ADHD: underdiagnosed v overdiagnosed - has the pendulum swung too far the other way?

As the demand for ADHD diagnosis consultations rises, many are turning to expensive private clinics for help - but investigative journalists have uncovered a scary trend in overdiagnosis and over prescription of medication

Experts working in neurodiversity have long lamented the underdiagnosis of conditions such as ADHD. Women, especially, have slipped below the radar due to the manifestation of ADHD often being very different in the female population than in the male one. Yet, with the rise of TikTok and other social media platforms with their attention-grabbing ‘do you have ADHD?’ clips and quizzes, people are increasingly clamoring for a diagnosis. 

Waiting for a diagnosis

Such is the demand that healthcare practitioners are struggling to cope with the workload, and waiting lists are often stretching into years. One doctor in the UK’s NHS pointed to a twenty-fold increase in people asking for ADHD diagnosis appointments in the last few years. 

So, an inevitable result of this zeal for a diagnosis has been the rise of private clinics offering ADHD assessments and medication prescriptions. Unfortunately, many of these clinics seem to focus on their services' money-making potential rather than on their client’s well-being. It is particularly worrying that there are no official guidelines for diagnosing ADHD in adults in the US. And even though the European Union, Canada, Australia, and the UK (such as the NICE recommendations) do have guidelines, many clinics don’t seem to be following best practices. This has left patients paying for assessments out of pocket, often with a hefty bill, and - much worse - potentially with a script for a medication that could worsen an existing mental health condition.

Relaxed regulations

Moreover, it seems like the COVID pandemic has also inspired a lot of people to reach out for help. Because regulations were relaxed during the lockdowns regarding telemedicine to allow practitioners to issue prescriptions via Zoom, this has resulted in an explosion of people taking ADHD medication.

"I wasn't someone who was struggling with their mental health and needed help, I was just money to them.”  Casey

The BBC’s Panorama program recently went undercover in the UK to ascertain just how easy it is to get an ADHD diagnosis at a private clinic. Before embarking on the research, Rory Carson, the reporter, conducted a lengthy test with a leading NHS consultant psychiatrist who told him he didn't have ADHD.  Yet, when he approached three private clinics, the reporter was shocked to be given a rapid positive diagnosis and a prescription for medication. 

person sitting while using laptop computer and green stethoscope near

ADHD diagnosis consultations need to be carried out by a verified professional

Furthermore, the fact that the online consultations were often conducted in a quick, check-the-box kind of way also set alarm bells off for Rory. He was asked very few in-depth follow-up questions, nor was a psychiatric history taken. This would have revealed his unsuitability for specific medications, for example. Rory spoke to Casey, who had also been diagnosed rapidly at a private clinic. She had borrowed money to pay for the appointment, and was then disheartened to discover that her calls and emails to the clinic were often ignored after being diagnosed. "It was kind of like a diagnostic factory," she recalls.

How to get a proper ADHD diagnosis

So what should you do if you think you might have ADHD but can’t wait years for an appointment with your local healthcare provider? 

  • Do your research - don’t book an appointment with the first clinic you find - no matter how enticing their offer may seem.
  • Make sure the people at the clinic have a verifiable certification. Since the diagnosis of ADHD in adults is a relatively new process, it’s essential to find a qualified professional.
  • Be prepared for the appointment by writing down the reasons you think you have ADHD, your mental health history, any other mental health concerns you have, and any family mental health issues that you’re aware of.
  • If you get a positive diagnosis, schedule and keep follow-up appointments to make sure you have a treatment plan that works for you.
  • Consider talking with a specialized ADHD coach who can help you navigate the nuances of your own unique ADHD and help you with workable solutions for your symptoms.

The important thing is to take agency for your health. Only you know how your symptoms are affecting your life. If you feel you’re not beinyou’re not being listened to or your issues haven’t been solved, insist on seeing someone else. Your mental health is too precious to ignore.  

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