By EK Wills
There is a lot of information, and not all of it helpful, around developmental conditions such as ADHD. Ironically, it has become the focus of attention for a while now, particularly on socials, but there is still lack of clarity about where to go to get help.
The committee for the private practice in psychiatry has had people with lived experience report that they and others in support groups have significant challenges in navigating the complex health system to find help. There is conflicting information online, it is unclear who can do assessments, it can be costly and while there are different pathways, it’s not clear which one is suitable for which individuals.
It’s important to note that traditionally a person would present to their doctor (generally a GP) with symptoms or complaints and the doctor would then direct them to a relevant service. With much information in the public domain now, the situation is somewhat different in that people are often requesting specific assessments when they presented with a symptom cluster, such as for ADHD.
However, while it may seem apparent this set of symptoms could be ADHD, there are a number of conditions that can mimic this - from organic conditions related to physical health to other mental health issues such as depression.
What is ADHD?
ADHD stands for attention deficit hyperactivity disorder and is defined in the manual utilised in Australia and North America called the DSM-5 TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision). There are strict criteria to consider when making a diagnosis of this condition which means it can be an involved process. This is further complicated by the fact that there are several clinicians who are qualified to conduct this process.
Where do I start?
The best place to start is with your GP. This is because there are a number of tests that need to be conducted, such as blood tests, to rule out the possible physical health issues that may present with similar symptoms. This can include thyroid issues, vitamin B12, D, or iron deficiencies, etc. It is also part of the investigations your psychiatrist would like to see prior to doing their assessment so you can take along the results if you progress to the next stage.
Your GP will also be able to direct you further based on your needs. For example, if you have low mood or anxious thoughts around your symptoms, then a psychologist referral with a mental health care plan (MHCP) is useful because it also addresses conditions that could complicate an ADHD assessment.
Which specialist do I see for an ADHD assessment?
If you are a person under the age of 18, then it is reasonable to see a paediatrician in order to have an assessment of ADHD. Paediatricians have variable wait list times and require a referral from your GP.
If you are over 18 you can see a psychologist or a psychiatrist but these professionals have different approaches and treatments.
A psychologist or clinical psychologist will do a number of questionnaires and tests to determine a diagnosis of ADHD, or a neuropsychologist can do comprehensive psychometric testing, to look at areas of executive function such as attention and impulsivity. Psychologists can provide a provisional diagnosis of ADHD at this point given that one specific area has been tested.
If you feel you will require medication then a psychiatrist needs to do an assessment and prescribe this. A psychiatrist will also conduct questionnaires, so if you have already done these with a psychologist, then this can assist the process with your psychiatrist.
What is involved in the process?
Usually, the physical health aspects are considered first in order to rule out ‘confounders’ or ‘comorbidities’, meaning anything that looks like ADHD but isn’t.
This will also involve a comprehensive history to look at mental health issues such as bipolar disorder, trauma or personality vulnerabilities.
Then ‘collateral information’ which supports the assessment will be required. This would be teacher’s comments in school reports such as the person being ‘talkative’, ‘distracted’, or a ‘day dreamer’, etc. A parent or teacher can also complete a questionnaire.
The combination of all these investigations will then provide the outcome of a diagnosis or steps involved to then progress towards clarification. For example, if there is more than one diagnosis possibility, then one may need to be treated before the other can be confirmed. If there are substance use issues, this further complicates the picture as a second opinion may be required before medication can be prescribed.
How do I pay for all this?
The process can be many steps and involve seeing different professionals. The public health system is currently too overwhelmed to address ADHD unless it has significant functional issues such as legal or mental health escalations.
This means that you will need to see a private practitioner. Thankfully, Medicare can assist with rebates for sessions but generally it won’t cover all the costs. Be prepared to be out of pocket. How much will vary depending on who you choose to see. Just make sure that the referral goes to someone who is able to do the assessment and provide the treatment that you need.
Now I’m really confused!
This is an involved process that has many steps but don’t worry.
The best way to approach any mountain is to take the first step. Don’t think about the end goal yet, but look at what needs to be done first. The best place to start is with your GP, not socials, because they have the training and the tools to direct you down the path that will help you.
