Getting Assessed for ADHD: What You Need to Know

[00:00:00] Phil: For many that's the first time someone's actually listened to them properly and understood their struggles and challenges and to have that validation that you are not a crackpot you are actually a human being who's got something that can be helped Expecting somebody to find their way to a Victorian monolithic building that says you are a mental basket case before you walk through the door and stigmatizes someone and increases their anxiety is inappropriate for this patient group We probably spend more time choosing our holiday destination than we do assessing our own requirements for our healthcare and that's something that's within our gift that we've got to change our mindset
[00:00:36] Ian: Hello and welcome back to the Smart ADHD podcast. Today we're diving into the topic of getting assessed for ADHD and what you need to know about the process. ADHD is often misunderstood and many people struggle to know where to start when they think they might have it. Today I'm joined by Phil Anderton, founder of ADHD360.
[00:00:55] Now, Phil had a career as a senior police officer, but he saw how untreated ADHD can lead to unintended social consequences, including involvement in crime. Driven to make a change, Phil created ADHD 360, which has grown far beyond expectations. He'll walk us through how and where to get assessed, how to prepare, and what to expect.
[00:01:18] Let's get on with it right now.
[00:01:19] Hi, Phil, welcome to the Smart ADHD podcast. It's great to have you here. How are you doing?
[00:01:23] Phil: I'm good, Ian. I'm really good. Thank you. Thanks for the invitation.
[00:01:26] Ian: Oh it's it's a real honor to have you on because I know that you have been in the ADHD field for quite a few years. You've told me that you've been speaking at the International ADHD Conference for a long time, and I'm looking forward to meeting you in person. I'd love to ask you, how did you get into all of this ADHD thing?
[00:01:45] You were a police officer, so could you give us like a brief overview of how you got here
[00:01:50] Phil: Yeah, of course I can. Now, you've set 20 to 25 minutes aside for this. I can blow that in the answering the first question. So, I'll abridge this as much as I can, but it, first of all, it's a delight to be on your podcast and if we can raise awareness and help people answer their questions, I think that's a really good thing.
[00:02:06] Thank thank you for the invitation. If we roll the clock back 20, 22 years, I was a middle ranking senior cop. in Lancashire and the Chief Constable had words of advice from the Home Secretary, let's put it that way, that there were too many young people coming into crime in Lancashire and he gave me the responsibility to change that and bring that number down.
[00:02:28] I sent a team away to find something that we were doing but we could do better and something that had never been done before that might have an impact on young people coming into crime. The thing that had never been done before was the link between untreated or poorly managed ADHD and criminal behavior.
[00:02:45] And that, that becomes the pathway of trying to get the NHS to treat people better, more effectively, to keep them out of crime, to give them better social outcomes. That, that was a challenge. That was a pretty interesting time in my career. And then fast forwards all the way through different aspects of my career, kept working with ADHD till eventually saying enough.
[00:03:07] I grabbed hold of two people I immensely respect and said let's just do this because no one else is doing it to a world class standard. Let's go out there and open our own clinic. And that's what we did five years ago. We started ADHD 360. We thought we'd see 20 to 30 patients a month and make a difference for those 20 or 30 and we're now, the clinic is now assessing 1, 400 new patients every month and growing.
[00:03:33] So that, that's the story in a nutshell, end to end.
[00:03:37] Ian: That's a staggering number of people that you are seeing every month. And if you want to hear a little bit more about the story, I'm gonna. put a link in the show notes to a longer episode. I was watching it last night, actually on YouTube. I can't remember the name of it, but it was, you gave a lot more into the story and it's a fascinating story.
[00:03:55] And it's amazing what you're doing now, obviously you're based in the UK. I'm based in the UK. We have an international audience. We have a lot of British listeners, but we also have quite a lot from the U S and Australia and other parts of the world. Although we're probably going to be focusing a bit on the UK.
[00:04:11] I know that you do have knowledge internationally. And so we will talk about international as well. But the point of this episode really is, okay, now we are thinking of, maybe we've, we realize we have ADHD, but we don't have an actual clinical diagnosis of that.
[00:04:27] And we had Tamara Rosier on the show talking about Reasons why it's important to get diagnosed in the first place as opposed to just thinking. I probably have adhd but I don't really need to seek the diagnosis we I think we've hopefully answered those questions in that episode now that we know we want to get diagnosed How do we go about doing that?
