I run an ADHD/ASD assessment service

[Trolleydolly123]

As the title says, curious to hear questions/thoughts.

Yes and it’s 90% of THESE people who get a diagnosis.

Exactly. The group of women are all likely to have something as we move in packs. Even in level of attractiveness! And they would be of an age were ADHD was only being accepted in boys.

I can understand what you're saying. But I am 45 year old and have been told that she I ASD (the original referral) and during assessment, have been told that I has ADHD traits that need evaluation. Now, arguably, as a married woman who cares for several family members with SN, I am capable. However, that capability comes at high cost. An ADHD assessment might explain why, despite having Mensa levels of intelligence (assessed as having the intelligence of an 8 year old at age 4), I could never display that in a conventional way. It would explain why I sabotaged my education, never managing to organise my study files, writing essays from first look at books to hand in in 5 hours. It would explain why I was a good care assistant, but couldn't seem to get the finer details (such as organising my patient's belongings) right. It would explain why I found myself panicking in job roles and burning out suddenly, then feeling like I had to leave with little or no notice period. It would explain why everything everyone around me does seems so infuriatingly slow. I could go on.

Perhaps, if I had the opportunity for diagnosis and treatment, I would find life manageable. DD3 was diagnosed with ADHD a couple of months ago and the medication has transformed her ability to cope with life.

Why should we have to wait until we are hospital level unwell to be treated?

I totally agree that medication could be life changing for you and its awful its not quicker. But to answer your question 'why should we have to wait..' to put it crudely, because there is not enough resource to go round.

In terms of figures, NHS teams provide assessments of ASD (many hours of assessing with around 75% confirmed) and ADHD (shorter ax, 90% confirmed), provide prescribing, titration and reviews of meds, plus navigating meds shortages and change requests. Also transitions from CAMHs for both, liasion with other teams,advice and guidance to inpatients and screening referrals.

The average team in our entire regional area has figures like this:

Wait list has of 6000.

Referrals 200 to 300 per month, majority accepted.

Closed epsiodes of care around 250 per year. This is assessment complete, treatement complete, patient relocated or patient deceased.

Team of max 10 staff in a range of roles but all working on assessments or treatment. Remember no treatment for ASD.

This isnt 10 staff working all year either, there is leave, sickness, training, part time, maternity and vacancies in the pot.

I totally appreciate everyones want or need for dx is so valid for them, but this is not sustainable with these numbers.

It's worrying. I completely appreciate your viewpoint.

If private assessment was more financially accessible I wouldn't hesitate to go down that route for my DD as long as the assessment was accurate and couldn't be bought e.g. it was a true diagnosis and that any diagnosis would be recognised universally.

My 6 year old DD is struggling in school. The new school year is approaching. Her current teacher seems to have the measure of her however then it starts all over again and I am worried about it. Showing signs of adhd at home and autism at school. I feel like we need to know what it is to do our best by DD. I don't know enough about either to really ask for what I think will work for her. It's stressful. Those numbers are frightening.

Don’t you think we’ve lost sight of understanding personality types? Back in the day we all knew a weird John who chatted non stop about stamps, or space cadets like me and my daughter who just gaze off into space and talk to ourselves and create all these stories in our head, and Louis the boy who never stopped running or spinning. It makes me a bit sad, like we’re reducing everyone to two categories. And who the hell wants to think of themselves as NT? That’s like people identifying as ham sandwich, salted crisps and water meal deal people. Much more exciting to be ‘ND’.
Like with the trans thing, what so many people are yearning for is community and culture. White people want to be part of a special club.

Much more exciting to be ‘ND’

It’s really not though.
In reality ND can be extremely debilitating and limiting.
(Not sure what the inverted commas mean to convey?)

My tuppence-worth is that with life nowadays being so pressured and, with the rise of social media, so public, we've created a world that doesn't work for them and doesn't have space for them. There is this pressure on everyone to be perfect in a bland, beige, "cookie-cutter" kind of way, and it is very public and widespread due to social media. And schools nowadays have much less space and resources for those who previously would have been seen as "oddballs" in some way, and often having a diagnosis is the only way to access any resources or dispensations. Brenda the scatterbrain might have had her teachers exasperatedly eye-rolling her in 1990, but in 2025 she'll spend half her school life in isolation just for forgetting stuff and being disorganised unless her ADHD is picked up on.

