Getting an adult ADHD diagnosis in the UK is simple for some, and tricky for others. Working out your ADHD symptoms – and going to the appointment prepared – is vital.
TL;DR – actionable list
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- Research. Pinpoint your symptoms and their impact on your life.
- Call your GP, make an appointment.
- See mental health nurse for ‘interview’.
- Receive tests in the post. Complete.
- See consultant (psychology-focused doctor).
- Receive diagnosis. Discuss treatment. Get prescription, if needed.
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Background
I’d thought something was wrong with me for a long time. My lack of focus, terrible working memory and inability to just do the thing was a burden through childhood and beyond.
When I was a kid, I was “ditzy”, a “dilly daydream”, “unfocused”, and so on. My school reports were full of the usual complaints: “She’s clever, but she won’t apply herself”.
As an adult, I got an easy anxiety diagnosis and a succession of unhelpful prescriptions. I blamed a lot of my quirks on those factors.
I also assumed that many of my failings were due to my alcoholism. When I got sober, in March 2016, I realised (to my considerable annoyance) that swearing off the cider didn’t solve all my problems. I existed in a stagnant pond of procrastination; an unfocused mess.
Why was I this way?
Reluctant to accept the obvious answer – I was a useless human being – I started researching. On-and-off, of course.
I thought for a while that I was somewhere on the autism spectrum (I’ve still not ruled it out). I am often overwhelmed by stimuli, and I hate people touching me. Eye contact is a societal fetish that I refuse to indulge. Still, though, that answer didn’t seem quite right.
Breakthrough
A friend shared an article on Facebook. It was about women with ADHD: how the disorder presented, and why it was so often missed in girls.
I read it all the way through with unusual focus, equal parts amazed and appalled. That was me. The person writing was (apart from some minor details like being a successful NYC journo) me.
I was hesistant about self-diagnosis, especially as I knew my bias. I wanted it to be true. If I did have ADHD, I would have an explanation for some of the worst parts of me. Not only that, I might have a solution to some of them.
Still, I put off calling the doctor for several months. You know how it is.
Your mileage may vary
I went from initial appointment to diagnosis and treatment in a little under six months.
I was fortunate in three ways:
- I live in a part of the UK that has an ADHD consultant with a shortish waiting list
- Every person I dealt with – GP, nurse and consultant – was familiar with ADHD. Better still, they knew that ADHD in women presents differently than in men
- I am privileged: I am white, I have a ‘posh’ accent, and I am good at research. I came prepared and was given the benefit of the doubt by default
If any of those three factors are missing, it can take many months more – even years – to get an NHS diagnosis for adult ADHD. Private diagnoses are possible, but expensive. If you can’t persuade an NHS GP to take a private prescription, you’ll pay out even more for any medication.
Step 1: Making a GP appointment
- Call the GP and ask for an ADHD referral appointment.
- Wait anywhere from a week to a couple of months (the joys of an underfunded NHS).
Preparing for the referral
- Put together a list of your relevant symptoms. I made mine with the help of this list, from the superb ADD-UK
- Beneath each ADHD symptom, write a brief explanation of how you think it’s affected your life
- If possible, get a statement from someone who’s known you since childhood. A parent or other close relative is ideal. Other possibilities are long-time friends and teachers you’ve maintained contact with
Attending the appointment
I took my bit of paper to the doctor, who agreed that, yes, it sounded like I had ADHD.
She would not be able to diagnose me, though; she would have to send a referral to a specialist unit.
Word of warning
I was lucky from the start. I have a reasonable GP.
Other British ADHD-havers told me that their GPs wouldn’t give them referrals because they over-prepared. Organisational skills of any sort, in any situation, disqualified them from assessment.
I suppose some professionals still think us all incompetent.
Even if you decide not to pass the document along, it’s important to make your initial list of ADD symptoms and affects. It will help you make your case.
You will definitely want a statement from a parent or other compliant loved one.
Step 2: Seeing a psychiatric nurse
I’d been impatient with a two-week wait for my initial GP appointment. I didn’t expect the months-long delay before I could see a psych nurse.
- No real preparation needed – but really try to turn up to the appointment. If you miss it, you might have to wait ages for a new one.
- Trigger warning: the appointment involves conversations about your past, including abuse or addiction
On the day of the appointment, I toddled along to the mental health clinic. I chatted with a lovely, very French, psychiatric nurse. She asked me a lot of questions about… well, more or less everything.
