ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is an umbrella term that covers three different presentations. Inattentive type (formerly known as ADD), hyperactive/impulsive type and combined type (a combination of both of the other types).

There are a range of symptoms that are noted in those who struggle with undiagnosed ADHD. These include but are not limited to:​

  • Listening difficulties
  • Easily distracted
  • Short attention span
  • Procrastination
  • Fidgeting / restlessness
  • Talkativeness
  • Impulsive
  • Losing / misplacing items
  • Forgetfulness
  • Struggling to see tasks through to completion
  • Making ‘silly mistakes’
  • High energy
  • Interrupting and unable to wait ones turn
  • Listening difficulties
  • Easily distracted
  • Short attention span
  • Procrastination
  • Fidgeting / restlessness
  • Talkativeness
  • Impulsive
  • Losing / misplacing items
  • Forgetfulness
  • Struggling to see tasks through to completion
  • Making ‘silly mistakes’
  • High energy
  • Interrupting and unable to wait ones turn

Traditionally, males often present as hyperactive with behavioural disturbances, whereas females are frequently noted as predominantly presenting with inattentiveness and can be viewed as ‘daydreamers’ or known for ‘zoning out’. Inattentive ADHD can easily be missed. It is less likely to come to the attention of teachers, parents and subsequently mental health professionals as there is usually no evidence of any disruptive behaviour. A child who sits at the back of a class zoning out is most likely to ‘slip through cracks’.

To assist in diagnosis, a full psychiatric history will need to be taken which includes information like previous treatments trialled, any other explanations for your symptoms, any medical conditions you may have, and much more! Some psychiatrists can make a diagnosis of ADHD on your initial appointment however it is also not unusual for this process to take another 1-2 follow ups (up to 20 minutes in duration) to clarify.

The gold standard for the treatment of ADHD is generally with the use of stimulant medications. Whilst there is certainly some societal stigma associated with the prescription of stimulants, most of the concerns that the general public have had about these medications are not based in reality.

There are also non-stimulant options that can be used which your psychiatrist can go through with you, especially if you are not suitable for a trial of a stimulant.

Medications are not the only option and various non-pharmacological approaches do exist. Often these are overseen by what is known as an ‘ADHD coach’. These are usually psychologists who have a special interest in ADHD and work with you to trial various methods to compensate for the dysfunction caused by ADHD symptoms.

Nevertheless, regardless of your desired treatment option, your psychiatrist will be happy to answer any questions you may have. Sometimes it is worth having a consult in order to have an open discussion regarding any thoughts you have – there will be no pressure to commence a particular treatment pathway!

‘Complex’ ADHD

ADHD in most cases is diagnosed over one or more sessions by your psychiatrist. In some cases patients may present with a clearly established diagnosis (either already on treatment or having been diagnosed and treated as a child). Once a diagnosis is established by your psychiatrist, treatment can be initiated at the psychiatrist’s discretion, if considered appropriate. When stimulant treatment is commenced, the psychiatrist must submit a ‘Notification’ to the Department of Health. This identifies your details and whichever medication the psychiatrist / patient may have chosen to start. Essentially, we are telling the health department that we have started you on a stimulant.

There are some cases where even if the psychiatrist wishes to start stimulant medication they are not able to without prior approval. These cases are termed (unofficially) as Complex ADHD cases. In these cases, we must ask for permission rather than simply commencing a stimulant. There are a range of reasons why permission must be sought, some (but not all) reasons are as below:

  • Substance misuse or dependence within the last 5 years – this can be anywhere from methamphetamines, marijuana to legal substances such as alcohol.
  • A diagnosis of bipolar affective disorder
  • A diagnosis/history of psychosis (e.g. schizophrenia, depression with psychotic features, drug induced psychosis etc)

Why does the health department mandate asking for permission in the above cases?

  • Using stimulants poses a small long term risk of psychosis, but combining stimulants with other psychoactive substances (particularly marijuana) can increase the overall risk of psychosis.
  • A previous history of psychosis predisposes a patient to having a higher risk of psychosis when prescribed a stimulant (eg it may trigger off a psychotic episode)
  • Those with bipolar affective disorder may have a relapse of their condition if a stimulant is prescribed, therefore risking a manic episode.

What is the process for asking for permission from the department of heath if you do fall into one of the above criteria?

  • Once your psychiatrist has confirmed the diagnosis of ADHD and is agreeable with the use of stimulants to treat this, permission is sought by completing an application for the stimulant panel. In addition to the application, your psychiatrist must complete a detailed report outlining your psychiatric history, as well as steps your psychiatrist (and you) will take to ensure that the risk stimulants pose to you is minimal/minimised.
  • Prior to accepting the application and report, it is essential to be able to demonstrate a clean supervised Urine Drug Screen – note that this is a requirement for all those requiring permission and not just those with a history of drug use/misuse.
  • In addition to the above, the stimulant panel will generally NOT accept applications until a non-stimulant medication has been trialled for the ADHD. In some cases, an exception can be granted to this rule but this is only in specific circumstances and will be guided by your psychiatrist.

ADHD stands for Attention Deficit Hyperactivity Disorder. It is an umbrella term that covers three different presentations:

  • inattentive type (formerly known as ADD),
  • hyperactive/impulsive type, and
  • combined type (a combination of both of the other types).

