Adult ADHD, Autism and Tourettes Team (AAATT)

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a lifelong neurodevelopmental disorder affecting 3% of adults but may not have been diagnosed in childhood. There are different subtypes of ADHD:

• Combined presentation - a wide range of inattention and hyperactivity/impulsivity symptoms present
• Inattention presentation - mainly inattention symptoms (e.g. being easily distracted or having difficulties with organising tasks) present.
• Hyperactivity/Impulsivity presentation - mainly hyperactivity symptoms (e.g. fidgetiness, restlessness, constantly on the go) present
• ADHD in partial remission - some ADHD symptoms after a previous diagnosis, but does not meet the full criteria anymore.

People without ADHD may experience ADHD symptoms, but for people with ADHD this happens often and interferes with the person's ability to do the things they want and need to do in everyday life.

People with ADHD may also experience mental health difficulties including mood and anxiety issues.

Getting an ADHD diagnosis

The first step to receiving a diagnosis for ADHD is speaking to your GP or other relevant healthcare professional.

If they think you would benefit from our service, a screening appointment will take place to decide whether an assessment is required. If this is agreed the person will be added to our waiting list.

The diagnostic process typically includes either 1 longer (approximately 2 hours) or 2 shorter appointments with a diagnostician. Prior to this, questionnaires are to be completed by the person and ideally someone who knew them as a child. Feedback is usually at the end of the appointment and will include a discussion of your potential follow-up options.

ADHD support we offer

Depending on the persons, our ADHD Advice Service or our Comprehensive/Complex Therapeutic Intervention Pathway may offer the following support:

• Psychoeducation - to enable the person to better understand ADHD, develop coping strategies for associated challenges, and/or promote independent living skills. We may also offer some support with further education and employment if appropriate.
• ADHD medication - If you wish to consider ADHD medication, you may be offered an assessment appointment and depending on the outcome you will be referred to one of the following pathways:

1. Non-medical prescriber
   You will be required to do a physical health check at your GP surgery to ensure it is safe for you to start ADHD medication. You will be supported to find the right dosage for you (known as titration), and you will be monitored with a non-medical prescriber throughout your ADHD medication journey. To find out about the ADHD medication process please go to the Frequently Asked Questions section of this webpage. Once stable on the medication, your care will be transferred back to your GP for continuous of ADHD medication. Frequent reviews will take place, to support you throughout the process.
2. Community Mental Health Team,
   This team will do your physical health checks with you to ensure it is safe for you to start ADHD medication.You will be supported to find the right dosage for you (known as titration), and you will be monitored by the team throughout your ADHD medication journey. They will offer you all your medication appointments, and any medication queries will be dealt via CMHT.

ADHD Advice Service

We run a virtual Advice Service for adults with ADHD (18 and upwards). This service offers advice is offered on a variety of topics issues, such as learning about ADHD, anxiety, and impulsivity, managing anger, and medication. Our support worker can offer advice on activities of daily living, such as budgeting, daily planning, meal planning and budgeting. This service is on the telephone and/or video.

You can use this service if you:

• Have been assessed by our team and their carers.
• Have a diagnosis of an ADHD.
• Are 18 years of age and over.
• Have a Northamptonshire GP.

An initial assessment is required to ensure the service is suitable for your needs. People who are diagnosed by our team are automatically assessed.

For individuals who are already diagnosed, please visit your GP, and ask to be referred to the Adult ADHD, Autism and Tourette’s Team & Asperger’s Team. We will need a diagnostic assessment report to be provided to us prior to your appointment. The assessment does not need to have been carried out by our team, however we do require evidence of a comprehensive diagnostic assessment in line with NICE guidelines. If no report is available, you can be referred for a diagnostic assessment with our team by your GP.

 What if I am already diagnosed with ADHD or ADHD and Autism  (dual diagnosis)?

If you already have a diagnosis, you may be able to receive short-term support from our team (as above). An appointment would be offered to assess whether we are the best team to support your needs.

Waiting for your diagnostic assessment and wish to be seen quicker?

You have the right to opt for your assessment and/or treatment via an alternative provider than NHFT AAATT service.

You can choose to obtain your assessment and/or treatment via the Right to Choose pathway OR a privately funded provider.

These options may mean shorter waiting times for a formal diagnosis. However, it is important to note that if you opt for "Right to Choose" or a privately funded diagnostic assessment, there can be variations in quality. This could potentially impact the timely progression if you later seek further NHS treatment from AAATT.

If that occurs, you may require a diagnosis review to be completed by NHFT AAATT, which is subject to waiting times, currently over 12 months for the review alone. If it is deemed suitable for you to progress to the medication pathway after your diagnostic review, you will then be subject to AAATT medication pathway waiting times , which is currently 12-18 months.

Primarily, this is to ensure robust patient safety and quality measures are maintained within NHFT AAATT's service.  Regrettably,  a private or Right to Choose diagnosis cannot be used as a leapfrog mechanism to avoid waiting lists for treatment within NHFT. Therefore, if the NHFT AAATT clinician determines further diagnostic steps are required to validate diagnosis, those steps must be followed.

If you wish to explore these options, you can discuss with your GP who will be able to guide you through some of the key considerations in selecting an option that is right for you and your particular circumstances.

• If you do opt to choose an alternative route for your diagnosis, please ensure you inform AAAATT who will remove you from our wait list and enable another patient to occupy that place.

For Professionals - Supporting Patient Choice

In order to support your patient in making an informed decision about their diagnostic options, you may wish to consider the following:

There are significant variations in diagnostic quality across various providers. Northamptonshire ICB should be able to assist you in determining which providers have achieved positive outcomes. (Please note: The ICB is currently unable to comment on quality. However, once the Accreditation framework is established, they will be able to advise which providers have successfully been accredited after undergoing a thorough due diligence and quality review process.)

Some providers offer diagnosis only or diagnosis and treatment. It is a patient right to opt for post diagnostic treatment to be delivered by providers other than NHFT AAATT.

If a patient opts to choose NHFT for their post diagnostic treatment after receiving their diagnosis by an alternative provider, in order for them to smoothly progress to pharmacological treatment with us, diagnostic reports MUST demonstrate that providers have adhered to current NICE guidelines - Available here Recommendations | Attention deficit hyperactivity disorder: diagnosis and management | Guidance | NICE

Lack of evidence of these guidelines being met, may result in your patient requiring a diagnostic review to be completed by NHFT AAATT, which is subject to waiting times, currently over 12 months for the review alone. If it is deemed suitable for your patient to progress to the medication pathway after their diagnostic review, they will then be subject to AAATT medication pathway waiting times , which is currently 12-18 months.

Primarily, this is to ensure robust patient safety and quality measures are maintained within NHFT AAATT's service.   Regrettably,  a private or Right to Choose diagnosis cannot be used as a leapfrog mechanism to avoid waiting lists for treatment within NHFT. Therefore, If the NHFT AAATT clinician determines further diagnostic steps are required to validate diagnosis, those steps must be followed.

Patients may not be on both NHFT AAATT and Right to choose waiting lists at the same time. If your patient decides to opt for an alternative provider than NHFT AAATT, please inform us and we can remove them from our waiting list.