Offer ADHD help before diagnosis, NHS task force says
Everyone who thinks they might have ADHD should be offered special adjustments such as flexible working or extra time at school, an official NHS task force has concluded.
A report said that support should be provided for people with 'possible' symptoms before they have a formal diagnosis, amid 'unacceptably long' waiting times of several years for diagnostic assessments.
It said that, without the right support, ADHD was 'a potent route into educational failure, long-term unemployment, crime, substance misuse, suicide, mental and physical illness'.
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The NHS believes attention deficit hyperactivity disorder affects about 2.5 million children and adults in England, but only 800,000 have a formal diagnosis.
Experts have called for sweeping reforms across all public services, particularly the education sector, to meet the needs of people with ADHD.
The report said that early support should be 'needs-based' and 'uncoupled from diagnosis' and offered to all those with suspected ADHD or on waiting lists for services. This support could include 'quiet rooms' in classrooms, parenting lessons and flexible working hours.
The national ADHD task force was set up last year by the NHS, in response to a surge in demand for services, with researchers working with government departments.
The panel's interim report, published on Friday, said that ADHD can be viewed as 'lying along a spectrum' and that support may be needed to those who 'fall just below or near the diagnostic threshold'.
Professor Anita Thapar, who chairs the NHS ADHD task force, said: 'Needs in school won't be the same as needs at home or needs in the workplace. You look at people's strengths and challenges and work out the best way to enable them to be the best version of themselves.
'For example, say if a child is finding it really hard in a class, they might need a quiet room to have a five minute break. In the workplace, someone with ADHD might find it challenging sitting in the same spot for hours looking at a screen. So they might need more frequent breaks. They might need somewhere quiet where it's not so noisy.'
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Thapar, a professor in child and adolescent psychiatry at Cardiff University, said that intervening early when children are in school is a cost-effective way to prevent complications further down the line, such as unemployment or A&E trips, and prevent 'wasted human cost and wasted economic cost'.It said it was 'especially important' that schools and nurseries intervene early to help children showing signs of ADHD, and that this 'should be needs-led and not require a clinical diagnosis'.
Thapar said investment was needed to train teachers and business leaders about how to recognise ADHD and what help to provide.
In the coming months, more specific recommendations about what adjustments schools and workplaces should make for ADHD will be issued by the Department for Education and the Department for Work and Pensions.
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The report said that many with ADHD do not need medication, but that those with severe symptoms could be 'fast-tracked' to specialist clinics to get medication.
ADHD is a neuro-developmental disorder and people with the condition may have trouble concentrating or struggle to sit still and organise their time.
More than half a million people are on waiting lists for an ADHD assessment, two thirds of whom are aged between five and 24. Waiting times for NHS services are up to four years for children and eight years for adults, the report said.
Ministers are alarmed about how a rise in ADHD is fuelling soaring disability claims, and Wes Streeting, the health secretary has argued there is an 'over-diagnosis' of mental health conditions with 'too many people being written off'.
The report said tighter regulation and monitoring is needed of private clinics, which have been accused of overdiagnosing patients. It said: 'Inability to access NHS services has led to a significant growth in the use of private providers that are not regulated, resulting in two-tier access to services, diagnosis and treatment; one for those who can pay and another for those who cannot.'
Dr Adrian James, NHS England's medical director for mental health and neurodiversity, said: 'We know that too many people with ADHD have been waiting for too long for support, which is why we launched the task force last year to help respond to the significant growth in the need for care. It is clear that much more needs to be done to improve ADHD assessment and care in England and ensure people can get a timely diagnosis, and we welcome the findings from the interim report, and look forward to its final conclusions later this year.'
Parul Singh, 29, was diagnosed with ADHD in 2021 after struggling with sleep and anxiety. She believes that workplace adjustments can be hugely helpful in managing symptoms.
'Care for ADHD is about more than just medication. People on waiting lists should be given educational tools and information on reasonable adjustments at work and their rights under the equality act,' she said.
'Reasonable adjustments might include flexible working because sometimes you can hyperfocus and work long hours, or transcription tools if you do a lot of meetings, as my attention wavers so it's hard to take notes.'While her diagnosis was relatively quick, Singh has struggled to access treatment. She been 'passed around' a series of private clinics providing services for the NHS, which subsequently lost their NHS contracts.
This means she keeps having to get re-diagnosed in order to access her medication on the NHS. 'I've had to have three ADHD assessments in four years. It doesn't make any logical sense.'
Charlotte Atkins, 28, was told she would have to wait 'ten to twelve years' to get an ADHD assessment on the NHS when she first sought help from her GP in 2023.
She had no choice but to go to a private clinic — paid for by her work health insurance — and was diagnosed with ADHD, starting on medication which was 'life-changing'.
But when she tried to transfer her care and prescriptions to her NHS GP, she was met with a system of 'bureaucracy and gatekeeping' and told she would have to get re-diagnosed at an NHS clinic — meaning several more years on a waiting list.
Atkins, who works as a consultant in London, eventually managed to get prescriptions via an online service. However, she then had to go cold turkey for four months because of a national shortage, which meant her 'health suffered significantly'.
Atkins said that 'waiting for a diagnosis and waiting for a medication is absolutely horrendous' for people with ADHD and it is vital the NHS gets a grip on waiting times, adding: 'ADHD is hard enough to live with. Getting treatment for it shouldn't be harder.'
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