@Sunnygreenbecause so many people have done some vague online assessments and declared themselves autistic or ADHD and they can’t really remember which they identified more with so just say ‘ND’. I hear it a lot!

there is not enough resource to go round.

This lack of staff is a political decision by successive Govts and it harms the the whole nation to wait until people are hospitalised or in prison before assessing and treating them. Nothing has improved since my first CAMHS referral over thirty years ago.

Being autistic doesn't always mean being unable to work.

Much more exciting to be ‘ND’.

For a value of "exciting" that means walking out of concerts half-way through because I can't cope with the lights and volume any more, melting down in the supermarket because they've moved the coffee, and being fired from two jobs.

Your ableism is appalling.

Yes. We live our lives in a panopticon made up of our peers with cameraphones, where any miss-step can become a viral, global amusement from which you can never escape. Conversations that were had in person, undocumented and soon forgotten, are now held via WhatsApp and can be screencapped and posted online, so your social errors can haunt you forever. Imagine the pressure that puts on someone who cannot understand the social rules.

At the same time, we are bombarded with stimuli online and offline. Billboards move that used to be static. Even lighting is brighter and bluer because of the shift from incandescent bulbs to LEDs. Life is harder to deal with across the board for ND people. ND people who coped forty years ago in a quieter, stiller world are disabled by their environment now, yet it requires a formal diagnosis to get one's school or employer to make the "reasonable adjustments" to the environment that the ND person needs.

A should be seen immediately by a medical assessment team. It seems like he needs this supported living placement and is so disabled he can't live independently (this seems open and shut)

B and her friends should read a book about ADHD coping strategies. GP should investigate other possible causes of symptoms (menopause/hormonal issue?) before assuming ADHD and should push back as OP is doing about how much a dx will really unlock ("it will be validating" should not be accepted. The GP can give whatever "permission" they feel they need to just do the things)

C should be advised to get a hobby. He might have very high-functioning ASD but a stamp collecting club or general support group for "retired professionals who feel antsy after stopping work" probably will contain several similarly-minded people anyway, instead of people like A who he has nothing in common with

D should be treated via some kind of dedicated psych support as part of the justice system. Similar to B, the professionals should evaluate his behaviour holistically (it sounds like his home life is shot to pieces) and consider other causes. I would guess his access to meds would probably be monitored/restricted in some way due to his background?

E should be told to read a self-help book and do anything he finds helpful, ignore bits he doesn't find helpful, and otherwise come back if he actually has a medical need

ducks

Just as well you're not responsible for making these decisions then isn't it.

@HistoryisadiscardedVHS my son has an ASD diagnosis but doesn’t like talking about it at all. He just wants to be ‘normal’ and fit in with the rest of his friends. He struggles with his school work. There’s nothing fun about it for him.

Needlessly antagonistic IMHO. It seems to me that most ‘NT’ people would come to a similar conclusion as @OneAmberFinch

How would you allocate finite resources ( and resources are always finite)? Pull names out of a hat?

Would people say this about treating depression or anxiety? We know what a huge impact that has on people's lives but we have moved on from people have never experienced depression or anxiety saying "just get over it" or "it's all in the mind" and not offering drugs or therapy. That's even been increased through iapt so it's easier to access. Still the MH service isn't briiant for those who aren't at the extremes ( low level easily helped by cbt or needing intense support) but it's recognised.

Not a perfect analogy but For NT people just to write off the struggles of the ND or reduce access to support is just wrong.

The way to deal with it should be a fair priority of need triage system?

I am sure people wouldn’t be happy to attend A and E with a suspected stroke/heart attack and wait to be after someone with a broken finger as they were there first. And ofc I’m not saying being ND is a broken finger, I’m using it as an example of triage and immediate risk.

