Have you decided to receive a formal diagnosis of ADHD, but you aren’t sure where to begin? If so, I hope this guide will help!
I’ve created this overview of the different steps towards receiving an adult ADHD diagnosis as a guide towards helping you on your way, and I’ve also provided various links to provide more in-depth information.
Please note that not everyone’s diagnosis journey will involve the exact steps.
The full ADHD assessment process takes place over these 6 steps:
1. Do Your Homework
ADHD screening tools/rating scales are forms that you fill in and based on the ratings, will gauge the severity of various symptoms associated with ADHD. They are useful tools to help you understand how the different associated symptoms impact you daily, and based on how you’ve answered each question, they can be used as a guide as to whether or not you have ADHD.
Please note that these scales are used as a guide– only a qualified practitioner can fully diagnose someone with ADHD.
There are many different quizzes you can take online to explore, and I have listed below some of the most common screening tools for ADHD in adults:
- Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist- link from ADD.org (18 questions based on the most consistent symptoms of ADHD)
- ADHD Rating Scale IV (ADHD-RS-IV) With Adult Prompts- link from QandADHD.com (18 questions based on criteria from the DSM-5 which rates the severity of ADHD symptoms covering inattentive and hyperactive-impulsive presentations)
- Adult ADHD Clinical Diagnostic Scale (ACDS) v1.2- link from Harvard.edu (6 questions designed for quick screening for identifying ADHD in adults)
- Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults (Consists of 40 questions covering various common symptom areas by severity)- Unable to find link online.
For access to more rating scales, UKAAN (The UK Adult ADHD Network) have provided free forms at the bottom of this page.
Once you’ve printed out your screening tools and filled them out, place them in a binder or folder so they are all in the same place, ready to present to your GP.
Start journaling your ADHD diagnostic journey:
Writing a journal will help give your GP and ADHD consultant a window into your daily struggles with ADHD.
Here are a few ideas to get you started:
Check your symptoms:
Everyone’s ADHD will present differently. Women and AFAB individuals may experience ADHD symptoms differently from men, and children may present differently from adults.
There’s also the additional question as to how heavily some people have masked their symptoms which will affect how they present outwardly.
Finally, there are also three different ADHD subtypes/presentations: inattentive, hyperactive-impulsive, and combined (which means a blend of both inattentive and hyperactive-impulsive presentations). You may experience symptoms in one or more of these presentations, or shift between them.
The Paediatric Oncall website has provided a form based on the DSM-5 Criteria for ADHD. You can place a tick beside the symptoms that you experience, and when the form is completed, it will inform you as to whether or not you meet the DSM-5 diagnostic criteria, and what presentation you may fall under.
AADD-UK have provided an extensive list of symptoms that are worth a look.
Outside of the DSM-5 criteria, some symptoms have been reported frequently by those who have ADHD, such as:
Once you’ve identified which symptoms you mostly experience, it’s time to consider how they present for you in the present, and your past. You can use the questions in the screening tools as prompts to write down in your journal as a timeline, or as a list.
You can ask your family for examples if you feel comfortable doing so, they may be able to provide additional information.
The more examples of how the symptoms hinder your day-to-day life since childhood that you can provide will help your GP and consultant in giving you the correct diagnosis.
2. Ask Your GP for a Referral to an ADHD Assessment Service
Once you’ve done your research, your rating scales, your journal, and your timeline/list of your symptoms, it’s time to book an appointment with your GP if you’re opting to go the NHS route, or funded by NHS’s Right to Choose.
What is the NHS Right to Choose?
If you live in England and you need specialist care, you may be eligible to choose which specialist provider you wish to go to depending on if the specialist care provider is available via Right to Choose, and your eligibility.
(I believe currently Right to Choose is only available to residents in England. Different rules may apply for Scotland, Northern Ireland, and Wales).
The only way you can get a referral through the NHS route or Right to Choose is via a letter of referral from your GP.
If you want to go the NHS route, there is a high possibility that the waiting list will be quite long, depending on where you may be in the UK.
If you want to go the private route using the NHS Right to Choose, check out this guide at ADHD UK. There is also a list of providers who accept Right to Choose, and a letter explaining the Right to Choose and your rights as a patient under NHS England that you can print, fill out, and give to your GP.
When you’re looking for a private assessment provider for Right to Choose, make sure they accept Right to Choose referrals. Do additional research by asking the ADHD community for their input and experiences, this will give you a better idea of what’s available so you can decide which practitioner is best for you.
