PI Brief Update

How To Get Help for ADHD - Dr Mark Burgin

18/09/26. Dr Mark Burgin explains how to avoid the current pitfalls in ADHD care and why a holistic mental health and disability approach can improve outcomes.

Waiting times for ADHD assessments are long with 2-5 years being commonplace, many feel pushed towards costly private alternatives. The diagnoses are often based on psychometric video-based assessments which are detailed but many lack the holistic assessment that some people require. Many people are unable to pay for ongoing costs such as follow up and talking therapies. These problems are leading to a medication dominant treatment pattern. The Right to Choose (RTC) has led to many private providers offering a limited service.

Many concerns have been raised by sufferers, those treating ADHD and those who are critical of the current system. Some providers have been criticised for shortened, checklist-heavy approaches that are designed to find ADHD and ignore contrary evidence. The qualifications of some assessors are limited to ADHD so they lack the expertise to make other diagnoses. GP records are rarely available to complement the person’s memory but schools only keep reports on previous pupils for a few years.

Schools have improved in their ability to pick up neurodifference but the coverage is patchy and universal screening is not available. The large number of missed adult people with ADHD mean that the current approach will take decades to address the backlog. The insistence that people with ADHD must show disability means that those with hidden disabilities can be ignored until their coping mechanisms collapse. These high masking people may remain underdiagnosed until employment burnout, educational failure and secondary anxiety or depression manifests.

Screening tests

I recommend online screening tests for neurodifferent brain patterns ASD, ADHD, OCD and dyslexia and then discusses the results with the GP. This is a practical, scalable and virtually free way of ensuring that everyone in the UK who has any neurodifference is screen positive. A comprehensive assessment may be required but reasonable adjustments can be offered on the basis of the screening test. If a reasonable adjustment is effective then it can be used without formal diagnosis.

Screening tests have other advantages as each person can compare their scores across the range of neurodifference. It is normal to have some features of neurodifference such as a love for routine, being forgetful, having messy writing or checking the door is locked. Screening tests can indicate how significant each of these features are and whether holistically the person has a pattern.

Having an overall view of the way that the brain works makes it easier to link disabilities with neurodifference. A person might be a workaholic and have problems but they are unlikely to want to ‘cure’ the workaholic aspects. Screening tests can help identify the brain patterns that are causing the problems and suggest alternative solutions. Rather than suggesting that the workaholic takes time off sick they might be helped with energy management and relational communication.

The holistic assessment

There are many things that can go wrong with the brain and just because a person has ADHD does not mean that it is causing all the problems. Many people with ADHD develop burnout and anxiety and these need to be addressed for a full recovery. In general, the longer a person waits for a diagnosis the greater the number of other diagnoses will be present. Many undiagnosed adults intentionally use anxiety (hyper-vigilance, catastrophic thinking, perfectionism) to override their task paralysis.

Many people with ADHD have suffered poor childhoods when hyperactivity means that they were classed as naughty children. Parents and teachers often struggle to understand the child’s needs leading to constant conflict. The adults find the attention deficit difficult as the child may not appear to paying attention so they can escalate the punishments. As ADHD is associated with a good memory it can be difficult to forget the trauma that the child has suffered and disrupt their self-confidence.

ADHD does not protect the person from serious mental illness with genetic links like psychosis. If they have a reduced threshold due to their family history, then psychosis may be triggered by self-medication. Drugs such cocaine and cannabis taken to self-medicate increase the risk of a serious breakdown in some people. This can complicate the treatment as mental health services will often insist that the person stop self-medicating before addressing the underlying ADHD.

What is a reasonable adjustment?

Having ADHD is like owning a powerful car, the problems come if you do not know how to drive it. I use the image of a person who does not know how to change gear. They are driving down the motorway at 50mph in first gear with the engine roaring. If the person can be shown how to change gear the noise and the speed will both improve. Teaching a person how to use the superpowers associated with ADHD is the simplest type of reasonable adjustment.

For many people with ADHD neuro-stimulants such as Methylphenidate and Lisdexamfetamine are transformative. They become less distracted and it reduces the restlessness associated with boredom. Unfortunately, there are side effects which go beyond the bank balance such as making it more difficult to treat other problems. Many people find the effectiveness wears off and may need increasing doses to have the same effect. ADHD neuro-stimulants can mask depression and identity problems such as low self-confidence and cause emotional flatness.

In life (and ADHD) there no single magic bullet that solves all the problems. A full disability report can provide a range of reasonable adjustments to address each of a person’s problems. The combination of approaches (medication, understanding, workplace adjustments and treatment for other problems) will be more effective than any single approach. Current provision for mental health is often siloed and the person is not offered joined up care.

Conclusions

Some private providers are unable to offer coaching on ADHD or counselling for other issues due to the high costs. There is concern that some private providers do not assess any other mental health symptoms based on lack of communication. Clinical letters from private providers are normally ADHD centric with little evidence of a holistic approach. This can give the impression that the private provider has not recorded the past psychiatric history or asked about adverse childhood experiences. The CQC should offer guidance for private providers on a basic minimum letter and addressing non-ADHD issues.

Access to Work (UK) is a government grant scheme that funds workplace adjustments, ADHD coaching, assistive technology and support workers without requiring a formal diagnosis in many cases. Similar schemes are available to students at university but problems with funding at schools means that an EHCP may be required before help is offered. Schools should screen all students and offer those with screen positive ADHD the low-cost reasonable adjustments rather than waiting until they develop disabilities.

The current system fails to use the most important diagnostic test in medicine, a trial of treatment can help clarify whether the diagnosis should be questioned. By using medication rather than other approaches first line it can be difficult to determine if the person is responding to the stimulant or has ADHD. Many people with disabling anxiety are diagnosed with ADHD because they may also have the trait but the symptoms overlap. A holistic assessment can reduce the risk of diagnostic shadowing from a finding of ADHD.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is a Disability Analyst and is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 01226 761937 websites drmarkburgin.co.uk and gecko-alligator-babx.squarespace.com

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

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