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Telegraph
6 days ago
- Health
- Telegraph
Can ADHD really be diagnosed with a simple 18-question test? We ask the experts
There are now 2.6 million people in the UK with ADHD – and diagnoses are on the rise. Looking at 18 years of anonymised NHS patient records, researchers at University College London noted a 20-fold increase in the diagnosis of ADHD in adult men, and 15-fold in women. Meanwhile, demand for a diagnosis has soared by more than 400 per cent since the pandemic, according to figures from the ADHD Foundation. As those looking for an ADHD diagnosis face a wait as long as eight years on the NHS, the two-minute Adult ADHD Self-Report Scale (ASRS), which asks individuals to answer 18 questions themselves, has become widely used. But when Oxford University made the decision to use it to grant extra exam time to almost all students who got a positive result, it called to question the efficacy of the quick test. The students underwent a 90-minute assessment by an unqualified expert after the initial screening but still, it opened a heated discussion about whether the ASRS test was fit for purpose. There are two main concerns surrounding this test: One being that the ease at which people are accessing it is contributing to the fact that doctors are being inundated with diagnosis requests from people who believe they have ADHD. And secondly, if people know that a positive result on the ASRS test could lead to extra time in exams, or to being eligible for benefits, then there could be incentives to answer a certain way. What exactly is the ASRS test? Written in 2005, the self-reporting test was devised by the World Health Organisation (WHO) and experts from Harvard Medical School. It is generally used as an initial screening for ADHD and is widely used by the NHS and private clinicians. The test is only meant to be used as an initial screening and to assess whether a further assessment by a specialist clinician is necessary. 'It was designed to screen for what we call ADHD traits. The main purpose is to flag those patients to primary care providers like GPs, who might want to refer them to secondary care where a more thorough assessment can be done. It's not meant to be used alone for a diagnosis,' says Dr Alessio Bellato, clinical psychologist and lecturer in neurodiversity and mental health at the University of Southampton. With no blood test or objective criteria, ADHD is tricky to diagnose – and sometimes open to abuse. 'ADHD is a constellation of behaviours, but there's no specific gene or signal in the brain that we know about, so we have to rely on observations,' says Dr Bellato. 'The presence of symptoms alone is not enough for a clinical diagnosis; they must have negative consequences that are clinically impactful in everyday life, like maybe the person can't hold down a job or perform at university.' Ideally, a diagnosis should include extensive clinical interviews and evidence of impairment across more than one area of life, according to NICE (National Institute for Health and Care Excellence). So what's the theory behind this two-minute test for ADHD and is there still a place for it? Concerns over diagnosing ADHD with a two-minute test Dr Bellato believes the ASRS test, provided it's used correctly, is a useful tool for initial screening and referrals. 'As of today, it's the best screening tool we have – it's supported by the WHO and designed and developed by researchers from reputable institutions. We have to be realistic about the time GPs have, and ADHD assessment is not their job,' he says. But it isn't perfect. Since ADHD is being widely talked about amongst friends and on social media, most people now understand what boxes to tick on the test, and in some older versions of the test, the answers with the highest scores are also obvious because they're shaded grey. Dr Marios Adamou is a consultant psychiatrist with the adult ADHD and Autism Service, South West Yorkshire Partnership Foundation Trust. He's concerned that too many people are referred by GPs for an assessment after completing the test and are adding to already lengthy waiting lists. 'It used to be useful in the UK, but I don't think it's useful now. People are coming in and demanding a diagnosis because they have already diagnosed themselves,' he says. In his trust, they've recently started to trial a new system. 'GPs contact us and we complete a one-hour face-to-face interview for a referral,' he says, saying that the trial has significantly reduced referrals. Although some clinicians and politicians have claimed that ADHD is being over diagnosed, experts rightly point to the fact that, although it is estimated that around 2.8 per cent of adults have ADHD in the UK, only around 0.32 per cent currently have an ADHD diagnosis, although numbers are rising. How the ASRS test works The test has 18 questions linked to the criteria for diagnosing ADHD, which is set out in the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5. The manual classifies ADHD into three types: predominantly inattentive, hyperactive-impulsive and combined. None of these types are inherently more severe; it simply depends on how ADHD shows up in each individual. People with predominantly inattentive ADHD may struggle with focus, forgetfulness, procrastination, concentration and following through on tasks. Those with the hyperactive-impulsive type are more likely to experience restlessness, impulsivity and difficulty sitting still. The combined type includes significant symptoms from both categories. The ASRS test asks questions that help to identify traits of each type of ADHD outlined in the DSM-5. So part A of the test contains six questions that cover both symptoms of inattentiveness and hyperactivity-impulsivity. Part B has a further 12 questions that provide additional clues for clinicians and asks a broader set of questions about how severe the symptoms are and the impact on people's lives. Experts think that the criteria – and the questions – are due an update though, in light of how much researchers are beginning to understand about ADHD. 