When you’re speaking to your GP, be open and honest about how you’re feeling. Show them your research and screening tools results. Finally, ask them to refer you to whichever ADHD private assessor you’ve decided to pick.
Hopefully, at this point, they will be happy to write you the required referral letter, and you’ll be on the waiting list for an assessment.
If you want to go the private route (without Right to Choose), you’ll have the option to shop around to find a private psychiatric service that you feel the most comfortable with. As mentioned above, check out the ADHD community for reviews based on their own experiences.
You do not need to seek a referral from your GP if you plan on going privately and paying the fee yourself without NHS Right to Choose funding.
3. Wait for Your Assessment
If you have a long wait ahead of you, I can understand it is a struggle.
You’ve discovered the possible reason why your life has felt so difficult, and now you just want to know the result.
This quote I found to be extremely helpful, especially when dealing with imposter syndrome, which leads to thoughts such as “do I have ADHD or is it all in my imagination?” or, “what if the consultant doesn’t believe me?”
This is the perfect time to lean on the ADHD community for support, advice, and to share how you’re feeling.
There also are many helpful books and articles you can read to learn as much as you can about living with ADHD.
It’s also important to know that you don’t need an ADHD diagnosis to seek the additional support of a counsellor who specialises in ADHD, or an ADHD coach.
4. The Assessment Process
The day of your assessment is here! What should you expect to happen at your assessment?
Depending on the service you’ve selected, you may be attending a face-to-face assessment or a meeting over a video conference call similar to Zoom.
Make sure you have your notes and don’t forget to add any questions you might have for the consultant.
The consultant will ask you questions about your day-to-day life, your work, your childhood, your relationships, and your symptoms.
These questions will mostly be connected to the screening tools you’ve already answered, so if you’ve already explored your symptoms and how they present for you now and as a child, you’re already prepared.
You might also want to take the opportunity to discuss how some of the additional symptoms affect you, such as rejection sensitivity dysphoria, emotional dysregulation, etc.
Don’t worry too much if you’re concerned that you may be masking, the consultant is well versed in identifying this. If you have ADHD, they will be able to tell.
In many cases, you’ll receive the diagnosis on the same day, and the consultant will discuss a recommended medication treatment plan for you.
In many cases, you’ll receive the diagnosis on the same day, and the consultant will discuss a recommended medication treatment plan for you.
Not everyone will be recommended medication for various reasons, and if this applies to you, your consultant may recommend different therapy options that are available instead of medication.
If medication is recommended, the next step will be titration.
5. Titration
Titration refers to the process of introducing medication to the patient over a period to find the correct dosage. Medication is normally prescribed at a low dose and increased slowly to find the optimum dosage for you.
Depending on how the assessment service works, you may be working with a consultant or a nurse who specialises in ADHD medication, and they will discuss with you the different options available, and you can decide together the best way forward.
You may end up being prescribed that very day or go on a waiting list for titration. This can be quite common as currently there is a high demand for diagnosis and treatment.
Stimulants are normally the first type of medication offered to adults unless there is a reason why they may not be suitable.
Here is a list of the most commonly distributed ADHD medication used in the UK, and their brand names:
The NHS website has information on the different types of medication that are available in the UK, with some of their most common side effects.
The titration period lasts as long as it needs to, and it can vary from weeks to months.
Some may find the first medication to be the right one for them, others may need to try various medications and dosages to find what works best for them.
It will take time, but you will have support from your consultant or titration nurse every step of the way until you find what works best for you.
Keep track of how you’re feeling on your medication daily in your journal so you can provide a clear picture of how your symptoms are affected, and if you have any side effects that need monitoring.
Once your titration nurse and consultant are satisfied that you are stable on your medication (helping your ADHD without intolerable side effects), your medication will be issued by your surgery, and you’ll attend a review to make sure everything is still going well.
6. GP Shared and Full Care
Shared care is an agreement between the consultant and your GP. The medication you’ve been taking will now be prescribed by your GP, and further monitoring will also be arranged by your GP. Reviews may still be carried out by your consultant or titration nurse, depending on the individual provider.
Here is an example of a shared care protocol for ADHD, and here is an overall shared care agreement (yours may differ).
After an agreed period, there may be a final consultation leading to an agreement for your GP surgery to take over full care.
Thanks for reading, I hope it’s been helpful. Get in touch if you have any questions or comments, and best of luck on your diagnosis journey!
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Other Links on the Topic:
Getting an NHS ADHD diagnosis (ADHD Aware)
ADHD Rating Scales: What You Need to Know (Healthline)
