What is behind the precipitous increase in the number of adults diagnosed with ADHD? A BBC Panorama The survey transmitted on Monday (15 May) showed a worrying number of private clinics, some of which now also see NHS patients, diagnosing people with the condition and offering prescriptions for stimulant medicines on the basis, on at least one occasion, of a 45 minute Zoom Consultation focusing on a series of generic and meaningless questions such as: Do you have trouble concentrating in school?
THE Panorama Reporter Rory Carson was diagnosed with ADHD and offered medication from three private clinics. He paid between £685 and £1,095 per appointment and was quoted for prescription costs of over £50 a month, indefinitely. When he visited an NHS consultant, who met him for an in-person interview that lasted over three hours and delved into his mental health and personal history, the psychiatrist concluded that he did not have ADHD . Carson’s research has suggested that the vast majority of people who attend these private ADHD clinics receive a diagnosis of ADHD. (All three clinics denied overdiagnosing people.)
The documentary was not received well by patient advocacy groups, such as the ADHD Foundation, which argued in its response to the program that the bigger problem is that the condition remains underdiagnosed and that most people with ADHD are offered little or no support. (The group also noted, quite fairly, that the NHS psychiatrist was the only one told in advance that his consultation had been filmed as part of an investigation and that few NHS patients were being interviewed three hours.)
ADHD is a neurodevelopmental condition characterized by problems with inattention, hyperactivity, and impulsivity that can be severely impairing: Studies have suggested that people with unaddressed ADHD are more likely to be socially isolated, struggle in school, be involved in motor vehicle accidents or other accidental injuries, have substance abuse problems, and be involved in the criminal justice system. Last year, I reported on the dramatic increase in adults being diagnosed with ADHD in the UK.
Yet many of the symptoms of ADHD are prevalent who doesn’t have trouble concentrating these days? and determining who meets the threshold for a diagnosis is not an easy decision. If you set the clinical bar too high, you potentially exclude vulnerable people from receiving specialist support, life-changing drugs and a helpful way to understand how their brains work. Setting it too low, the diagnosis becomes essentially meaningless: ordinary human behavior is needlessly pathologised, people who don’t need it are encouraged to take long-term drugs with potentially harmful side effects, and the idea takes root, in certain circles. uncharitable, that ADHD is simply an excuse and not a real thing.
[See also: The NHS cant help the mentally ill can influencers?]
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Much of the public conversation around ADHD has centered on this issue: Are we diagnosing too many people or not enough? But the urgent question raised by the Panorama documentary is best thought of as: how many people are staying measdiagnosed with ADHD, when would a different mental health diagnosis and different support be more helpful?
A substantial proportion of people willing to spend hundreds of pounds to see a private psychiatrist, while NHS waiting lists are years long, will be desperate and emotionally vulnerable. It’s no surprise that many of them suspect they have ADHD, given how common the symptoms are and how the condition has come to dominate online discussions of mental health, but what’s surprising and statistically unlikely is that around 90% of the time the underlying problem is really ADHD, rather than say depression or bipolar disorder or substance abuse or insomnia or just unhappiness.
This was a concern that Allen Frances, a prominent psychiatrist and professor emeritus at Duke University in North Carolina, raised when I interviewed him last year. Frances, who presided over the publication of the fourth edition of the so-called psychiatry bible, the DSM IV, and later argued that mental health disorders are grossly overdiagnosed, noted that mental health diagnoses are subject to fads: underlying symptoms rarely change, but the way we tend to understand and interpret them does. Human nature is very stable, but people’s understanding of anguish is labile, she told me. One risk for psychiatrists who diagnose ADHD hastily, sloppily, and inaccurately is that they make people sick, particularly if they offer these patients the stimulant drugs used to treat ADHD. You don’t want someone who has bipolar disorder, which is classically characterized by inattention and hyperactivity, to be given a stimulant because stimulants can make bipolar disorder even worse, Frances warned. This is true of a number of other conditions that are mistaken for adult ADHD.
When the psychologist employed by a clinic called Harley Psychiatrists told Carson over Zoom that she thought he met the criteria for ADHD, she ended the call with the words there’s no due date, you’re diagnosed for life. How could these words be received by someone desperately unhappy, alone and scared? The only follow-up was a seven-minute video call with a psychiatrist who prescribed stimulant drugs without even asking Carson if he suffered from any other mental health conditions. Although the clinic has admitted Carson shouldn’t have been able to get a prescription and said it has updated its processes, we have no way of knowing how many desperate people have been misdiagnosed, or even how many have found themselves being processed by that. which a former Harley Psychiatrists patient appeared on Panorama, Casey, described as a diagnostic factory. These people were supposed to help me and they took advantage of me, Casey tells the BBC, wiping away her tears. Simply viewing this as an overdiagnosis issue underestimates the scale of this national medical scandal.
[See also: Are you mentally ill, or very unhappy? Psychiatrists cant agree]
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