Assessments for adult ADHD: what makes them good enough?

As a medical student, I have observed colleagues on the MB ChB struggle with ADHD symptoms whilst awaiting assessment. And I have also witnessed NHS patients become suicidal because of such untreated symptoms. I understand that the NHS waiting time for an ADHD assessment can exceed 4-years. But, what if, due to their symptoms, patients were unable to work or study? What does life look like for those who medicine forgoes? I know what it is like to lose years of life to illness. It is unpalatable to me that such loss could happen due to a limit of resources in healthcare. Are we risking producing a generation of psychiatric patients who mourn the loss of what should have been some of the most exciting, and possibly productive, periods of their lives? Surviving but never thriving. Waiting for life to start. Furthermore, I would predict that the burden of the management on health and social care for some individuals whilst waiting for assessment exceeds that of obtaining a prompt ADHD diagnosis and its associated treatment. NICE recommend not treating ADHD pre-emptively. But could a trial of medication be diagnostic? Would perhaps ADHD medication even be of benefit to those who are subthreshold for diagnosis?

I expect some GPs do trial ADHD medication empirically, based on their own clinical reasoning. Conversely, I am aware that both RCGP and RCPsych have been approached by GPs for training in ADHD and that such requests have been declined. Consequently, the cost of obtaining a timely diagnosis is passed to those patients who can afford to access the private sector. This further divides society; marginalising those patients who need care the most. And so, we can address the quality of a diagnosis, as this article does. From a spectrum of a Gold Standard diagnosis to the top differential based on history and signs: what is the threshold for treatment? This threshold should be the balance between risk of treatment versus risk of untreated illness – thus considering the ideas promoted here. We have an opportunity to change the narrative.