Teachers tend to raise concerns if the child is noted to have hyperactivity/ impulsivity/ disruptive behaviour. Parents may be told that the symptoms are due to their home environment or due to their parenting. Girls tend to have inattentive type of ADHD hence are picked up by teachers much less. Currently, Paediatricians or Child and Adolescent psychiatrists diagnose and treat ADHD in children. There are often long delays for appointments, and some services only accept referrals for young people with ADHD which meet the treatment threshold (meaning, with severe symptoms) and comorbidities. After diagnosis, when the medication doses are effective and stable, care is transferred to GPs for routine monitoring and repeat prescriptions. Approaching adulthood, adolescents may be discharged from their team but not be accepted by an adult team. In adults, the services have very long waiting lists (more than a year) and some service commissioners may fund an out-of-area diagnosis while others may not.

Boys get diagnosed with autism earlier than girls, as girls are better at masking and get diagnosed around puberty. Most screening tools are based on male samples. It is very difficult to find clinicians who can diagnose autism in girls (or indeed in women), because it requires the clinician to notice subtleties in communication, and to have a higher threshold of suspicion even if the assessment score is lower.

When would pursuing a diagnosis of developmental disorder such as autism and ADHD advisable, even in adulthood? Here are 5 reasons

  1. To help avoid receiving unhelpful labels due to mis-diagnosis. This is not to say that someone with developmental disorders will not have a comorbid psychiatric disorder, such as anxiety or depression, but some labels are particularly unhelpful especially to children and young adults. If a person has had difficulties in executive function, communication and social interaction since childhood, even if they fell below the radar, getting assessed for ASD or ADHD will clarify the situation.
  2. To seek appropriate behavioural management. Tailor communication, to overcome difficulties in information processing. Keep a consistent approach using clear language; state the obvious; avoid inferences/ implying things.
  3. To predict difficult situations by planning ahead, for example if anticipating a change of housing, school or employment.
  4. To request reasonable adjustments at the workplace. To explain to others why a person needs to have things done a certain way, eg routines, transitions, unusual sleep patterns, using assistive and accessible technology such as sound recording, text-to-speech software, screen overlays, and screen readers. Some workplaces are more accommodating than others.
  5. To show to the person that there are others out there like them, who can give accounts of first hand experiences and how they overcame challenges. Reading posts on Facebook by people with lived experience, who belong to relevant support groups, is very helpful.
  6. To have a high index of suspicion for other developmental conditions, such as dyslexia, dyspraxia or dyscalculia, in the person or in near relatives.
  7. To educate the person so they can create a life around themselves which as much as possible suits them: by choosing friends that accept them, by developing and building on areas of strength and by requesting adjustments from school, university or work.

A group of UK experts including ADHD patient groups, clinicians, academics, UKAAN (Adult ADHD network), educational and occupational experts met to discuss shortfalls in providing ADHD services in the UK and published https://www.adhdfoundation.org.uk/wp-content/uploads/2022/04/Failure-of-Healthcare-Provision.-Consensus-Statement.pdf

ADHD and Autism may co-occur. 20% of individuals with ADHD may have autism, and this group is at higher risk of developing comorbid psychiatric symptoms (such as anxiety) than either alone. Both run in families and certain behaviours may be considered “typical” for certain families so less likely to report it. Moreover, families may apply accommodations at home, which may minimise reported difficulties. The UK ADHD partnership convened a consensus meeting attended by group of UK experts and published https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01585-y with recommendations for the identification, assessment, interventions and treatments for adults and children with autism and ADHD. Please see Tables 1,4,5,6,7,8,9,10 for practice recommendations for comorbid ADHD and ASD. Notice how the recommendations include interventions that are not medications: rather, they are behavioural, environmental, psychoeducational, and proactive.

A developmental history, and psychiatric history are fundamentals prior to any diagnosis.

To diagnose ADHD the following scales are used

DIVA-5

WEISS

To diagnose Autism, rating scales are not diagnostic instruments, but tools to aid diagnosis.

ADOS-2

ADI-R