ADHD

This page outlines our processing of ADHD medication requests.

Summary points

• The Diagnosis must be made by a suitably qualified ADHD specialist. Please see the National Institute for Health and Care Excellence for further details 
• Any ADHD medication needs to be started by the specialist and prescribed by them until the patient is on a stable dose. That means no further dose adjustments are needed (generally after a minimum of 3 months).
• The specialist can then request that the GP takes over prescribing. Both the specialist and the GP have to enter into a Shared Care Agreement. This defines who has what responsibility relating to monitoring and any issues that may arise. Until a shared care agreement is in place all prescribing needs to stay with your specialist. 
• The shared care agreement ends if for any reason the medication dose changes (for example there are significant side effects, the medication is ineffective or medication is restarted after a longer pause such as a few months).
• The shared care agreement ceases if the agreement is not adhered to. This includes monitoring and follow-ups. This is particularly important for any patient being seen privately.
• The general principles of shared care include clear and timely communication from the specialist directly to the GP, communication cannot be via the patient. The dosage should not exceed the product license or NHS formulary. Please see our Summary of Shared Care Responsibilities for further details.
• We need asurance that care will continue especially when self-funding or using a private insurance. This includes changes due to any medication shortages that need to be managed by a specialist. We will not make any dose changes or increases to ADHD medication 

Clarification Notes

Due to the long waiting lists on the NHS a large number of providers offering ADHD assessments and treatment have arisen. While many are offering appropriate care and doing detailed assessments, there have been documented reports of patients being given an ADHD diagnosis and advised to start treatment based on inadequate assessments.

Because of the impact of ADHD medication, we ask all private providers whom we are not familiar with for an assurance on the training of staff making the diagnosis. Until we have this, we will not be able to prescribe your medication. Please refer to out our ADHD Checklist page for more information.

There are many adults nationally with undiagnosed ADHD. Media and social media coverage of this has led many patients to suspect they have ADHD and to come forward requesting referral for an assessment. We can appreciate why, for these patients, getting clarification and potentially a diagnosis of ADHD is important and potentially life-changing. Unfortunately, as a result of the huge increase in adults with suspected ADHD, the waiting times for assessments on the NHS has become very long (up to 5 years). Waiting times for children are fortunately much less but still significant.

Understandably some patients are reverting to self-funding private assessments. Often this results in a request for us to start prescribing stimulant ADHD medications. Unfortunately for many patents this is not possible. We will briefly explain why below. We have an ADHD checklist which explains our process and circumstances when we could prescribe ADHD medication.

Stimulant ADHD medications are major psychostimulants and potent medications with significant side effects. They carry significant risks to your health and can cause addiction and are subject to abuse and for are sold illicitly at high value. These are the reasons why these medications are under strict regulation that applies to other medication containing morphine, fentanyl, diamorphine (heroin) or cocaine under Schedule 2 of Drugs Act 1971 (MDA) and the Misuse of Drugs Regulations 2001 (MDR).

The list of side effects include:

• insomnia
• weight loss
• aggression
• nausea
• vomiting
• raised blood pressure which can increase the risk of strokes and heart attacks.

This is in addition to worsening of any underlying mental health conditions and can lead to anxiety, depression, hallucinations and personality changes. In children their growth can be affected as well. Therefore this type of medication needs close initial monitoring followed by regular lifelong monitoring.

• Methylphenidate for adults
• Methylphenidate for children

Similarly the use of these drugs is not advised (contraindicated) in a wide range of medical and psychological conditions (listed on our ADHD Checklist Page).

A variety of medical and psychological conditions may present in a similar way to ADHD (listed on our ADHD Checklist Page). Therefore The National Institute of Clinical Excellence and Psychiatry guidelines require that the specialist (usually consultant level psychiatrist) needs to be suitably qualified in excluding these other causes. Diagnostic criteria and treatments vary from country to country and we will only accept a Diagnosis made according to the UK Criteria.