Adult ADHD
Perhaps you feel constantly restless, on the go all time and yet despite this, feel unfocussed and may feel forgetful. Perhaps this daytime restlessness continues at night, disturbing your sleep. Has sustaining your attention for any length of time always been a struggle and led you to feel exhausted by the effort? Perhaps you frequently feel impatient when needing to wait and you feel that your mood is not as stable as most other people.
Many of the above symptoms are normal in us all, but when they cause significant impairment and have persisted over time, they can cause distress, low self-esteem and affect relationships and hamper careers. They can also, worryingly, increase the risk of developing other psychiatric disorders, such as anxiety, depression and substance misuse problems. Furthermore, there are also other psychiatric conditions which commonly co-exist, such as ASD (autistic spectrum disorder), dyslexia, OCD (obsessive compulsive disorder).
Please do not suffer unnecessarily, as comprehensive assessment and treatment can significantly improve your quality of life.
Assessment
My ADHD assessment is a detailed and comprehensive and takes approximately 2 hours (sometimes a little more). This is needed for a detailed general psychiatric assessment, detailed assessment of ADHD symptoms and impairment (I use the DIVA assessment tool) and time is needed to obtain a collateral history from someone who knows you well – ideally a parent (as they will recall childhood symptoms), but where not possible, a partner or longstanding friend can help; I would ask you bring them where possible, or where not possible, please provide me with details of whom I can contact to obtain collateral history, please do get their consent for this. Old school reports can also be very helpful. I’ll then set out a detailed plan and advise on the next steps. Where I diagnose ADHD I will give you a holistic plan which will include the option of medication titration, if you wish. Where I advise that ADHD is not the correct diagnosis, I will provide a comprehensive assessment and advice on treatment of other conditions that I may identify.
Treatment
Treatment of ADHD requires a holistic approach, including not only medication, but developing an understanding of the disorder, developing strategies and techniques to support you. Medication has the strongest evidence for effectiveness and requires specialist initiation, which I am able to provide. I recommend that prior to assessment that you contact your GP for a referral, as is usual for all my patients. This becomes particularly important as it is your GP’s choice as to whether to agree to share care with a specialist once ADHD medication is titrated to its optimum dose and is stable and so an early collaborative approach is best; I’m very happy to discuss shared care with GPs as a matter of routine. If your GP did not agree to share care, I could still continue to provide private prescriptions for you, but this is more expensive for you.
Further investigations
Occasionally further investigations such as an ECG may be required. Where this is the case, you will have the option of obtaining that from your GP or conveniently from the Wellbeing Clinic privately.
Shared Care
Shared Care describes an arrangement for prescribing between a specialist (such as myself) and a GP. It’s necessary for a number of medications, and Adult ADHD medications are one of those indications, as these are controlled drugs.
A specialist commences and titrates (adjusts) the medication until the dose is stable. Thereafter, GPs can prescribe the medications, providing they agree with the shared care (this is at their discretion). As part of this agreement for ADHD, a specialist review is needed at least once a year. A GP review is needed at 6 months, to include a review of weight, pulse and blood pressure, so providing all is stable, you would need to see your GP once a year, and myself or another specialist once a year (6 months after your GP, to facilitate monitoring of your physical observations).
I do recommend you contact your GP if you are considering ADHD assessment to ask if they would be willing to later share care after titration of medication, if applicable. It may be helpful to provide your GP with my website address (www.drmikeskelton.co.uk) so they can assure themselves of my high quality standards, which includes a high level of experience as an NHS general psychiatric consultant, which I continue and also that I work as a consultant psychiatrist in a specialist NHS Adult ADHD service in Nottingham. They are welcome to contact me if they’d like to ask me questions. Please note that if your GP does not take over prescribing, that you will be liable for the cost of private prescriptions yourself.
Titration of medication
Management of ADHD undoubtedly requires a holistic approach, addressing areas such as sleep, structure, work and relationships. Medication has a very high level of evidence of helping people in a number of areas of ADHD.
The medications that are recommended first line by NICE (the National Institute for Clinical Excellence) for Adult ADHD are methylphenidate and lisdexamfetamine. Both are stimulant medicines (and are Controlled Drugs) and require a specialist such as myself to carefully initiate and titrate to a stable dose. This process takes approximately 3-6 months and depends on the person’s response to the medication as well as other factors such as pre-existing physical and mental health co-morbidities. Occassionally, some people cannot tolerate these medicines well or respond well to them and another medication, called atomoxetine is available.
I ask that you obtain a blood pressure machine which can display blood pressure and pulse (I recommend Omron which are used medically and can be found for approximately £30) as you will need to provide this information whenever I change your dose, as part of required monitoring. I will obtain your baseline weight and this will need monitoring at 6 monthly intervals, as will blood pressure and heart rate.
Fees
Adult ADHD comprehensive assessment: £1,199. This takes approximately 2 hours, includes a general psychiatry assessment, screening for comorbid conditions (e.g. OCD, Tic Disorders etc), taking a collateral history from someone who ideally knew you as a child. Where I diagnose ADHD, I give helpful advice to understand the condition and immediate psychosocial (non medication) actions you can take. This doesn’t include commencement of medication, which when appropriate, is done at a separate medication appointment.
Initial medication appointment: £199. This includes initial private prescription to commence ADHD treatment titration.
Followup medication appointment: £199. Monthly followups are required during initial titration; I aim to help you achieve your stable dose as safely and quickly as possible. Approximately 3-6 appointments may be needed, but this can vary (and is difficult to predict), depending on response, potential side effects and co-morbid (other) conditions.
Private prescription (outside of an appointment): £39. Physical observations (blood pressure, heart rate and weight where indicated) to be provided by you please, prior.
To take over care and titrate medication where ADHD has already been diagnosed elsewhere (and there is an existing report): £799. Please note that I will need to have reviewed the prior assessment first and be in agreement with the diagnosis. Where this is not the case, I will advise a full assessment be repeated, at a fee of £1,199.
Mandatory annual review as part of shared care with your GP: £199.