Who is most at immediate risk: a teenager already involved in county lines FFS, risking prison or death - or an adult professional with a family and job? Would you seriously expect and be happy to “leapfrog”over a young person like that? I understand all too well the struggles and hiding in plain sight for xx years etc, but we need to be realistic about the system - it’s fucked and it’s overloaded. I’m not minimising the struggles people face as I know they’re debilitating/disabling (whatever choice of words/language you want to use) but there is a level of need we simply have to be realistic about. Immediate risk of harm.

most ‘NT’ people would come to a similar conclusion as OneAmberFinch

And forty years ago, most able-bodied people would have thought that not having step-free access to public buildings was OK. It's easy to decide that something isn't necessary when you don't personally need it.

I was referred for assessment by a psychiatrist, this was a couple of years ago now and I still haven't heard anything, have I been forgotten about or is this usual?

One thing that I will point out is that for none of the profiles did I recommend that the person "just get over it, it's nothing".

For B I recommended specific practical resources that could be accessed immediately and a holistic consideration of other contributing factors for their context

For C, a social/community based support group and restructuring his day to day life to be more suitable

For E, informational resources as seemed appropriate given no specific issues affecting the person

We can argue the toss about whether my specific suggestions are the right ones - happy to hear alternatives - but clearly as @TriagePriority says, A/D should push these people down the list and it's not because I'm some uncaring jerk who hates the disabled. There aren't unlimited funds. So what do those people do in the meantime? Books and environmental changes are not ignoring them, they are practical solutions that can help right now and make a huge difference.

“How would you allocate finite resources ( and resources are always finite)? Pull names out of a hat?“

I’m interested to hear your answer to this question @selffellatingouroborosofhate We are all in agreement that resources are finite. How would you manage the waitlist referred to above? Do you agree that assessments should happen in accordance with the date of referral - or that some form of triage needs to be undertaken to prioritise those with more urgent or profound needs? And advice such as those mentioned by @OneAmberFinch provided to those (advice could be developed by people with ND as well as medical professionals) to help them in the meantime whilst the more urgent assessments can take place? It’s a real problem that needs solving, at the moment the system is or has effectively collapsed under the weight of referrals and some sort of action needs to be taken short as well as long term - what are your ideas?

There should be triage. Profound needs should be prioritised more highly. "Try this" self-help is a legitimate response for those waiting for assessment.

At the same time, in real life, we have people who fall in between A,D and B,C,E. We have people (F) who are still working but who are struggling with the move to a new office where the lights are bluer and brighter and there are fifty people in one big space when previously five people each shared smaller spaces, and can't access reasonable adjustments because, without a condition to declare, you can't request them[1]. We have highly-qualified people (G) who aren't working and who are struggling to get and keep jobs because they can't maintain the pretence of "normality" well enough and keep falling probation (a relative was like this for decades) and keep getting sanctioned by the Job Centre. We have new parents (H) who could cope before they had kids and now can't because kids are noisy and they aren't getting enough sleep and everyone they talk to is saying "you just manage, that's parenthood".

Chucking everyone bar A,D off the list ensures that the people I describe won't get the help that they need, It keeps G on the dole, puts F on the dole, and results in H's children ending up in care.

If we funded mental health properly (and I count neurodivergent services as MH) then we could assess F,G,H. Underfunding healthcare whilst funding nuclear submarines is a political choice.

[1]: "But reasonable adjustments are needs-based!" Yes, they are. And if you read the Equality Act, you'll find that an "impairment" has to exist in order for the person to be considered "disabled" to be entitled to the reasonable adjustments in the first place. That "impairment" is the diagnosed condition. I can't just say "I need you to fit opaque blinds because it hurts my eyes", I have to justify with a named condition why the light is a problem for me when everyone else seems to be fine.

The whole point is I think lots of us would expect you to try wearing tinted glasses /sunglasses for the light issue, before leaping straight to getting a disability diagnoses.

This is exactly the problem now, too many people reaching instantly for diagnosis and official 'adjustments' rather than at least trying to help themselves first?
The person who's completely and utterly globally delayed, has no bladder control, very little cognition or understanding, no speech or language and very little awareness of what's happening around them clearly needs to take priority because they are totally unable to take any steps to help themselves in even the tiniest way.