'The DSM was created decades ago and is constantly updated by clinicians who also involve the public. Right now, signs of emotional dysregulation are not part of the diagnostic criteria, but when we move to DSM-6, I expect we might see that change,' says Dr Bellato. Questions about inattentiveness With ADHD, inattentiveness looks like difficulties focusing on details, organisation, remembering appointments, procrastination, making mistakes, losing things and struggling with concentration. So the ASRS also asks several questions about those things as well as their impact on life, like staying focused at work when doing a boring task, having difficulty concentrating on what people are saying to you or being distracted by noise or activity. 'Attention is a cognitive function, so what we are looking for here is someone with impaired function. If you're honest when you fill it out these questions could signal an attention problem. Of course, there could be other causes like depression, anxiety, alcohol disorder and trauma,' says Dr Adamou. For an ADHD diagnosis, inattention would usually need to have been present since childhood and be pervasive across multiple areas, like work and home. When it comes to ADHD, inattention and procrastination are often linked to the demands of the task; if it's boring, it can be impossible to get started, but if it's stimulating, ADHD people can hyperfocus for a long time. 'There are theories that say that lack of motivation in people with ADHD is due to altered neurotransmitters, including dopamine. This means that doing things that are not really engaging or exciting are much more challenging than they should be, then if something is exciting, they over focus, which is a trait that overlaps with autism,' says Dr Bellato. Questions about hyperactivity and impulsivity 'Hyperactivity is mostly applicable to children,' says Dr Bellato. 'It's the child with ADHD who can't sit still, who is always active, in a way that is excessive for their age. Impulsivity, on the other hand, is related to difficulties in inhibiting a response – for example, let's say, you provoke me and I will react immediately in an inappropriate way. ADHD is very closely related to aggression, and people often struggle with inhibiting their responses which aren't socially acceptable.' So the test also includes several questions that speak to the hyperactive and impulsive nature of ADHD. For adults, these can be physical hyperactive symptoms like difficulties sitting still or staying seated in meetings, feeling constantly restless or fidgety, unable to unwind or relax, or being overly compelled to do things as if being 'driven by a motor'. The questions also aim to measure how the impulsive behaviours relate to inner difficulties, asking whether people often interrupt others and finish their sentences, talk too much and find it difficult to wait their turn. Scoring the test A score between zero to nine indicates a low likelihood of ADHD, between 10-13; a moderate likelihood, 14-17; a high likelihood and 18-24; a very high likelihood. The questions that score highly can also indicate the ADHD subtype, which could be hyperactivity-impulsivity, inattentive or combined. Only the first six questions in Part A of the test are scored, and in 2024, the scoring system was updated to provide more nuance. Each question has a multiple-choice answer of Never/Sometimes/Often and Very Often, with a score ranging from zero to four points for each. Questions seven to 18 are answered in the same way but they're not included in the total score. They're simply used by clinicians to get a more detailed picture of how much of an impact the traits are having on an individual's life. Researchers are continuing to work on better diagnosis methods for ADHD, but in the meantime, Dr Bellato believes the ASRS can be helpful, provided it's used correctly as a first step and not a standalone diagnostic tool. As Dr. Bellato puts it, 'It's not the tool that's the problem, it's how the tool is used.' Where can I find the ADHD Self-Report Scale test? The updated ASRS test is freely available online. You can find a user-friendly version on the website of the charity ADHD UK, the updated version on the Psychology Tools website, and the original version on the ADD website. Experts advise answering the questions honestly and without overthinking your answers. A positive score is a sign to seek further clinical assessment, not a diagnosis of ADHD. Experts recommend sharing your results with a GP, who can refer you for a formal ADHD assessment if appropriate. The test can be a useful tool and a helpful first step if you have a history of symptoms, a family history or other mental health symptoms. But he emphasises that people shouldn't forget 'this is a self-reporting tool, so any non-honest reply will affect the final results, and each individual might have different opinions about how to define something occurring 'rarely' or 'sometimes'. It is always important to talk to your GP or clinical practitioner and only an expert and trained clinician can diagnose ADHD and it might be that follow up assessments rule out ADHD,' says Dr Bellato.
