include an assessment of the person's needs, coexisting conditions, social, familial and educational or occupational circumstances and physical health. For children and young people, there should also be an assessment of their parents' or carers' mental health.

People often look at the symptoms of ADHD and feel that they ‘fit’. It is true that all people will struggle with some of the difficulties associated with ADHD, particularly when they are tired or stressed, or experiencing difficult periods or transitions in life such as loss, relationship breakdown, parenthood or changes to jobs or living situations. People may also have other conditions or disorders which mean they experience these difficulties such as Autism, memory difficulties, or physical health problems.

People with ADHD have persistent problems with the above symptoms, meaning that symptoms have been present since childhood and impact them significantly in a number of ways and in different settings.

The main treatment people think of for ADHD is medication. Not all parents want to try medication. If medication is something you would like to consider for your child more information should be available via your GP. More information is also available here.

Not all parents want to consider medication for their child. It is possible to manage and support difficulties related to ADHD with environmental changes and strategies. It can be helpful to have space to think about your child’s ADHD and the impact it has on their life, education, as well as the family. The following treatment options are available:

• Post-diagnostic support - often people seek an assessment of ADHD for thier child already feeling very strongly that their child has ADHD and so the diagnosis is expected. Some people seek an ADHD assessment for their child as part of a wider assessment to answer questions about their experiences, and a diagnosis can come as a surprise.

  Post-diagnostic support is a short-term process which can help parents to:

  • learn about ADHD and how it might impact on your child, you, and your family.

  • work though any feelings you might have following your child’s diagnosis

  • explore what wider support may be availbel for your child at school and home work

  • think about how to tell your child about their diagnosis

  • think about who to tell about your child’s diagnosis and how to explain the diagnosis

Find out more about the consultation and post-diagnostic support we offer at NeuroNest Psychology.