Could It Be ADHD? Understanding Adult Diagnosis & Coaching

Dr Marianne Trent (: 00:00

Do you struggle to concentrate to finish tasks or feel like your brain is constantly jumping channels? It might not just be stress, it could be a DHD. More and more adults are learning that what they've been battling for years wasn't just laziness or lack of willpower, but undiagnosed A DHD. In this episode, I'm joined by Dr. Cara Davey, a clinical psychologist who herself has A DHD, but also specialises in the assessment and coaching of people with A DHD. We unpack the signs, the diagnostic process, and what it's like to finally understand yourself. I hope you find it super useful.

(: 00:42

Hi, welcome along to the Aspiring Psychologist Podcast. I am Dr. Marianne, a qualified clinical psychologist. Now, unless you've been living under a rock, you cannot have failed to have noticed the rise in people talking about A DHD and neurodiversity that's led lots of people to consider, whether that might be something which could help them to understand themselves or someone that they care about, or maybe even both. I thought it was time that I met with someone who's qualified and experienced to talk us through all of these considerations about what the diagnosis is, what the assessment is, what it means about ourselves. And so I am delighted to welcome Dr. Cara to the podcast. Let's dive into our conversation and I'll catch you on the other side. If you do find the content helpful, please do subscribe, follow the show, like comment. Tell everybody I'll see you very soon. Hi, I just want to welcome along our guest for today, Dr. Cara Davy, for anyone who's a regular to the podcast, if you ever hear me talk about Dr. Cara, this is she. Hi, Cara.

Dr Kara Davey (: 01:53

Hi Marianne, lovely to see you. Thanks for inviting me on.

Dr Marianne Trent (: 01:56

So nice to have you here. And you have so many interesting things I could have invited you on to talk about. And in fact, later in the year, we're going to be talking about baby loss Awareness week, but today we're thinking about adult A DHD, aren't we?

Jingle Guy (: 02:11

Yes,

Dr Kara Davey (: 02:12

We

Dr Marianne Trent (: 02:12

Are. Can you tell me why that's resonated with you, if that's okay?

Dr Kara Davey (: 02:19

Absolutely. So yeah, I specialise in A DHD. I was diagnosed myself as an adult about five years ago now, and I suppose so a little bit about my kind of journey, the reason that we'll come on to talk about baby loss and infertility later in the year, I had a difficult fertility journey, including numerous losses and a stillbirth, and around that time also became apparent. So most of my infertility was kind of secondary infertility, and around that time noticed repeatedly kind of struggling with executive functioning type tasks. So for anyone who doesn't know what I mean by executive functioning type tasks, things like remembering things like I was forgetting my keys often and just struggling with things that weren't so much of a problem before. And I think as someone who's worked in trauma for a long time, initially my thought was, well, of course there's a lot going on in terms of the infertility and the grief and trauma, so I thought probably that's what's going on.

(: 03:17

But as I did trauma work to work that through and felt really much better emotionally, I was still struggling with more A DHD type tasks and that kind of forgetting things, et cetera, and started to look for what else is going on here. And after lots of reading and research managed to put together the dots that actually it was a DHD and that the kind of trauma and grief had turned up the symptoms of A DHD and that, although they'd always been there, I'd managed to compensate and find ways around that, but actually they were becoming much more problematic. So that's my kind of personal interest in it. And then professionally, I've gone on to train to assess A DHD. I also provide specific therapy and A DHD coaching to support people after diagnosis.

Dr Marianne Trent (: 04:04

Okay, that's really interesting. And actually what you're saying is that maybe a change in someone's personal circumstances can affect their resilience, which actually means that they're less able to cope with everything that's going on and therefore dropping more balls like rubber ones as well as glass ones and just not getting done the things that are actually quite important for your functioning. Is that kind of what you mean, Cara?

Dr Kara Davey (: 04:32

Yeah, I mean, I don't know if I would like the word resilience as such, but I think yes, essentially a lot of people who are diagnosed with A DHD as an adult have found ways to mask, to cope, to function despite the kind of challenges they have. And there can be a change in circumstances that suddenly mean it exceeds your ability to juggle and cope. And suddenly the things that before you were managing to get by on, it's like, oh, I've made a mistake there. Oh, I've made a mistake there. And it's like, why do I keep doing these things that I wouldn't have done before? And so I think it's to do with exceeding the capacity. There's only so long you can go on trying to function in a neurotypical way and do everything and compensate before the brain starts to say, well, I'm not sure if this is getting a bit much. And I think personal circumstances, trauma, grief can certainly be ways that one can exceed that capacity quite quickly. And just generally parenting for lots of women too is another one that suddenly exceeds capacity.