My day-to-day life, my childhood, whether I’d experienced abuse.
I welled up a bit at certain points – like when we talked about bullying at school – but the nurse was skilled at tactful interrogation.
At the end of the appointment, she said she was “almost certain” I had ADHD. It was “written all over me”.
I must have looked affronted, because she reassured me that she liked people with ADHD – we were interesting. This was gratifying.
Emotional response
When I got home, I burst into tears.
It was the release of months of gearing myself up, and of years of frustration and beating myself up for being so bloody useless.
I now felt validated, relieved, and hopeful. I had a diagnosis. Nearly.
Another couple of months passed before I got to see the consultant (doctor) to make it official, and to start treatment.
Step 3: Seeing the consultant about ADHD
I received a letter with an appointment date. Enclosed were 15 pages of questionnaires, including CAARS (similar to this – PDF) and DIVA).
Some of them were for me to complete; some of them for family or other close people.
It’s quite funny that the NHS deals with ADHD patients by sending them a folder-full of paperwork to lose – I wondered if it was part of the test.
- Fill in ‘your’ forms with as much honesty as possible
- Get your loved ones (I used Mum and my then-fiancé) to do the same
- Block out an entire day, if possible – at least a full morning or afternoon. The appointment is 2+ hours long, and the emotional impact might stop you from being yourself at work or school.
- Attend appointment
The main event
I managed to bring all my bits of paper to the clinic (hoorah!).
I saw Dr. E, a consultant who was delightfully interested in adult ADHD – especially in women.
She told me at the start of the appointment that she’d researched ADHD in women, and attended seminars. This was a huge relief; I’d worried about having to convince someone of my problems.
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- Likely to be less hyperactive than male counterparts – often daydreaming/spacing out instead
- Severity of symptoms affected by estrogen levels – this means an increase in severity at puberty, while boys often see a decrease
- Introversion more common than in boys/men
- Often better at hiding symptoms (due to societal expectations)
- More likely to present with co-existing (comorbid) conditions or symptoms like eating disorders, hair pulling, skin picking
- More likely to display OCD-like symptoms
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Dr. E looked at the questionnaires and gave me a couple more to fill out
We then talked about all kinds of things – but the focus was on how my symptoms have affected my life. The topics included:
- School (my track record with homework, grades etc.)
- Socialising (any issues with friendships or bullying)
- Relationships (problems caused by my disorganisation, forgetfulness and low self esteem)
- Work (slow progression in career due to bad focus and motivation)
- Substance abuse (in my case, alcoholism – was I self-medicating? Spoiler alert: yes.)
The appointment lasted two hours, but it flew by. I enjoy talking about myself.
I was more honest with Dr. E than I have been with anyone. I owned up to lies about work and my past that I still maintain in ‘real life’.
I’d done a better job of preparing emotionally for this appointment, so I only cried once. Oddly, this was when I told Dr. E about my lost ability to read books.
I used to be the wriggliest book worm you could hope to meet; but the ability to focus had faded, inexplicably, after I stopped drinking. My theory is that alcohol switched off the distracting parts of my brain. Whatever it is, I find it deeply upsetting. (The point of that tangent is to illustrate the surprising things that might smack you between the emotional eyeballs during diagnosis.)
Verdict; and ADHD medication
Dr. E agreed with the nurse: I was a textbook case of undiagnosed ADHD in women. Every bullet point of my past and present showed it.
At this point, I asked about treatment. I was tentative when I brought up medication; wary of coming across as a drug-seeker, especially given my history with booze.
As it happened, I needn’t have worried. Dr. E would have suggested meds as my first option, given the impact of my symptoms.
I received a prescription for Elvanse (known as Vyvanse in the US). Much, much more on that in other posts.
Post script
I want to stress again that I was really bloody lucky through this process.
I saw understanding, sympathetic and knowledgeable medical professionals. I ‘only’ had to wait a couple of months between appointments.
I’m afraid to say that your mileage may vary considerably.
If there’s anything I’ve left out from this overview, please let me know. I will try to answer any questions. I know how much easier this all is if you’re given the chance to prepare.
[su_box title=”Further Reading” style=”soft” box_color=”#ec7935″]
- Symptoms: Attention deficit hyperactivity disorder (ADHD) (NHS)
- FAQs (AADD-UK)
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