ADHD - what is best practice for diagnosis?

[bibblebobblebubble]

DS is 9 years old and we've wondered on and off through the years about ADHD. He is having real difficulties focusing at school and has some characteristics typical of ADHD - very impulsive, fidgety, highly energetic, difficulties focusing on one thing for any period of time, can't sit still and quiet in class, can't stand in line at school, and (most recently) some dishonest behaviour also.

We want to get him assessed and willing to pay privately but I am so confused about (1) what medical specialist we should look for - psychiatrist, psychologist, or both together (2) best practice for diagnosis - I've seen a range from a single 1.5 hour meeting, to a series of questionnaires, meetings, and an observation in school. I've even looked at NICE guidance but it's very vague.

Any help would be massively appreciated, and any names of specialists especially so (we are in London).

[Waitingforsleep]

We have been to see dr keen on Harley street- she has a website. She still works for the NHS and as such her report is take. Seriously.
I'm not sure about the best practice bit?
We had lots o reports from different people ep, ot etc that she had before hand and we them spent 2 hours with her..

[FJCE83]

We opted to pay privately as the wait on the NHS was 2 years! We searched for a child Psychiatrist local to us and were offered an appointment within 2 weeks.

We spoke over the phone first where we outlined our concerns, from this he felt that we would benefit from an assessment. Initial appointment was around 1.5hrs where he took a detailed history. We were then sent a set of questionnaires to fill in and the school were also sent some to compete. We didn't see a psychologist and no school observations were needed. Once the questionnaires were competed we went back to get the results (ADHD confirmed) At this appointment we were offered medication which we had already decided to accept as our boy was really struggling at school. We now have to go back every few months for a check up and medication review.

I don't think there is a best practice if you go privately, best to see what's out there and go with what feels right for you.

Schools input have been vital as there results matched our own which helped with the diagnosis. If you haven't already I would maybe arrange a meeting with the teacher and/or the school SENCO to see if they will cooperate. We did ask them to draft a letter outlining there concerns as well to pass on to the psychiatrist, he did also request a referral from our GP to.

Hope that helps

[LiefievdM]

These are the NICE guidelines that deal ADHD diagnosis: (1.3 in specific deals with diagnostic process and criteria) www.nice.org.uk/guidance/cg72/chapter/Recommendations#diagnosis-of-adhd

They are very much evidence based and aim to guide professionals to what is best practise based on evidence. The diagnostic criteria etc mentioned are international standards and even private professionals should be following these really.

[LiefievdM]

Sorry, I know you mentioned reading the guidelines, but I thought I should point out 1.3 which seems quite specific. I know I have personally sometimes been lost in those NICE guidelines.

[bibblebobblebubble]

Thanks for this, I am reading more and starting to get my head around it. Sounds like there need to be structured questionnaires for us and school, and then at least one and maybe more long appointments to go through the history. Was wondering about whether a school visit necessary but sounds like probably not. Does the same person also then advise afterwards on medication, and do all the follow-up i.e. checking on how medication is working? Or does that pass back to the GP?

Thanks for the name of Dr Keen, looking at her website now.

[FJCE83]

We visit the psychiatrist every few months for a medication review and to check blood pressure, weight and height. He prescribed the medication and we had to pay for this private prescription for the fist few months, once he was happy with his progress our GP agreed to shared care, now any repeat prescriptions come for the GP. The GP can't alter/change the medication though so we occasionally have to pay for further prescriptions from the psychiatrist until the GP has been updated. So far we've had no issues

[LiefievdM]

I would say that it might be worth finding someone who also consilta for the NHS on ADHD diagnosis, because many NHS trusts (and LAs) won't accept private diagnoses. So if you were hoping to take your private diagnosis report to the GP and ask him to do the medication bit you might just be told to wait for an NHS diagnosis anyway. If it was done by an NHS HCP then they have less of a leg to stand on in this regard.

[LiefievdM]

*consulted not consilta