Before Getting an ADHD Assessment
Before you think about getting assessed for ADHD by a professional, it is important to learn more about the condition and how it might affect you. This is because it can be difficult for some people to pursue a diagnosis, and some medical professionals lack knowledge of how ADHD presents in adults. In order to prepare for an assessment, you will need to learn about ADHD traits (symptoms) so that you can describe what you are experiencing and how it affects your daily life. You can start learning about ADHD here, before you begin the journey of getting a diagnosis.
We encourage anyone who thinks they might have ADHD to sign up to the ADHD Aware newsletter and attend our support meetings. A lot of people who come to our meetings don’t yet have a diagnosis, and it can be a good way to learn about what it’s like to be an adult with ADHD.
Who Can Assess ADHD in the UK?
If you are an adult in the UK, the only people who can formally assess you for ADHD are:
–A Psychiatrist: a medical doctor who has specialised in psychiatry and is able to prescribe ADHD medication.
– A specialist ADHD Nurse: a qualified nurse with additional accreditation in assessing ADHD. Depending on their qualifications, they may also be able to prescribe ADHD medication.
–A Psychologist: Psychologists can assess someone for ADHD, but they are not qualified to prescribe medication.
GPs and other mental health professionals such as counsellors, cannot provide a formal diagnosis of ADHD.
How to get an Adult ADHD Assessment in the UK
There are three ways to get assessed for ADHD in the UK. Options 1 and 2 are BOTH covered by the NHS- you will not have to pay for assessment or treatment if you are diagnosed (other than the usual NHS prescription charge).
While the NHS has much that it does well, due to its size and bureaucracy it can take years before some people are able to get an assessment. Because of this, if you live in England, we recommend that you access an ADHD assessment through the ‘Right to Choose’ pathway (Option 2) because it is a lot quicker.
If you choose Option 3, you will have to pay for diagnosis and initial treatment, which can be expensive. It is possible to transfer to treatment paid for by the NHS, but this can sometimes be difficult.
Option 1- NHS Assessment
To get an ADHD assessment through the NHS, you will first need to go and speak to your GP about why you think that you have ADHD. Your GP should take you seriously, and ask why you think you might have ADHD. Following this conversation, they may ask you to fill in a screening tool called an ‘ASRS form’, which you must complete before you can be referred for an assessment. The GP should then refer you for assessment, and put you on the NHS waiting list. If you are having trouble getting referred by your GP, there is some advice further down the page on what you can do.
What to Expect at an ADHD Assessment
When it comes time for your assessment, it will be with a specialist psychiatrist, psychologist or specialist nurse, as these are the only healthcare professionals who are qualified to diagnose ADHD in the UK. If you are assessed by a psychologist, they will be unable to prescribe medication to treat ADHD.
The assessment may be in person, but it is not unusual to have one conducted via video call. It usually takes 45-90 minutes, during which time you will discuss your overall mental health, mental health history, and any family mental health issues that you are aware of. If you have a family history of ADHD, it can be helpful to mention that during your assessment, as ADHD is genetic.
You will also be asked questions relating to Hyperactivity and Inattention, and assessed according to the DSM V criteria for ADHD. You will be asked a number of questions that relate to this criteria, and you need to answer with examples that demonstrate the trait (symptom) that is being assessed. To receive a diagnosis, you must have at least 6 traits (symptoms) which are present now, and when you were a child.
For example, you may be asked if you often lose things. To answer this, you need to give a general description of how often you lose things (e.g. “I lose things all the time”), and give several examples of times that you lost things that were necessary for a task. You will also need to give examples of times that you lost things when you were a child e.g. “When I was in school, I always used to forget my homework.”
We recommend that you familiarise yourself with the different traits (symptoms) of ADHD that will be assessed during your appointment. Many people with ADHD find that their mind goes blank in such situations, so it is important to think about which traits (symptoms) of ADHD you can identify in your own life, and write down examples before your assessment.
After the ADHD Assessment
After the clinician has finished asking you questions, they will let you know what happens next. If you are given a diagnosis of ADHD, your clinician should discuss treatment options with you, which will usually be either medication or CBT therapy. Once you have a treatment plan in place, you will be referred back to your GP for shared care.
If you are not given an ADHD diagnosis, they will tell you why they think that you do not meet the criteria. It may be that you did not give enough detail about the difficulties you experience, or that another diagnosis explains your traits (symptoms) better than ADHD. You do not have to accept this diagnosis if you disagree with it, and you are entitled to seek out a private provider for assessment if you still think you have ADHD.
