to want to medicate DD’s ADHD but don’t know how to?

[MigraineMarnie]

Long and short of it is that DD is massively struggling in secondary school and we have finally decided medication may be the best route to go down.

How do you find a private GP to prescribe?

She had her assessment in another country ( my home country ) as the NHS lists were approx 3 years but now I’m going to really struggle getting my hands on the so needed medication.

Can anyone help?

@Efacsen Im aware of the guidelines, I am not giving advice, I’m voicing an opinion.
Someone else has asked what I would recommend. That is a question I will not answer other than to say research and draw conclusions that are appropriate for your child.

@DogDaysAreOverr
You could request right to choose referral to one of the providers contracted with NHS some do child assessments, just make sure they also include medication titration as some are diagnosis only. They may accept the private diagnosis and only do meds but would allow you to access the shared care route so NHS covers future meds & psych review costs. Your GP may take over shared care then or if refuses still the provider would usually carry on prescribing and bill NHS.
https://adhduk.co.uk/right-to-choose/

Psychiatry UK have a currently have temporary pause on accepting any referrals but heard it maybe only 1-2 months while they catch up.

GP could also refer to local NHS ADHD provider to take over prescribing, I know locally the adult service does accept certain providers private diagnosis and takes over the prescribing/reviews, though I'm not sure how long you'd wait for that and some may decide need to be diagnosed by them.

Thank you for this!

So…
I’ve contacted various private places and the one who can see us in the next month costs £300 for the consultation, 6 week review after that at £300, 3 month review after that at £250 before agreeing a “
shared plan “ with the GP and then 6 monthly reviews at £300 each.
£30 for repeat prescriptions… is this about right??

So the thing with prescribing that needs to be accounted for is that the initial medication may not be right for your child and this will only be established through trial and error. This could prolong the process which will be expensive and difficult to stop once started. A private assessment will not expedite you being seen in the NHS at Camhs/Paeds for prescribing as then people could do this to skip the queue which would create further inequality. I would push for the referral to Paeds or Camhs and then contact them and try and escalate on the basis of risk (currently out of school and significant decline in functioning and mental state).

Why don't you contact the doctor in your home country and get a prescription there?

Yes £250-300 sounds about right for review appts

Not sure about £30 for repeat prescriptions - cost price of Ritalin is 10p/tablet

The appts seem quite widely spaced - are you able to speak to them between appts?

before agreeing a “shared plan “ with the GP I'm not sure what you mean by this
Has your GP agreed to this?
Does your GP have a 'shared care agreement' with the private provider?

NB Check the performance of this private provision on Trust Pilot before agreeing to anything - some have shockingly bad reviews

That sounds about right although the cost of meds varies wildly from £100 a month ish for the likes of elvanse and concerta to £35 for atomoxatine. My son has tried a variety and we've settled on the latter as the others are stimulants and affected his appetite and sleep too much. We use ADHD 360 who have been good but our GP has continually refused shared care so we've been forced to go private- like you we had a diagnosis from overseas. It's better though as they are very responsive and it's all online which means we can make adjustments and have calls as and when needed. Best of luck with next steps

@BertieBotts also some very good evidence regarding the effects of not medicating. No one wants to medicate their child but the effects of not doing so can be far more devastating. Anyone arguing otherwise does not understand adhd. Few professionals do, bertiebots. Walk a day in our shoes etc. As a specialist in ADHD told me, in the whole of psychiatry, ADHD meds are the most effective - they change lives.

Well exactly! I don't know why you're tagging me. I think the bias against ADHD medication especially for children is extremely damaging and stigmatising. Parents already worry about medicating children, no reason to back this up with dubious "research studies" on google scholar - go and talk to a doctor.

I have no idea what “ shared GP plan “ means - it’s just in their email

no reason to back this up with dubious "research studies" on google scholar - go and talk to a doctor
Thanks for the little dig but at no point did I suggest that op should not medicate their child.
As for the Google scholar comment, you are aware that it’s commonly used in universities?

Could you post your links please? I can't find on either pub med or my uni site?

Seratonin pooling

Onset of depression

infertility in rats

‘ chronic’ what microgram over what period of time is classed as ‘chronic’ ?
genuinely asking as my child has her meds in school for school and nothing in the holidays. Since she taken them for 8 months her gcse grades shot up by two grades and she’s now able to access the course of her choice and her mental health has improved significantly.

And this one states the risk of depression is low …. But the flip to that could be research I read today saying that low self esteem is one of three biggest factor for cause of adolescence suicide.

unmedicated adhd can definitely lower one’s self esteem

GENUINELY asking if there are other drugs for ADHD that have no risk or a lesser risk than Ritalin ( can’t spell the non branded name !)
as I want to strike a balance of helping my child’s brain work to its full capacity and keep her mental health positive but not at her long term brain health / but then you risk depression from non medication
…… what’s the answer ?

There are other drugs including a non stimulant drug.

That sounds promising but maybe helpful to confirm with the private co or your GP if 'shared GP plan' means that GP will definitely take over prescribing after 3 months?

Generally GPs won't do Medication Reviews for ADHD medication as it's a specialist task ie Child Psych/Paeds so you will likely need to continue with the private provider for that? Worth clarifying as you said reviews are expensive

I feel dreadful I didn’t medicate or wasn’t open to medication back with the initial diagnosis as maybe things would be better by now as now I worry it’s too late for the self esteem to come up and academics improve to the extent he enjoys school and makes friends 😢

@MigraineMarnie I posted earlier about my DD14 who is on Elvanse.

The consultant will work with you to get the medication right over a few appointments. Once it's right it will get handed over to the GP and will cost the normal amount (under 16 is free)

You will then probably only see the consultant every 6 months or so...they like to keep track of weight and height in younger kids and teens but also to monitor how they feel it's working.

The other thing is it comes down to what your kid wants, mine didn't want to take it all the time but acknowledged it helps her enormously at school, so we asked for one that is daily rather than one that has to build up over time and take consistently.

I hope that's of some help.

More information please . Is it the stimulants that may cause the longer term issues ? and what is the research on the non stimulants
what are the non stimulants called and do I have a right to them under the nhs

@Namechangeforadvicepleaseandthankyou please don't be worried about ADHD medication by random comments on this thread.

There is plenty of really good quality info about ADHD medication out there. Non stimulant medications tend not to work as well for children/teens - the stimulants on average do better. Regardless if you have found something which works well for your DD, don't underestimate that! It is really really valuable when you get the right dose/drug - I wouldn't go second guessing it and worrying. There is actually some really good evidence that the earlier you medicate the more "normalised" (terrible term but medicine is like that) the patient is into adulthood. This is not really well known, probably because there are so many narratives in the general public that medication is something terribly dangerous and strong and must only be used as an absolute last resort, it's drug companies wanting to make money etc. Meaning that HCPs really have to walk a fine line between recommending effective treatment AND making parents feel that they are not rushing into anything. But ADHD medications have been used for decades in the US which means that there is a lot of long term info about them. It's only in Europe where we have been much more cautious about them.

I will link some resources for you to read further. Bear in mind that some of these are American and not all of the US brands are available in the UK.

https://www.additudemag.com/webinar/benefits-of-adhd-medication-children/

https://www.youtube.com/playlist?list=PLKF2Eq0eYbbrWLf34RL1T9B27XCUuHCfB

https://www.pbs.org/wgbh/pages/frontline/shows/medicating/interviews/barkley.html

https://www.amazon.co.uk/Taking-Charge-ADHD-Third-Authoritative/dp/1462542670