[00:04:47] What are the key differences? The different countries, like here in the UK, we have the NHS then there's in Europe, there's a different system in the US, Canada, Australia, what are the main differences between the country that we live in, in in terms of getting a diagnosis?
[00:05:00] Phil: It's a great question and we fundamentally have to recognize there are incredible differences. And I think the Brits, I think we're very easy to put down our own services and our own, the NHS long waiting lists with regard to ADHD. We have in the UK, we have champion change and we have moved things on quite a lot.
[00:05:20] And, although we, we have inappropriate waiting lists in the UK, we have actually broken down some barriers and access to services is completely different and freer and more available than in other nations. And I think that's part of our own problem is we've got waiting lists because more people are now availing themselves with services.
[00:05:37] We have the private sector. We have the National Health Service providing assessment diagnosis free at the point of charge free at the point of need. and that's the rub. We've opened it up to so many people who have a validity. That we've, we now can't cope. So that's the UK's problem.
[00:05:53] Other nations have different problems. America we the Brits talk about the United States of America. But fundamentally most states in America do ADHD differently. So there isn't a national profile. There isn't a national way of assessing, diagnosing and treating people. And we have to recognize that's a challenge straight away.
[00:06:12] Medicaid isn't necessarily covering ADHD, so a lot of people who are less wealthy in a different social strata are struggling to gain access to services. Australia my first meeting today was with Australian psychologists who are trying to work out a way of having a better model in Australia, because at the moment, there They're still considerably behind other nations in terms of access to services.
[00:06:37] So there are differences globally. The Middle East, where we're also looking to do some work, very little access to services there. So there are global differences, but it does all boil down to a common set of denominators. And that common set, it is about, we have to have access. To have access, we have to have awareness.
[00:06:57] And once we've got access, we then have to have availability of suitable treatment for people. And that's common across the globe.
[00:07:04] Ian: Yeah, it's so that's interesting. There are differences, but there are commonalities as well. So we're at the beginning of this journey. We think we have ADHD, but we we want to know So, how do we go about that diagnosis? What are those first steps and obviously that will vary depending on the country we're in but can you give us some Ideas on where we start?
[00:07:25] Phil: The first responsibility anybody has is do your homework. Find out where, what clinic is going to suit your needs. Do you want a psychological approach to this, which is more about nurture rather than nature? Do you want a medical approach to whatever your outcomes are going to be?
[00:07:41] Are you looking towards medicine for treatment? How impaired are you? How are your symptoms affecting your life? How quickly do you want to get into that treatment pathway? And what kind of reputation do you want the clinic that looks after you to have? In the UK, are they a licensed provider?
[00:07:57] Are they registered with the with the regulator? Are they providing services to the NHS as well as the private patient? Gives you a benchmark What waiting lists do they hold? And are they going to be able to meet your needs? So the first thing is do your homework. And typically we'll find that people with ADHD find that relatively easy to do because to sit and Google things with a purpose, suits the ADHD.
[00:08:20] Yeah. set of mindset, really. So do your homework, find your provider, and then work out what the referral pathway is. You could go privately. That's not something that everybody can avail themselves of. You could apply to your local NHS through your GP and inevitably you're going to come across a waiting list for all the things we've just discussed.
[00:08:39] Or you could exercise your right to choose if you're in England. Where you can choose your provider under certain criteria and the NHS will fund your care even if it's with a private provider. And all of those things are explained in great detail on websites such as ours and other providers. So you have options once you've decided who you want to go with and exercise your choice.
[00:09:01] Ian: Yeah, I think that's important I do your research and it can be quite overwhelming all of this, you know You've mentioned things like Right to choose and whether you go down the NHS route and in the UK or whether you go privately obviously this will depend where you are in the world One of the issues that I hear a lot and hopefully this is getting less of a problem But when you maybe see your GP your doctor Locally, they may question whether you have ADHD and this was maybe I didn't I had a little bit of this experience.
[00:09:31] They were a little bit dubious about it. I've heard of other people who have gone down that and say well, you're far too intelligent or you're, you've got a degree. So you can't have ADHD. There are these kind of stigmas that we hear a lot. How can we prepare ourselves for that first meeting, particularly if it's with somebody who is less specialist like a general practitioner because Those experiences can really rock you, if you're not prepared for that and can start, you can start going into this kind of downward spiral because you start to question whether you have ADHD in the first place.
