May 22, 2023
Is ADHD in adults a big old con?
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ADHD, especially in adult women, has been a hot topic on social media of late... with questions being raised around its diagnosis being a current trend. Even more so, since the BBC Panorama program, released an expose on private clinics in the UK, misdiagnosing ADHD.So what is all the fuss about?
This week, after watching the documentary, Cass weighs in with her thoughts on why there's been an increase in ADHD diagnosis in recent years, and pulls apart the various holes in the BBC exposé (and there are some BIG ones).
If you loved this, definitely head into the back catalogue to hear Candin Phillips and Cass discuss why there's been an increase in adult women being diagnosed with ADHD in greater detail.
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Transcript
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A listener production. Well, welcome to another solo episode of
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Crappy to Happy. I am Cass and I am your host.
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I have just returned from my trip to Amsterdam just
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to give you a little personal update, where I've been
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invited to work with a company up there on their
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corporate wellbeing plan for twenty twenty three. So that is
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super fun, really worthwhile work. Love getting into organizations and
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working with fabulous, creative, talented people and helping them live healthier,
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happier lives by all meets. Give me a shout if
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you want me to come and work with your organization.
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But meanwhile, let's get into the topic for today. And
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this is something that I wasn't planning to talk about.
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I was just inspired to talk about this today following
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recent BBC Panorama expose on the over diagnosed of ADHD
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in private clinics here in the UK and what an
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uproar that has created on the internet. I'm not an
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ADHD expert, but I was really I had some things
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to say about this whole situation which I thought I
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would share with you. As you probably know, I have
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talked about ADHD here on the show. I've talked about
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it in relation to procrastination. I've had Canden Phillips, who
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is an ADHD expert and coach on the show to
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discuss ADHD and how it presents and why it is
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being so frequently diagnosed now and what hasn't been in
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the past. This kind of gotcha journalism, this undercover reporting
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where a BBC journalist went into private ADHD clinics and
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got an ADHD diagnosis in a relatively short space of
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time when he in fact doesn't have ADHD, has really
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potentially caused a lot of people to question and even
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more how real some of these diagnoses are. And there
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are plenty of people who really are skeptical about ADHD
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and the rate at which it's being diagnosed, particularly in
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adults at the moment, and certainly a show like this,
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a presentation like this doesn't help. In contrast to those
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private in contrast to the experience of his rapid diagnosis
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in those online clinics, he had an assessment with an
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NHS which is public health provider here in the UK,
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with an NHS psychiatrist which was much more in depth,
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much longer, in which it was found that he does
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not have ADHD, and so he used that as the
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kind of gold standard, this is what should happen in
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an ADHD assessment, compared to what then happened when he
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fronted up and paid a lot of money to some
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private clinics, private assessors here in the UK, and obviously
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there are private practicing psychiatrists and psychologists in most countries,
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so that's no different. And use this to sort of
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say that this is a scandal and that a whole
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lot of people who don't have ADHD are being pandered
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a diagnosis and then prescribed this strong stimulant medication when
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they potentially do not have the diagnosis, and how dangerous
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that can be. And no question, if somebody's being diagnosed
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stimulus medication and they don't have the diagnosis, then that
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shouldn't be happening. But let's talk about what was really
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happening here. Let's just unpack this a little bit from
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my perspective as a psychologist, and again I'm not an
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ADHD expert, but I do have some understanding of how
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these conditions are diagnosed and assessed and how they're potentially treated. So,
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first of all, just in terms of the journalistic quality
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of this program, it started with a tip off from
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a patient or a parent of a patient who was
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concerned that her daughter had been diagnosed very quickly and
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she was concerned with the diagnos wasn't accurate. These private
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clinics also charge a lot of money, by the way,
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so there's that there's this whole idea that this is
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a money grabbing thing. So it started off. He went
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to an NHS psychiatrist who knew that this was being
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filmed for a BBC Panorama episode. The psychiatrists in the
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NHS had plenty of time to prepare and he spent
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three to three and a half hours with this journalist
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to provide a full and complete assessment before telling him
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that he does not have ad EHD. The rationale for
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presenting this was that he wanted to show what a
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proper diagnostic process should look like, like how it's supposed
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to happen, and then compare it to what did happen.