There are a range of symptoms that are noted in those who struggle with ADHD symptoms. These include but are not limited to:

  • Listening difficulties
  • Losing / misplacing items
  • Easily distracted
  • Forgetfulness
  • Short attention span
  • Struggling to see tasks through to completion
  • Procrastination
  • Making ‘silly mistakes’
  • Fidgeting / restlessness
  • High energy
  • Talkativeness
  • Interrupting and unable to wait ones turn
  • Impulsive

Yes – the traditional, stereotyped view is of hyperactive boys with behavioural disturbances. Inattentive ADHD can easily be missed and is frequently noted as the predominant presentation in women/girls. In other words, girls can often present as ‘daydreamers’ or known for ‘zoning out’. This is less likely to come to the attention of teachers, parents and subsequently mental health professionals as there is usually no evidence of any disruptive behaviour. A child who sits at the back of a class zoning out is more likely to ‘slip through cracks’.

Awareness of ADHD has certainly risen in recent years. Various social media platforms have raise this awareness and many people have reflected, realising that they too could have ADHD. The reality is that whilst some have thought that ‘ADHD is overdiagnosed’ this is far from the truth. The prevalence of ADHD is thought to be up to 5% in the adult population. Only a small fraction of these are actually diagnosed and treated. Therefore in fact, it is certainly reasonable to opine that ADHD is underdiagnosed. There are many adults with inattentive ADHD pushing through their struggles for many years, who have finally realised that ADHD could explain their mental health journey.

Initially, please book in for your initial consultation. To book in this appointment, a referral from your GP is required which is sent to referral form. This is then reviewed by the psychiatrist named on your referral (if there is one named). If this psychiatrist is unable to accept the referral, it will be circulated to the other psychiatrists in the clinic in case another may be able to accept. You will advised whether the referral has been accepted within several weeks and advised of the outcome via email. There are many reasons that referrals can be rejected so please do not take this personally – this can range from the psychiatrists’ preferred case-mix, the complexity of your case or whether the psychiatrists’ books are open are close.

The initial consult covers a full psychiatric history which including information like previous treatments trialled, any other explanations for your symptoms, any medical conditions you may have, and much more! Some psychiatrists can make a diagnosis of ADHD on your initial appointment however it is also not unusual for this process to take another 1-2 follow ups (up to 20 minutes in duration) to clarify.

There is nothing specific that you must bring. However, it can help if you bring a support person to clarify some of the symptoms you have been experiencing. If possible, this is best someone who has known you since you were a child (eg a parent). We understand however that this is not always possible!

It can help to bring in school reports to your appointment. This can give your psychiatrist an indication of what symptoms you had growing up. Often, reports from later years can be the most useful (years 9 to 12) as the dysfunction caused by ADHD can be more evident.

Sometimes you may be requested to undertake neuropsychological testing. This is done by a clinical neuropsychologist and can be used to clarify the diagnosis of ADHD or sometimes recommended to explore possible diagnoses of Autism Spectrum Disorder (ASD).

It is not usually a compulsory part of diagnosis.

The gold standard for the treatment of ADHD is generally with the use of stimulant medications. Whilst there is certainly some societal stigma associated with the prescription of stimulants, most of the concerns that the general public have had about these medications is not based in reality.

There are also non-stimulant options that can be used which your psychiatrist can go through with you, especially if you are not suitable for a trial of a stimulant.

Medications are not the only option and various non-pharmacological approaches do exist. Often these are overseen by what is known as an ‘ADHD coach’. These are usually psychologists who have a special interest in ADHD and work with you to trial various methods to compensate for the dysfunction caused by ADHD symptoms.

Nevertheless, regardless of your desired treatment option, your psychiatrist will be happy to answer any questions you may have. Sometimes it is worth having a consult in order to have an open discussion regarding any thoughts you have – there will be no pressure to commence a particular treatment pathway!

In some cases, even if the psychiatrist wishes to start stimulant medication they are not able to without prior approval. These cases are termed (unofficially) as Complex ADHD cases. In these cases we must seek permission from the Department of Health rather than simply commencing a stimulant.

There are a range of reasons why permission must be sought, some (but not all) reasons are as below:

  • Substance misuse or dependence within the last 5 years – this can be anywhere from methamphetamines, marijuana to legal substances such as alcohol.
  • A diagnosis of bipolar affective disorder
  • A diagnosis/history of psychosis (e.g. schizophrenia, depression with psychotic features, drug induced psychosis etc)

The Department of Health require this because:

  • Using stimulants poses a small long term risk of psychosis, but combining stimulants with other psychoactive substances (particularly marijuana) can increase the overall risk of psychosis.
  • A previous history of psychosis predisposes a patient to having a higher risk of psychosis when prescribed a stimulant (eg it may trigger off a psychotic episode)
  • Those with bipolar affective disorder may have a relapse of their condition if a stimulant is prescribed, therefore risking a manic episode.

  • Once your psychiatrist has confirmed the diagnosis of ADHD and is agreeable with the use of stimulants to treat this, permission is sought by completing an application for the stimulant panel. In addition to the application, your psychiatrist must complete a detailed report outlining your psychiatric history, as well as steps your psychiatrist (and you) will take to ensure that the risk stimulants pose to you is minimal/minimised.
  • Prior to accepting the application and report, it is essential to be able to demonstrate a clean supervised Urine Drug Screen – note that this is a requirement for all those requiring permission and not just those with a history of drug use/misuse.
  • In addition to the above, the stimulant panel will generally NOT accept applications until a non-stimulant medication has been trialled for the ADHD. In some cases, an exception can be granted to this rule but this is only in specific circumstances and will be guided by your psychiatrist.

Our psychiatrists see a wide range of age groups. Children are welcome to be referred however for ADHD assessments, patients must be 15 and above. If you have a child who is 14 but may be 15 by the time they are seen, then they are welcome to be referred for ADHD assessment.

There is no specific upper cut-off however this will depend on the particular presentation (eg presentations more likely to be consistent with dementia processes likely will be more suitable for an old age psychiatrist) and the overall physical health of the patient.