[00:10:05] Phil: It's really interesting that we probably spend more time choosing our holiday destination than we do assessing our own requirements for our healthcare. And that's something we, that's within our gift that we've got to change our mindset. We shouldn't expect the GP to know everything about everything medical, because by definition, they're a general practitioner.
[00:10:26] So we have a responsibility to help them understand why we've gone through a referral. The easy way of answering your question is that the standard adult self reporting screening tool, the ASRS screening tool, Approved by the World Health Association, has 18 questions. And if the patient downloads that and answers the 18 questions, and it's very easy to work out what a positive screen is, take that to the GP, and you're educating the GP.
[00:10:54] I believe I have ADHD because, here's my life story, but also, here's a screening tool that I've taken that would say that this is a positive screen, and I warrant an assessment. And that's the easiest way of doing it, is to take a screening tool into your GP and say, Ta da! It's unequivocal, I need some help.
[00:11:12] Ian: Yeah, that makes sense. And it's a good point about spending more time on working out all the holiday plans or all the latest gadget that you want. We spend a lot of time on that often. How do people know they're getting a reliable diagnosis, so There are obviously lots of different providers that we've talked about in the UK.
[00:11:32] There's NHS there's private that would be, similar in different parts of the world. How do we know we're getting a reliable diagnosis? What should we be looking for when we're choosing a provider? And are there any things that we need to be cautious about or thinking about here?
[00:11:47] Phil: Yeah, absolutely. There's going to be an available counter argument to what I'm going to say now, but I would straight away say, The individual clinician who's working on one afternoon a week, seeing three people a week, is unlikely to be able to provide a completely holistic service for the patients. You need to be likely going to a clinic that can not just provide assessment and diagnosis, but also complete that whole treatment pathway.
[00:12:15] Medicine, non medical interventions, provide emotional support, provide scaffolding, structure, therapeutical interventions. And have the whole picture available to you. What happens if you're in a one man band psychiatrist? Who then stops work or goes off on three weeks annual leave? What happens to your care?
[00:12:35] Look after yourself right from the get go and have a clinic that can wrap itself around you. And watch that you've got that depth. And then look at what the regulator has to say and there's all sorts of criticism about the regulator. But if nothing else, you want to be with a clinic that's availed themselves of the regulatory framework.
[00:12:50] So in the UK, that will be the CQC . And then, I, and this is contentious and I accept what I'm about to say is contentious. If you think that medicine is going to be what you need for your ADHD, don't go to an educational psychologist or a psychologist for your assessment because they can't provide that.
[00:13:08] You need to go somewhere that actually works within the medical model. If you think therapy is what you're going to want as an outcome of having your ADHD diagnosed, then a psychological or educational psychological perspective may suit you. So again, it's back down so you sit down and work out what you want and then look for someone that can supply the services that you want.
[00:13:28] And that's a huge piece of choice that will be better if you've done that homework. And giving it the time that you would give your gadget or your holiday before you embark on the journey.
[00:13:39] Ian: That's a really good point. And also I would say bear in mind that you may change your mind. This is a situation that I'm in that I it's not a case of changing my mind, but I didn't want to go down the medication route to begin with. I for various reasons, which we'll probably talk about in the next episode when we look focus on medication.
[00:13:55] But I had all these kind of hangups about medication and then I've changed my mind. And so I'm in a good situation, but if I'd chosen provider who didn't offer the medication route, then I'd be in a very difficult situation, I think. So that's another thing to bear in mind. Now, there's been a lot of, and I almost don't want to bring this up because it makes me a little bit cross.
[00:14:17] There's been a lot of kind of negative reporting, particularly in the UK about some private clinics making it too easy or, Overdiagnosing or misdiagnosing, there was the, I haven't even watched it, but there was a BBC Panorama episode about all of this. But presumably, there is some truth in that, there are some private clinics out there that are doing dodgy things.
[00:14:40] Where's the truth in this? How do we make that choice?
[00:14:43] Phil: Great. It's great that you put that right front and centre in the conversation. Because it's really important that people understand that. The propensity for society to look negatively on ADHD is huge. There's been a rise in awareness and a rise in diagnostic capability. Telehealth remote working has changed the landscape.
[00:15:03] Great. And to some degree it plays into the mindset of the naysayers who want to put this down. But let's flip the coin. Have modern ways of dealing with ADHD made it easier? Of course they have, and absolutely they should do. Expecting somebody to find their way to a Victorian monolithic building that says you are a mental basket case before you walk through the door and stigmatizes someone and increases their anxiety is inappropriate for this patient group.
