This has long been recognised in children and adolescents but there remains relatively inconsistent medical help available in the UK for adults. These are either people who had the diagnosis in childhood and symptoms are persisting (perhaps in a somewhat different form into adulthood), or in whom the diagnosis was not made in childhood but subsequent problems have emerged in adult life or other family members have recently been diagnosed and they recognise similar symptoms in themselves.
Often people have been diagnosed overseas and are needing to have the diagnosis confirmed in the UK and to ensure continuity of supply of medication. This is an area of specific expertise, with up-to-date knowledge of the drugs available in the UK and their US or European equivalents and experience of switching safely from one to another.
Dr Woolley is also able to prescribe the ‘controlled drugs’ sometimes used in ADHD treatment on a private basis and liaise with general practitioners (GPs) to help negotiate the possibility of getting ongoing prescriptions via the NHS once the medication and dose is established and stable.
The assessment
There is no single test for ADHD, and no specific blood test. A proper thorough diagnostic assessment with a structured interview, ideally assisted by a family member such as a parent, provides the best guide. This can sometimes be a lengthy process, but assisted if there are previous clinical letters, school reports etc to provide additional background. Typically a new patient assessment would take about 1 hour, followed by some additional questionnaires to complete at home and a subsequent followup appointment to review the results of these and decide on treatment options. Due to the concentration and attention difficulties often present in ADHD, we find that splitting up the assessment like this is more likely to provide useful information that attempting to complete it all in one long appointment, but if you have other requirements to split or combine the elements of the assessment in another way please do not hesitate to get in touch and we can be flexible around your needs.
The interview will be used to ask you about the presence of ADHD symptoms that you experienced during your childhood and adulthood. During this process we will try to find examples of each of the common symptoms that may be present in ADHD, so it can be helpful to have a think of some of the main ways in which it affects you in advance - both as an adult and in childhood. First of all you will be asked questions and then your partner and other family members (if present) will be asked the same questions. Your partner will most likely have known you only since adulthood and will be asked questions about the period of your life that he or she knew you for; your family will have a better idea of your behaviour during childhood. Both stages of your life need to be investigated in order to be able to establish the diagnosis of ADHD.
Additional medical investigations such as a blood test and heart tracing (ECG) may be suggested depending on treatment plan and medical history, and can be done as part of the assessment process.
Please do get in touch with any other queries or requirements.
New research findings…
Positive effect of stimulant medication for ADHD
The abnormal brain structure of Attention Deficit Hyperactivity Disorder (ADHD) patients may be repaired by long-term stimulant medication, according to a new meta-analysis of structural imaging studies. The research, from the Institute of Psychiatry (IoP) at King’s College London, was published in the American Journal of Psychiatry.
The review looked at 14 structural neuro-imaging studies of 378 ADHD patients and 344 healthy individuals and found that ADHD patients have a lower volume of gray matter in a particular area of the brain, the basal ganglia, compared to healthy individuals. The basal ganglia are responsible for modulating behaviour, motor activity, self-control and attention, all of which are typically affected in ADHD.
The research also found that patients who had received long-term stimulant medication to treat ADHD did not show this abnormal brain structure, but had similar brains to healthy individuals.
Stimulant medication is the most common treatment for ADHD and is effective in about 70% of cases. However, patients, parents and professionals have previously expressed concern about the potential long-term effects of prescribing stimulant medication to young people whose brains are still developing.
Prof Rubia says: ‘What we’re beginning to see from these findings is that stimulant medication, commonly believed to have negative effects on long-term brain development, may in fact promote repair in the regions of the brain damaged by ADHD. These are very exciting findings, and merit further research in order to confirm the exact effects of these drugs.’
The research also found that the volume of the basal ganglia returned to normal with age whether or not the patient was taking medication, suggesting that children with ADHD may grow out of structural abnormalities in the basal ganglia.
For full paper: Nakao et al., (2011), 'Gray matter volume abnormalities in ADHD: vocel-based meta-analysis exploring the effects of age and stimulant medication', American Journal of Psychiatry doi:10.1176/appi.ajp.2011.11020281
“15 tips to help yourself”
Adapted from 50 tips by American psychiatrist Ed Hallowell in “Driven to Distraction”
- tell people: but don’t use the diagnosis as an “excuse”
- ask for help from your friends and family: but say exactly what you need
- get feedback about how you affect others: and ask for feedback about when you do things well
- use structure and prioritise: lists, notes, colour coding, reminders, planning, breaking down goals into manageable tasks
- reward yourself when things go well: (or don’t go too badly!)
- respond to boring tasks quickly: “OHIO” = only handle it once
- accept that some things are just difficult: so it doesn’t get you down
- plan difficult encounters: anticipate problems
- use what helps you concentrate: music, silence, something to “fiddle with” in your hands
- have “blow-out time” or “time outs”: gym, dancing, running
- don’t beat yourself up
- join a support group: (or start one!)
- learn to tolerate your moods (without panicking or catastrophising): NOT “I’m hopeless” or “I never manage to…”
- find friends who are good for you: and spend time with them
- be proud of yourself: yes really…you’re trying to make things better…