Many adults who receive a diagnosis find that it comes as a huge relief to know that they are neurodivergent, because it explains a lot about why they have struggled in life, but the feelings that it brings up can also be difficult to deal with. If you would like support, to share your experiences, or meet other adults with ADHD, you can sign up to the ADHD Aware newsletter and come to one of our monthly meetings.
While the NHS has much that it does well, due to its size and bureaucracy it can take years before some people are able to get an assessment. Because of this, if you live in England, we recommend that you access an ADHD assessment through the ‘Right to Choose’ pathway, because it is a lot quicker.
Option 2- NHS Assessment via ‘Right to Choose’
If you are based in England under the NHS, you now have a legal right to choose your mental healthcare provider and your choice of mental healthcare team. This important right means that, for instance, should you decide the waiting time for your ADHD assessment is too long, then you can choose another provider.
If you live in England, we recommend that you access an ADHD assessment through the ‘Right to Choose’ pathway. You can learn how to do this on our ‘Right to Choose’ page.
Option 3- Private Assessment
If you want to avoid waiting lists, or the other options are not available to you, you could pay for a private ADHD assessment. For most people, we would only recommend doing this only if you are NOT able to access a diagnosis and treatment through the NHS ‘Right to Choose’ pathway. This is because you must also be able to pay for any follow up appointments and treatment such as medication or CBT therapy, which can be expensive.
Even if you just want the diagnosis without treatment, be aware that your feelings may change in the future as you learn more about how ADHD affects you. You don’t want to get stuck in a position where you have a private diagnosis but are unable to afford treatment.
It is possible to get a shared care agreement with your GP for medication (so you only pay the NHS prescription charge), but some will refuse if you have a private diagnosis and that can make things difficult. That is why it’s important to check before you go for a private diagnosis. There is more information about getting a private ADHD assessment here.
Is it difficult to get diagnosed ADHD as an Adult?
The answer is: it depends. There are a lot of factors that can affect whether or not you get a diagnosis, such as how willing your GP is to refer you and how prepared you are to answer the questions when you go for your assessment. If you are a person of colour, assigned female at birth, or you are not a native English speaker, it can be harder to get a diagnosis because some medical professionals have preconceived ideas of what someone with ADHD looks like. Although there is a growing awareness of these biases, they are still present and they can make it difficult for some people to get the correct diagnosis and treatment.
It can also be more difficult to get diagnosed if you are multiply neurodivergent (e.g. if you are both autistic and ADHD), or if you have prior mental health diagnoses such as BPD or Bipolar. Some people may have been misdiagnosed with these conditions, so it is important to learn about the ways that they are similar to and different from ADHD. You can discuss your thoughts on this when you see a clinician for diagnosis.
Advice for speaking to GPs
If you are having problems accessing services, you can download and print this support letter from ADHD UK. You can give this to your GP, saying that you want to be referred for an ADHD assessment. You can also print quotes from NICE 87 guideline, that state that only a specialist can diagnose or refuse a diagnosis. GPs are not specialists- they are General Practitioners. Therefore, they cannot diagnose ADHD, or refuse a diagnosis from a specialist.
Sometimes medical staff will only see the fallout from having unmanaged ADHD and wrongly make assumptions about the cause. For many people, unmanaged ADHD can lead to significant problems with professional, interpersonal, and overall wellbeing and can often present itself as anxiety and depression. If this applies to you, you are allowed to refuse any treatments that they offer and make it clear that you are requesting an ADHD assessment.
It can also be helpful to look at a list of traits (symptoms) and think about how they might apply to your life.
If your GP still refuses to provide a referral you can consider:
– Getting a second opinion from another GP. You do this by requesting a second opinion from another GP at your practice, or by booking a new GP appointment and requesting a different doctor.
-Changing GP practice. If your current GP service won’t support you in getting a diagnosis, it might be worth considering changing practice. The NHS find a GP service here and there is an online based NHS GP service here.
If your GP says there is no ADHD service in your area:
England, Wales and Northern Ireland follow the NICE guidelines on ADHD, which gives a right to the provision of an ADHD service. That means if there is no local provision then 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 and can learn more about that here.
Scotland follows a different guidance system (SIGN).
If you have any questions about the diagnostic process, please email us at support@adhdaware.org.uk.