[00:15:30] So being able to be assessed from your own kitchen table is a huge advantage. So that has opened access, so therefore more people can avail themselves of these much needed services. The digital world has allowed us to not take five hours undertaking an ADHD assessment. We can gather data digitally and we can change that whole time period.
[00:15:50] So more people can be seen by the same resources if we're forward thinking. we got asked a question by the NHS last year. Why is it that 98 percent of the people you assess end up with a diagnosis? When, typically in an NHS clinic, it would be about 60 percent of people who were assessed end up with a diagnosis.
[00:16:10] And the interpretation there is that we're just assessing everybody and giving everybody a diagnosis, whether they've got it or not. But what, as is the case, what if the interpretation actually is, we'll only let people get to the chair in front of the clinician. if they warrant it. So we will screen, triage and triage out to make sure that the most expensive seat in the house is the one in front of a clinician, is filled with people who absolutely warrant an assessment and are likely to get a diagnosis.
[00:16:39] So in answering that question to the NHS, we looked at how many people screen on our website. and how many people come through them with a positive screen into service. And 75 percent of the people that screen, screen negatively and realize that ADHD isn't the service they need. We have to be very careful how we look at the stats and the numbers so that we're actually getting a true story.
[00:17:00] We're never going to get away from jobbing clinicians in the NHS. who've become turkeys that don't want to vote for Christmas. There is a lot of people that don't want change to happen in this regard because it will affect them. It will affect their clinical work. It will affect what they do and it may make them busier.
[00:17:19] It may make them a lot busier to move to more modern techniques and modern ways of doing things. So we have to be very careful. What we're reading, what's the purpose of what we're reading? And Panorama in particular was a travesty to the ADHD community. It was perhaps the most disgusting piece of journalism that we've seen in a long time.
[00:17:37] And those organizations that were caught up in that, and every human being with ADHD in the UK that got caught up in that, because it percolated through the whole ADHD community. Recognize now that was utter gutter to journalism that had missed the point totally. And the point should be that we've got incredibly long waiting lists.
[00:17:56] People aren't getting the help and treatment they need and we've got to do things differently.
[00:18:00] Ian: Yeah, definitely. I think that is such a good point. So we've got through the triage well and all of those stages you talked about and now we're sitting either physically in a room with a psychiatrist Or it's over some kind of we could be zoom or whatever. Because presumably, and this was the case for me, I did it over zoom, but it can be done virtually or in person.
[00:18:23] So what are we going to expect? What are the things that we should have prepared in the past before we actually sit in front of a psychiatrist and what's actually going to happen? Can you take us through the stages?
[00:18:34] Phil: Yeah, of course we can. First of all, there should be some form of preparatory data collection with you so that we've got the information we need to be informed before we meet you for the first time. The scaling nature of that will differ from organization to organization. But there should be that detailed data collection beforehand.
[00:18:52] Then when you get to your assessment, there should be some form of risk assessments of what we're dealing with here. May be dealing with a young mum who's struggling to be a parent for the first time, or we could be dealing with somebody that's living on the streets, homeless surviving off unlawful drugs and is really at the arse end of their life at the moment, really struggling.
[00:19:11] So a risk assessment gives us an idea of what risks we're dealing with outside of just working with somebody with ADHD. And then we move into the assessment process itself. The overriding manual for mental health for DSN has a large chapter on ADHD criteria. And sadly we are always looking at what's wrong.
[00:19:31] So you get an hour and a half questions about what's wrong, what's not working well, what's not going well? What's the level of impairment? How bad is it, is it for you? And that will on face value be a tough hour and a half of dealing with the negative. Although a good clinician should ask about your strengths, should ask about what you are good at, the criteria actually is about dwelling on impairments and symptoms.
[00:19:56] Now interestingly, as you get towards the end of that process, which can feel a little bit invasive and emotionally negative, as you get towards the stage of then understanding the diagnostic process and having affirmation if appropriate, you have got ADHD, That validates your struggles that you've had in life that have got you to that point of being with that clinician and all of a sudden at that moment There's generally a huge sense of relief that I now understand why my life has been so difficult and been so tough.