Dr Marianne Trent (: 05:36

Yeah, I hear you on that one. Can you tell us how A DHD might look different in children compared to adults?

Dr Kara Davey (: 05:44

Yeah, I mean, just to say around A DHD, firstly, it does vary for different people how it presents. So for some people they might be diagnosed with what we call inattentive A DHD. So they're struggling with attention concentration, but actually they don't show many signs of hyperactivity where they're struggling. The kind of classic thought of people struggling to sit still or needing to move, that's more hyperactive and you can be combined, which is a combination of both. So firstly, when we think of children, I think the kind of old school before we knew more about how A DHD presents, we think of children who can't sit still in class or might be behaving in a way that some people might have labelled in the past as kind of naughty. So often that's how we think of it, and often that's how it's kind of seen and picked up in children by the time someone becomes an adult, if they were presenting in that way, that hyperactivity tends to be much more internalised.

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They've learned ways to mask, to hide it, to, if they've received the average is that someone will receive about 20,000 more negative messages. If someone has a DHD as a child, then an adult who doesn't have a DHD. So they are constantly told, sit still, be quiet, don't do that. You're too much, you're too sensitive. All of these comments that mean by the time someone becomes an adult, they've often refined, I need to behave in a way that makes me seem more kind of neurotypical. So it's harder sometimes when you're diagnosing an adult to be able to pick up on, okay, what's there and what's a coping strategy? Whereas for children, often children act more in line with what they're experiencing and have done less of that masking. Yeah, but it will depend if someone is more inattentive or more hyperactive what you're looking for. But as a result, normally when you're working with adults, you're seeing the fallout of what has that masking done for them? So what is the emotional impact? How has it affected their self-esteem? How have they gone from perhaps over-functioning to try and mask those things to suddenly struggling to over-function? Yeah, people are trying to understand the impact that hiding their A DHD has had, even if it wasn't consciously. Whereas as children, there's less of that. If you can get it early on, you're actually helping with the A DHD rather than the impact of it.

Dr Marianne Trent (: 08:01

Yeah, absolutely. And I made me think about my own school reports, and they were always, Marriott talks, too much struggles to do this and that, but at the time, certainly wasn't the awareness really that girls could have a DHD or it wasn't quite so mainstream as it is now. And how does that pan out for women? Are there differences in the way that different genders would present with A DHD as an adult?

Dr Kara Davey (: 08:34

I think what we know is that often women are more likely to be diagnosed with inattentive A DHD, so less of that kind of hyperactivity. If they are hyperactive, it tends to be more internalised or it might show more as anxiety or kind of internal fidgeting under their desk or moving their feet where people can't see kind of. So that's what we know now is that that presents differently and it's more likely that women present that way. But actually I would say even to go further than that, I work with a lot of people who are quite high functioning who've not had diagnoses as children, but when they look back, it kind of makes sense. And that's the same for men too. There are other reasons that somebody who's quite high functioning might have been missed. It's not just women who struggle with inattentive A DHD.

(: 09:29

There can be men too. There are lots of factors, but yes, typically with women you see more of the inattentive type presentation. It's more internalised. It might come out more in kind of subtle things like friendship issues. You might see more of that kind of anxiety, as I say, as a result of that masking. There might be trying to overcompensate, be overly perfectionistic or yeah, that's more the kind of presentation you'll see in women, but it's certainly not exclusive to women. And what we know with women is it's also much more affected by hormones, which is obviously something that's less of an issue for men. But in terms of the monthly cycle in terms of pregnancy, postnatally, menopause, all of the times that women's hormones are fluctuating up and down, actually that affects a DHD symptoms in a way that is less understood because a lot of the research is still on men where that's not present.

Dr Marianne Trent (: 10:24

Thank you. And something called rejection sensitive dysphoria, RSD, is that more commonly expressed in women or does that seem to be kind of universal? Do you know?