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I'm going to say upfront, I love the NHS. I
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live in the UK and I think they're great. They're
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chronically underfunded. The Tory government has been just gutting them
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for the last twelve years. They are under resourced. You
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wait forever for an appointment. You know, you don't pay
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for it once you get there, but you do wait
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forever for an appointment, and reportedly the wait for an
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ADHD diagnosis with the NHS at the moment is five years.
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You cannot tell me that any NHS psychiatrist has got
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the time to spend three and a half hours doing
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a full and thorough assessment for ADHD unless they know
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they're being filmed by the BBC. So any of us
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in our jobs, if we know we're being filmed and
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we know we are presenting best practice, of course we
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are going to be doing our utmost to make sure
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that we present the absolute gold standard in terms of service.
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We'd be fools not to I don't think, and I
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know people in the UK and other NHS and private
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practicing clinicians in this country have all agreed that that's
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unlikely to happen in real life. Appointments don't typically go
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for three and a half hours. Don't hold me to that.
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I don't know. I'm just speculating that. I don't think
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that would really happen if he was a patient who
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walked off the street after a five year weight and
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if you've got a line of five years worth of
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weight out the door. Nobody spending that much time conducting
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an assessment. The other thing about psychological conditions in general
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is that they rely on patient report. If somebody comes
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to me as a psychologist and presents as depressed or anxious,
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or they describe to me the symptoms they're experiencing, the
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only thing I have to go on is what they
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tell me. We have assessments, we have checklists. They're all checklists.
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There was a big who are in this article about
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how this was a tick box checklist type of a process.
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I mean, yes, we probe and we draw out more information,
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but we're all using checklists, and we are relying on
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patients to tell us what they're experiencing. There's not a
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blood test for depression, there's no brain scan at this
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point for EDDIEHD, there's no care what does all swab
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for anxiety? We take patients at their word. We ask
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them to describe for us what they're experiencing. And so
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that is the thing that sets psychological conditions apart from
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other medical conditions. It's why it's also so effective that
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they can be conducted online, because there's no physical examination
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for a mental health condition. You know, this idea that
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these assessments are being conducted quickly online and that they're
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just going off what the patient told them and handing
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out an assessment. Well, you know, it's probably not unusual.
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That's what we have to go on. If somebody has
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walked into a clinic and described all of the symptoms
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of ADHD, and they've showed up at an appointment and
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paid a lot of money because presumably they believe this
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is what's going on for them, then there's no wonder
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that they're getting a diagnosis because they're describing the condition.
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So I think that that's a really important point to make.
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To get a diagnosis, you have to describe a condition. Now,
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some people will say, well, yes, this is the reason
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why with ADHD we talk to the other people around
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that person, and in ideal circumstances, then yeah, that is
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what should happen. I did talk to Canton about this,
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and there's various reasons why that's not necessarily helpful. And
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as an adult too, you know, you don't always have
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access to the people who are around during your childhood.
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If you're providing a developmental history and you're recalling how
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things were for you at school or growing up, you
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only have your own memory. A lot of people have
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very foggy memories and that's sometimes part of the condition.
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Sometimes people don't remember a lot of what was going
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on in childhood. Of course, the ideal is to have
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other people, you know, collaborate your self report with other
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people's reports. It's not always possible. So there's that. I
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just wanted to make that point. The other thing is
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that as a psychologist, I will spend time with the
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person and they can tell me what they're experiencing, and
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I know the DSM. I've been clinically trained, and I
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can pretty much diagnose depression or anxiety or have an
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idea that maybe this looks a little bit like bipolar,
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or maybe this looks a little bit like, you know,
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some other mental health condition. As a psychologist in Australia,
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I don't make a diagnosis, and I think that's kind
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of across the board, unless perhaps it's different in the
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States where psychologists do a high level of study, and
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you know often in the UK as well, they all
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have a PhD. You can't be a clinical psychologist in
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other countries besides Australia unless you have a doctorate, So
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it may be different, but certainly in Australia, I can
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make a provisional diagnosis if for any reason a patient
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of mine needs, for example, a more comprehensive assessment, or
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if they need to have their medication adjusted. If the
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GP has put them on some medication and it's not
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really working, or that needs to be tweaked and it
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needs more higher level kind of assessment of what's going
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on medication wise, then that will be referred to a psychiatrist.
