Child Psychiatry – ADHD (Attention Deficit Hyperactivity Disorder)

You will be seen by highly qualified and experienced professionals (Consultant Child Psychiatrist or Consultant Developmental Paediatrician) who have worked in the NHS for many years. The assessment process is robust and follows NICE (National Institute of Clinical Excellence) guidelines. At MUMS assessments take place face to face. The doctor will be able to observe your child in clinic, which leads to a higher quality assessment. Prices at MUMS are competitive and the ongoing cost for treatment is low. Please see How much is the cost of private ADHD assessment and treatment for factors to consider.

Prior to the appointment you will be sent free text and ADHD screening questionnaires that should be filled in by parents and school. Information from an educational setting is important as symptoms of ADHD need to be present at home and at school to make a diagnosis. These questionnaires will be reviewed prior to the appointment and the doctor may contact you before the appointment if there are any questions. The appointment needs to be attended by the child and at least one parent. For younger children or those who struggle to sit still for long it is best if you bring a second adult, who can look after the child while the parent talks to the doctor undisturbed. Sometimes parents are also seen without the child for part of the assessment to discuss concerns that they do not wish to talk about in the presence of their child. During the appointment you will be asked about ADHD symptoms. You will also talk about your child’s development, overall functioning, and the family. The aim is to do a holistic assessment of your child’s difficulties, decide whether a diagnosis is appropriate and identify contributing factors. The doctor also screens for other developmental disorders (like autism) and may make recommendations for further assessments if required.

The symptoms of ADHD in children and teenagers are usually noticeable before the age of 6 and need to be present before the age of 12. They are pervasive and need to be apparent in more than one setting, such as at home and at school. Children may have symptoms of both inattentiveness and hyperactivity and impulsiveness, or just be inattentive. Pure hyperactivity is very rare. Inattentiveness • having a short attention span, for example when reading or watching a film • making careless mistakes – for example, in schoolwork • daydreaming and not listening in conversations • struggling to follow instructions, especially if they have several steps • having difficulty organising tasks, for example packing schoolbags • avoiding tasks that need concentration like homework • losing things • getting distracted easily • appearing forgetful Hyperactivity and impulsiveness • being unable to sit still, getting up when supposed to sit down • constantly fidgeting • excessive physical movement • excessive talking • being generally quite loud • being unable to wait their turn • acting without thinking • interrupting conversations • little or no sense of danger

Many children and teenagers with ADHD also have signs of other problems or conditions, for example • anxiety, children may worry as they know they struggle with daily demands, • oppositional behaviour at home and at school • anti-social behaviour and drug use, mainly in older teenagers • low mood, depression, and problems with emotional regulation • sleep problems • autistic spectrum disorders • dyspraxia, co-ordination difficulties • tic disorders • learning difficulties, for example dyslexia

The cost of an ADHD service varies significantly between providers. It is important that you check not only the price of the initial assessment but also how much is charged for medication initiation, titration, and monitoring. In addition the cost of repeat prescriptions varies widely (you will need one every month). Some providers will also offer shared care with your GP (this means the GP takes over prescribing while the specialist does the monitoring of the medication). However not all GPs are happy to enter into shared care with private providers. At MUMS treatment costs are comparatively low and we offer shared care if there is agreement from your GP.

ADHD symptoms frequently continue from childhood through teenage years and into adulthood, with around 50-65% of children with ADHD experiencing symptoms as adults. This can affect academic achievement, work performance, relationships, substance abuse risk, and mental health. Adults with untreated ADHD are more likely to experience problems such as unemployment, lower socioeconomic status, legal issues, traffic accidents, difficulties maintaining relationships, and mood or anxiety disorders. Seeking diagnosis and following treatment plans can help mitigate these potential long-term consequences.

Effective treatments for ADHD include psycho-education and medication. Parent training and counselling or coaching can also be useful. Combining multiple approaches is often most beneficial. It is important that all adults looking after a child with ADHD have a good understanding of the condition and can support the child appropriately. Children and teenagers with ADHD need a lot of support. Medications such as stimulants can help relieve core ADHD symptoms like inattention, hyperactivity and impulsivity and also improve associated difficulties like oppositional behaviours, emotional regulation problems and anxiety. Medication effects and dosage need to be monitored and adjusted over time.

Sleep disorders occur more frequently with ADHD. Children and adults often struggle to fall asleep as their mind is always busy. They may also wake frequently at night. Some children with ADHD also get up very early and do not seem to need much sleep. Others are tired in the day. Teenagers frequently struggle to get up in the morning.