[00:20:27] And you should expect those emotions. And I read the feedback that we get from our patients, for many that's the first time someone's actually listened to them properly, and understood their struggles and challenges. And to have that validation, that you are not a crackpot, you are actually a human being who's got something that can be helped, it is.
[00:20:47] an affirmation that there is a normality available. If normal, it has got any benchmark. So you should expect an emotional journey through your assessment. You should expect difficulty and challenges dealing with the negatives, but then you should expect a switch towards that validation towards the end of that process.
[00:21:05] Ian: Yeah, I can definitely say that happened to me. There was this validation realizing that I'm not, I'm not lazy. It's not to do with laziness. And a lot of the guilt that I was carrying just dissipated. It was a wonderful, but for many people, it can also be a difficult time as well.
[00:21:22] You can think if only I'd known there can be a, sometimes there can be anger, there can be lots of different emotion. So the, you said 90 minutes, is that kind of how long the process would normally take? In the, in front of the psychiatrist.
[00:21:34] Phil: So two things there. First of all, we need a clinical specialist in ADHD. We don't need a psychiatrist and we need to make that point. And the second one is the way that we work clinically is the first hour to an hour and a half of a classic clinical setting would be getting to know the patient's background, taking data about overall health, mental well being.
[00:21:55] Why do you want treatment? Looking at your past history, your past records, your family records, cardiac history, what's your mood, what do you smoke, what do you eat, what do you drink, what substances do you take, all those kind of, you can imagine that barrage of questions coming. We do all of that online pre the assessment.
[00:22:12] We're knocking out an hour to an hour and a half of the assessment process by doing that onboarding process online. So the nuance of our approach, the hour and a half, is because that's the human bit between you and the clinician. So for our clinic, it's about an hour and a half. It will differ with others who perhaps don't triage and gather the information that we do.
[00:22:32] But the hour and a half is that pertinent moment when you are being heard. and questioned about your ADHD against the guidelines so that someone can make a very educated specialist decision on whether you are neurodivergent.
[00:22:48] Ian: That makes sense. We're almost out of time, but I did want to ask you what makes your company ADHD 360 different. You've already mentioned a few things about how you do things differently, but what's different about your approach?
[00:23:00] Phil: First of all, I'd say there are four or five big suppliers of services in the UK. And we've all got merits, and we've all got our struggles. And the beautiful thing is that the patient gets choice over who to go to. And I think the biggest thing that's come out of the last five years for ADHD is the patient genuinely has a choice now of provider of services for them.
[00:23:19] What makes us different? Things like the day of your diagnosis is the day we discuss your treatments. And if you want medical treatment, we start it that day. We don't put you into another waiting list and give you nine months of knowing you've got something, but we're not doing anything to help you.
[00:23:34] We see every patient within 18 weeks from their referral. So we're not part of the national problem with waiting lists. We're part of a national solution. And the second thing is all of my staff. who are clinicians, are trained to be empathetic and to give you that validatory experience. And that's really important.
[00:23:53] So, we're not, We're not a clinic full of wiry haired, crusty people with dickie bows at an angle and porridge down their top. We've got humans who want to empathize, emotionally connect with their patient. And the beauty from my clinical team is that they see the patient on first presentation, which is generally when you're at your worst, in terms of ADHD symptoms and impairment.
[00:24:15] And that single clinician takes you through your journey. to the point where you are stabilized and optimized on your medicine and able to lead your best life. So you form a partnership with that person and you go through that journey together. So you get, you the patient get to trust and build rapport with your clinician, but the clinician gets the intrinsic reward of taking you on that journey and ringing the bell at the end and saying, you're good to go fella, go and lead your best life.
[00:24:41] And I think that's quite an amazing piece of medicine to be able to do that.
[00:24:45] Ian: That is amazing. Yeah. And the diagnosis is only the start of the journey. There are lots of options. There's coaching, there's therapy, there's medication. I know that ADHD 360. You are definitely looking at the all of those different options. We're going to focus in the next episode about medication.
[00:25:04] This is something we haven't talked. I haven't talked about really much at all on this podcast. So that's going to be really interesting. Thank you so much, Phil, for spending time with us and to help us really understand the process of diagnosis and the importance of it as well. Really appreciate that.
[00:25:19] Thank you so much.
[00:25:20] Phil: Great pleasure, thank you.
[00:25:21] Ian: Awesome. Thank you so much for plugging us into your ears or watching on the YouTubes, but until next time, I encourage you to be smart with your ADHD. Toodaloo!
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