We all know that despite knowing for many years that ADHD often persists into adulthood, this fact, which is very obvious to sufferers, has only been generally accepted in psychiatric circles in the last ten years. As a result, services for adult ADHD are patchy or non-existent in most areas. Where they do exist waiting lists are typically very long, leading desperate people to feel that they have no choice but to go private.
Since ADHD is still regarded as a specialty within general psychiatry, such services as do exist are found within tertiary services – that is to access them a special referral is needed as the service sits one tier back from general “secondary” mental health services – those offering treatment for most other conditions. I argue that these tertiary ADHD services are effectively ivory towers, walls behind which teams are completely isolated from the scale of the problem of undiagnosed ADHD and the suffering which not being diagnosed brings.
I am lucky enough to be able to divide my time between a tertiary ADHD team (half a day per week) and a general frontline psychiatry service (the rest of the week). Since starting in this post just over two years ago, I have diagnosed over 400 people referred by their GPs for resistant depression, anxiety disorders, inability to cope or keep a job, mood swings, anger outbursts and many other conditions. I am lucky enough to screen the referrals and I have learned which ones to send to my clinic and which to send to colleagues who are not so ADHD aware.
Diagnosing and treating ADHD generally is an absolute delight after my years of seeing patients with other conditions which can often respond slowly or poorly to accepted treatments. By contrast many of my patients with ADHD leave after the first consultation with huge smiles on their faces, and dawning hope and realization that the pattern of difficulties in their lives can be put down not to laziness or stupidity but to a genuine and highly treatable neurobiological difference. Anyone who doesn’t think that ADHD medication in adults is genuinely miraculous for many many people should come and spend a day in my clinic. Or talk to patients…Or do anything but sit back in some location far removed from any actual patients and theorise….
And diagnosing ADHD in someone who hasn’t already made this jump, someone I know would be diagnosed with bipolar 2, anxiety, recurrent depression, personality disorder etc if they saw a colleague..is the most amazing and rewarding experience of my long clinical life. Seeing them get better, get their self respect back and walk out of the clinic with their heads held high is something I don’t think I will ever tire of.
But why am I the only ADHD specialist I know who works like this in the front line where the patients without the ?ADHD label are seen? What a dreadful waste – both of the scarce NHS resources used to (mis) treat those misdiagnosed cases….and the lives and hopes of those people for whom the journey and the outcome could be so much better?