ADHD: the trouble with diagnosis

A BBC Panorama investigation has sparked debate for suggesting that ADHD assessments undertaken at private clinics are “rushed” and unreliable”.

An undercover reporter working for the BBC underwent assessments at three private clinics, each of which diagnosed him with attention deficit hyperactivity disorder, a neurodevelopmental condition commonly referred to as ADHD.

But he was found not to have the condition after undergoing a “more detailed, in-person NHS assessment”, reported the BBC.

Subscribe to The Week

Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.

SUBSCRIBE & SAVE

Sign up for The Week's Free Newsletters

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

Sign up

The investigation found that the private assessment clinics were carrying out “only limited mental health assessments of patients” and that “powerful drugs were prescribed for long-term use, without advice on possible serious side effects or proper consideration of patients’ medical history”.

The findings of the investigation have sparked debate online, with some questioning the reporting methods used in the investigation, while others feared this could add further stigma to those seeking assessment or treatment for neurodiverse conditions and disorders.

Are ADHD diagnoses on the rise?

NHS Business Services Authority data shows that 646,000 ADHD-medication prescriptions were issued between October and December 2022, a 69% increase since 2017/18, said Pulse. The health professionals magazine quoted one GP who “said the figures matched what they were seeing in practice”.

But prescription totals do not include people with ADHD who don’t use medication, said Dr Tony Lloyd, the chief executive of the ADHD Foundation. He told The Guardian that his charity’s own figures suggested a 400% increase in adults seeking a diagnosis since 2020.

Content about ADHD symptoms and criteria are hugely popular on social media sites at the moment, with posts made using the hashtag ADHD garnering almost 25 billion views on TikTok, while celebrities such as Johnny Vegas and Sue Perkins, both diagnosed as having ADHD, have also raised awareness.

Medical journal The Lancet said the average global prevalence of ADHD is around 5% – meaning that some 2.6 million people in the UK could have the condition, including 1.9 million adults.

But according to Lloyd, “ADHD remains significantly under-diagnosed and under-treated in the UK – at great cost to public services and to the individual and the workforce.”

How long does it take to get a diagnosis on the NHS?

ADHD services on the NHS have been “swamped” as more people seek a diagnosis, experts told The Guardian in January, with clinicians worried that long waiting times and a “dearth of clinical awareness” could be leaving those awaiting a diagnosis in a “perilous position”.

“I think it’s probably as big a year as we’ve ever had. We are seeing a lot more people from all walks of life seeking a diagnosis later in life, particularly women,” Dr Max Davie, a consultant paediatrician and co-founder of ADHD UK, told the paper. “At the same time waiting lists have gone through the roof. NHS services have been swamped for a while and private providers are also closing their lists – there are wildly inadequate services for ADHD diagnosis, particularly for adults.”

Knowing exactly how long people are waiting in the UK for an ADHD diagnosis is “difficult to establish”, added the paper, partly because current clinical guidelines do not recommend a maximum waiting time, and because data on the number of people waiting for a diagnosis is not collected nationally.

New analysis suggests that “800,000 people with undiagnosed ADHD may be left waiting more than a year for a diagnosis”, said Sky News.

Charlotte Colombo, a journalist writing for Stylist magazine, was told by her GP she could be left waiting five years for an assessment.

How is ADHD diagnosed?

While a set of “strict criteria” is used to diagnose ADHD in children, the condition can be more difficult to diagnose in adults as there is “some disagreement about whether the list of symptoms used to diagnose children and teenagers also applies to adults”, according to the NHS.

But in some cases, adults will be diagnosed with ADHD if they have five or more symptoms of inattentiveness, or five or more of hyperactivity and impulsiveness, listed in the diagnostic criteria for children with ADHD.

Why was the BBC investigation controversial?

It is exactly because of these “extraordinarily long NHS waiting times” that many in the UK have had to “go private for ADHD assessments”, wrote James Bloodworth in The Times. The Panorama investigation “provides important scrutiny” of the growing private healthcare industry in the UK, he added.

In some states of the US, for example, “nearly 20% of children have been diagnosed with ADHD”, continued Bloodworth, offering a “cautionary tale as to how profit-based healthcare can incentivise the over-medicalisation of society”.

The Guardian’s Robyn Vinter wrote on social media that she was “surprised by the criticism” of the investigation as “patients deserve a thorough assessment with a clinical psychologist that rules out other neurological conditions and mental health problems as the cause of their symptoms..

Journalist Diyora Shadijanova, however, argued that the investigation had failed to adequately grapple with the “core issue”, namely that the “chronic underfunding of the NHS” meant that the wait for an ADHD assessment was now years long.

And former BBC journalist Sophia Smith Galer suggested the investigation would have done better to focus on the “lengths families have had to go to fund private diagnoses & treatment for *real* experiences of ADHD because of lengthy waiting lists”.

Many online also questioned the journalistic methods used to report on the private assessments, noting that the conditions the undercover reporter was assessed under “were different for the private clinics compared to the NHS”, said HuffPost.

A BBC spokesperson speaking to the news site said the Panorama investigation “makes clear that ADHD is a recognised condition affecting many adults and it highlights the long waits for assessment and treatment on the NHS in some areas.

They added: “It is an investigation into the way some private clinics diagnose and prescribe ADHD medication following assessments conducted over online video calls. Panorama’s research has uncovered serious failings by some clinics and we think there is a clear public interest in broadcasting the findings.

“We will be reflecting serious concerns that have been raised by clinicians specialising in this field as well as individuals who have been diagnosed with ADHD.”