Metro
22-06-2025
- Health
- Metro
This is why it seems like everyone has ADHD right now — including you
It might seem like 'everyone has ADHD right now' – but that couldn't be further from the truth (Picture: Metro) Opening up to a friend after I was diagnosed with ADHD, I voiced my struggles with time blindness, lateness, general disorganisation, and emotional dysregulation. 'But isn't it normal to get a little bit distracted sometimes? I probably have ADHD too, if that's the case' she said to me. My heart sank, feeling both rejected and my life experiences diminished in one simple interaction. I doubt she meant to upset me, but her words stung. There's an increasing perception that having ADHD is becoming a 'trend' or a 'personality quirk.' Just like OCD has been carelessly thrown about as being neat and tidy, ADHD is starting to become synonymous with making seemingly normal, harmless mistakes like misplacing a purse, or being 10 minutes late to a coffee date. As soon as I first read about ADHD in women, I knew that I had it. I once lost my house keys and paid my landlord for another set, only to find them wedged down the back of the sofa when I moved out. I also impulsively switched subjects during my GCSEs, A Levels and university; I had my library card revoked at the age of 10 after I failed to return the books I'd borrowed, and I'd spent my whole life feeling that my brain was simply a little bit different. So, does everyone really have ADHD now? Or are we just being equipped with the tools to navigate our own brains, and connecting with a like-minded community in the process? Have ADHD diagnoses increased in the last few years? In 2023, a study from UCL found that the number of people being diagnosed with ADHD has increased over the last 20 years, but this doesn't mean that 'everyone' has it now. Between 2000 and 2018, there was a twenty-fold increase in ADHD diagnoses, rising to almost fifty-fold in ADHD prescriptions issued to men aged 18-29. Largely owing to medical misogyny that favours research into symptoms in men and boys, women are still largely going undetected: the ADHD Foundation estimates that between 50 and 70% of the 1,000,000 women in the UK living with ADHD are undiagnosed. There might've been an increase in people seeking help for ADHD in recent years, but that doesn't mean that the condition is becoming more common. It still only impacts between 2% and 6% of the world's population. ADHD impacts between 2% and 6% of the population (Picture: Getty Images) Likewise, a 2025 review from King's College London looked at 40 studies across 17 countries and concluded that the prevalence of ADHD (AKA, the number of people living with a condition within a specific timeframe) hasn't increased since 2020. The author, Dr Alex Martin, noted that while much of the media has been concerned about a 'surge' in ADHD diagnoses, both 'assessments and help-seeking' are snowballing – which goes some way towards explaining why it might feel like more people have it now. There are also multiple barriers to diagnosis, including excessive NHS waiting times (as long as eight years in some parts of the UK), and the hefty cost of a private diagnosis, which averages out at £1,200 for adults. For many, self-diagnosis is their only option – and that's valid. Meeting the threshold for diagnosis Getting an ADHD diagnosis isn't an easy task, and psychiatrists certainly aren't handing them out like they're lollipops. To qualify, adults need to align with at least five symptoms on the DSM-5, the framework that's used to detect it. As psychologist and clinical director Dr Angela Pickering tells Metro, various symptoms of ADHD might seem relatable to the general non-neurodivergent public. But what differentiates these symptoms between being a normal part of life and being suggestive of neurodiversity is the frequency with which they happen and how debilitating they are. 'The key difference is that for someone with ADHD, these symptoms are persistent, pervasive and significantly impact their ability to function in daily life, across multiple settings such as work, school and relationships,' Dr Angela explains. ADHD isn't just being 'scatterbrained' or 'disorganised': in Angela's words, it's a 'neurodevelopmental condition rooted in differences in brain structure and function.' And so, a diagnosis doesn't just require checking off a few traits, but a 'detailed evaluation to understand the full context of a person's life and challenges.' As part of an ADHD assessment, psychiatrists will look at the pattern, intensity, and consistency of symptoms over time, even going as far as to ask a parent or family member to testify that their loved one's symptoms have longevity and started before the age of 12. When I was diagnosed in November 2021, I asked my mum to fill out the forms for me. Thankfully, she was able to recall with colour the school reports that were constantly telling me I was bright but needed to pay attention to detail and listen more; the eye tics that saw me blinking multiple times in a row, and my persistently hyperactive nature. I used to enjoy talking so much that I'd ask my parents if I could read my book aloud to them; my room was almost never tidy, and I had trouble paying attention in the classroom, often doodling into the line margins of my exercise books. So at the age of 23, I almost cried when I heard the words: 'you have combined ADHD' from my psychiatrist, as in one short moment, years of suffering were validated. Thankfully, I'd been able to skip the lengthy NHS waiting queue and had the cost of my private diagnosis funded through Right to Choose, so I was diagnosed within a matter of months, rather than years. Do you have ADHD, or is modern life just overwhelming? The reality is that, in the modern world, many of us will be feeling burnt out and overwhelmed by information. So, is it any surprise that we're increasingly distractible? As Dr Andrea explains: 'There's certainly growing evidence that people feel their environment – especially constant exposure to digital devices, social media and multitasking – can reduce attention spans and increase distractibility, even in people without ADHD.' With this in mind, the 'human brain simply didn't evolve to handle the level of information and stimulation we now face daily.' 