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When somebody goes to a psychiatrist, when that psychiatrist sees
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the person, they are taking all of the information that
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I've already gathered. And remember that before a person comes
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to see me, often they've also already been to a GP.
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So a GP has conducted an initial screening, They've decided
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that this person should see a psychologist. I've then done
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an assessment and then all of that information is sent
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off to the psychiatrist. So there was this part of
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this expose a which was the fact that a psychologist
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had done an assessment, had said you've got a diagnosis. Now,
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even in this I'm pretty sure that is not correct practice.
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A psychologist doesn't give that diagnosis. But when it came
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to the treatment, which is medication. The psychiatrist very quickly,
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within the space of ten minutes, said this is the
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standard sort of medication. We would normally start you on this,
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And it was a stimulant medication, which is the standard medication,
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sort of first line medication for an ADHD diagnosis. And
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so there was an uproar that the psychiatrist spent less
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than ten minutes with this person before prescribing stimulant medication.
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What wasn't taken into consideration was the fact that that
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psychiatrist was basing that on the fact that this person
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had been through an assessment process with a psychologist already,
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and that is standard practice the psychiatrist a lot of
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the time. I don't know currently what the process is
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in Australia. Maybe it's different because psychologists often un not diagnosing,
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but often the psychiatrist is relying on the information that
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has come from another trained professional. And this is the
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way we reduce bottlenecks in service delivery as well. The
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whole problem. Remember that this started with that the NHS
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weightlist is five years. I know that there is a
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long long waitlist in other countries. I know in Australia,
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people wait forever and spend a lot of money to
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get a diagnosis. There are clearly bottlenecks in the system,
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and so anything that we can do to facilitate an
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expedite people's journey through the system to get them to
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where they want to be, which is a diagnosis and
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some medication to get back their quality of life, I
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would normally think that that's a good thing. Yes, we
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don't want to lose our best practice, we don't want
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to skip steps and shortcut and mismanage people. These are
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serious diagnosis that these are serious medications. But this, this
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is a professional team of clinically trained people who are
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relying on other people's professional training. And I think that's
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not a bad thing. I think I alluded to this
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before already. But these people who are attending private clinics.
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In the UK, there are private psychiatry clinics and private
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specifically ADHD clinics that have popped up, presumably to respond
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to this increased demand for ADHD diagnosis. Now, the way
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this works over here, if you're not familiar, is that
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even as a private provider, they can apply they can
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be kind of listed as an NHS approved provider. So
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if the NHS can't provide a service to a patient
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within a timely manner, then a patient has a right
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to choose. So the patient can go to the HSGP,
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for example, and if the GP thinks that they again
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after an initial screening, if a GP thinks that they
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are a likely candidate that they warrants further investigation that
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they may have ADHD, but the wait list is five years,
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then the patient can request that they be referred to
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a private provider. In some cases, if they are actually
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kind of umbrellaed under the NHS, there's some sort of
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reciprocal arrangement thing, then the NHS can actually fund that
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person's assessment by the private provider. In some cases, they
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if it's not an official if they're not sort of
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a credited, approved whatever the process is by the NHS,
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then they need to pay out of their own pocket.
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But the point being that anybody who is showing up
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to a private provider and paying out of their own
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pocket upwards of seven hundred, eight hundred one thousand pounds
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for a diagnosis of ADHD is not doing it for fun.
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There's probably a really good reason why they trying to
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