'But while modern life can make anyone feel distracted, ADHD is a neurodevelopmental condition with symptoms that are consistent, long-standing and impairing across multiple areas of life,' she reminds us. So, whenever I hear people trivialising ADHD, I can't help but feel angry. It's not a quirky personality trait: it's an incredibly debilitating condition, and it's exhausting navigating a world designed by and for neurotypical people. ADHD isn't just losing your wallet or being a little bit 'scatty': it's so much more than that. Neurodiversity is finally in the limelight, and with awareness increasing, so many more people are sharing their stories. No doubt, it's saving lives. But the truth is that awareness without understanding is useless, and to suggest that 'everyone has it' diminishes the experiences of those who actually live with it. And no, it's not a 'superpower.' You don't have ADHD if you just forget your keys sometimes; you're probably just a regular human being living in an increasingly hectic world. Do you have a story to share? Get in touch by emailing MetroLifestyleTeam@ Arrow MORE: I'm desperate to lose my virginity but have a panic attack whenever I come close Arrow MORE: Video games are great for my mental and physical wellbeing – Reader's Feature Arrow MORE: Heston Blumenthal reveals touching wish after emotional moment with son
Telegraph
29-05-2025
- Business
- Telegraph
Nearly 2.5 million living with ADHD, NHS claims
Almost 2.5 million people in England have attention deficit hyperactivity disorder (ADHD), according to the first estimates by the NHS. That means about one in every 23 people across the country has the neurodevelopmental disorder, some living without a diagnosis. It is the first time the health service has made such an estimate public. People with ADHD may have trouble concentrating or sitting still. Other symptoms include being easily distracted, forgetfulness, finding it hard to follow instructions or organise time, and making impulsive decisions. Demand for a diagnosis has soared by more than 400 per cent since the pandemic, figures from the ADHD Foundation previously suggested. The lockdowns fuelled a near-doubling in the number of prescriptions for ADHD medicines, according to a study published earlier this year in the BMJ Mental Health journal. Researchers found that prescriptions per 1,000 people in England had risen from 25.17 in 2019-20 to 41.55 in 2023-24. The new estimates from NHS England also say 741,000 children or young adults aged between five and 24 have ADHD. The figures were developed using estimates from the National Institute for Health and Care Excellence (Nice) that suggest around 3 to 4 per cent of adults and 5 per cent of children and young people have ADHD. The NHS data suggests some 1.7 million are currently living without a diagnosis, although it does not capture anyone who has been diagnosed and treated privately, unless this has been added to their NHS GP record. While ADHD is not usually diagnosed in children under five – as some traits can be part of a child's normal development – estimated prevalence in youngsters aged four and under has been calculated to give an insight into how many may go on to be diagnosed. The estimates suggest that some 147,000 under-fives are likely to have ADHD. The new figures also suggest more than half a million people were waiting for an ADHD assessment at the end of March at 549,000, up from 416,000 a year earlier. Around two thirds of them were aged between five and 24. Experts have warned that the increase in cases may be in part down to the pandemic and changes to daily life and stress. They have also said there is an increasing awareness of ADHD, including via social media platforms such as TikTok and Instagram, which is likely to be encouraging more people to seek diagnosis and treatment. Benefits claims soaring However, officials are also concerned at the surge in benefit claims from people based on mental health and neurodevelopmental conditions. Advice from ADHD 'sickfluencers' on social media has coincided with a sharp rise in the number of people claiming up to £69,000 a year through the Access to Work scheme – which can be used on equipment and support, including work coaches, noise-cancelling headphones and Apple smartwatches. The total spent on the scheme increased to £258 million in the last financial year, up 40 per cent from 2022-23. Around a third of all demand is now driven by people claiming financial support for mental health conditions, up from just 5 per cent a decade ago. Louise Ansari, chief executive of Healthwatch England, said the figures were 'a first step in understanding the scale of demand for ADHD care'. 'Our new research highlights that many people with ADHD may simply be going without support,' she said. 'Long waits for assessments are one of the reasons people who show ADHD traits don't seek help, while those waiting for an assessment struggle to navigate the long waits.' Ms Ansari added that there was still 'a way to go to ensure data is comprehensive and robust'. She called for the ADHD figures to be added to official waiting list data, to 'give a clearer picture of waiting times, including who is experiencing the longest waits and why'.
Daily Mirror
27-05-2025
- Entertainment
- Daily Mirror
King Charles' sense of humour applauded by comic pal who mocks Harry on stage
Comedian and impressionist Rory Bremner says King Charles can see funny side of most things even in the royal household Rory Bremner says his friend King Charles has a 'terrific sense of humour' - thankfully, as he ribs the monarch's feud with his son Prince Harry on stage. The comedian and impressionist, who coached Dominic West in preparing for his role on The Crown, says the King takes all his material in good spirits. 'He's got a terrific sense of humour - he's got a great sense of humour,' says Rory. 'I've always liked him. I think he was ahead of his time. He's been wonderfully inspirational.' It's fortunate the pair get on, as Rory's latest joke involves Charles having to entertain US President Donald Trump during his upcoming visit. Rory's joke for his latest tour sees him quip in Charles voice: 'I'm expected to look after every Tom, Dick or… well, maybe not Harry.' In his skit, he makes out Trump's invitation, handed by Sir Keir Starmer, is 'like a red letter day from WH Smith', that he jokes Charles resents. 'He's been landed with the state visit and he's King of Canada,' laughs Rory. 'And Trump's talking about, 'Why don't you be the 51st state?'' As Charles he jokes: 'I would be able to show my face in Canada again. Even on the stamps.' But Rory believes he will see the funny side, as the King told him to 'shut up' when he previously quipped to him: 'In less than a year you've gone from head of state to head of prostate.' Now, Rory says his joke came out unfiltered due to him having ADHD. Speaking in the ADHD Foundation garden at the RHS Chelsea Flower Show he laughed: 'That's ADHD for you. No filter, it just came straight out.' Rory also sets up Charles as being an avid viewer of the controversial Netflix series in which Dominic portrays him. 'One of the lines I'm using now is the idea of Charles saying, 'I'm just watching The Crown, don't tell me what happens.'' But Rory insists his aim was to help Dominic portray Charles more sympathetically. 'Both Dominic and I sensed that the script was less sympathetic to Charles,' he says. 'We were, both of us, fans, if you like, and both of us like and admire Charles and feel that he's… we just like him. 'And I think one of the things we spoke about was when the script was being unduly unsympathetic, that somehow in the portrayal of the character, he could make Charles a more sympathetic character.' However, he adds: 'We did laugh quite a lot, Dominic West. I don't know how much I helped, I think we spent 45 minutes laughing. It's part of the body language as well.'
BBC News
28-03-2025
- Health
- BBC News
Dartford college celebrates receiving national ADHD award
A Kent college principal said it was a "tremendous achievement" to be recognised for its work with young people with neurodevelopmental Leigh UTC in Dartford, which specialises in engineering and computing, was recognised by national charity the ADHD deficit hyperactivity disorder, or ADHD, is a disorder where inattention and/or hyperactivity–impulsivity interferes with day-to-day life or development, according to the charity ADHD Kevin Watson said receiving ADHD Friendly School status was a "tremendous achievement". "It's confirmation that the work we are doing is making a noticeable impact on the young people we are working with, despite any barriers," he added."We are incredibly grateful to the ADHD Foundation for their invaluable support and guidance in allowing us to achieve this award."Colin Foley, training director of the ADHD Foundation, said: "I am so pleased that The Leigh UTC is getting the recognition it deserves in this area."In a busy high school, time, space and support is being given daily to those who might find school more challenging than others. Well done to everyone involved."A spokesperson for the foundation said the college had "gone above and beyond" to ensure the learning environment was inclusive to all young people, whatever their included adapting lessons to include movement breaks and dividing lessons into "learning episodes to support those young people who might struggle to pay attention for long periods."