Dr Kara Davey (: 10:36

I mean, I've certainly worked with men who talk about RSD too. I think RSD is for anyone who doesn't know this kind of finding rejection incredibly difficult and being very sensitive to that feeling of rejection. And some people argue it's part of emotional dysregulation that people are likely to be more emotionally dysregulated. Often women express emotions more freely than men, or men are kind of encouraged less to do. So you might see that women are more likely to talk about it or express that kind of RSD, but it's not solely women at all. Again, it depends on people's experiences and with everything A DHD can be there, but it also interacts with someone's own history. So people with A DHD might struggle with friendships, so they might make friendships very easily, but they might struggle to maintain those friendships. It's kind of a novelty. They meet someone, it's all exciting, and then they move on and find a new interest and they find a new friendship or it's harder to sustain it because people find it more annoying that they keep talking or whatever it might be. There are things that get in the way of friendship issues, and again, it's more common, but not always for women and girls to have friendship issues, especially in schooling. You find that girls often fall out more than boys do now if they've had lots of experiences of being rejected throughout schooling for those kind of things, you're more likely to be sensitive to rejection. So there's a combination of people's life experiences as well as things that you might be prone to as a result of having a neurodiverse brand.

Dr Marianne Trent (: 12:14

Thank you. And I'm extra glad that we've been able to nurture and sustain our friendship since 2008 as well, because it's just been a pleasure having you in my life in a personal professional, I value you, Cara, can we think when we're commonly screening for A DHD sleep can be a big one that basically you need to perhaps to have been problematic in the sleep criteria for that to be given the green stamp of approval in the past. Is that still given the same weight, do you know?

Dr Kara Davey (: 12:49

So firstly, just to say I massively value your friendship too, before I move on to that question, sleep is an interesting one. So sleep isn't a criteria on its own when you're looking to diagnose A DHD, people might ask around sleep, but it's not a kind of, it doesn't have to be there. It's not an essential criteria for someone to have a diagnosis. Again, what we might see is people who are internalising hyperactivity or kind of on the go a lot during the day or kind of holding in so busy that they're not really thinking about any worries or they've got quite a busy mind as soon as they go quiet to go to bed at night, suddenly that's when their mind's kind of very busy and it might affect sleep. So we do see sleep issues in people with A DHD quite common. And yeah, that's where lots of people are kind of overthinking, but it's not an essential criteria.

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People don't have to have struggled with sleep. Sometimes you find people are the opposite, where they are so busy in the day and they're so active and they're using exercise and things to manage kind of hyperactivity type symptoms that they just crash out instantly and they're like, oh no, I have no issues at all. I would say I've seen quite a few people where there's an overlap between neurodiversity and sleep apnea as well where people are actually struggling to get the right quality of sleep and kind of waking. And so yeah, there's some questions at the moment and kind of research around whether there's any link between that. But certainly if there are sleep apnea symptoms, that's likely to make a DHD symptoms worse and kind of exacerbate that We know that poor sleep doesn't help with a DHD symptoms.

Dr Marianne Trent (: 14:23

Very interesting. And I guess also it really depends how people have been sleep trained or not in their younger years as to whether they are good sleepers or not, but what distress that has cost them to kind of get there. Yeah, just talking to you has made me think, oh, I really miss the sleep of my late twenties, my mid to late twenties because my sleep patterns are certainly not like that anymore. And it's not for a lack of trying.

Dr Kara Davey (: 14:54

Yeah, absolutely. It's so much harder.

Dr Marianne Trent (: 14:57

Yeah, absolutely. Can we think then about what an adult A DHD assessment might look like? A great robust one, I guess Let's give that as an example.

Dr Kara Davey (: 15:08

Yeah, and I think it's worth, as you mentioned, a kind of robust one. There are a range of different qualities of A DHD assessment out there from people who are giving a diagnosis quite quickly and that might be cheaper as a result of that to people who are doing much more in depth assessments. And I think sometimes people can be attracted to the quick cheaper assessment because they often, people with a DH ADHD have often researched things a lot and go, I already know that I've got it. I just kind of want the piece of paper something official because it helps me to understand my life and to make sense of things. So sometimes people will be drawn to that. I think the downside of that is that sometimes these cheaper assessments are not being actually done by people who are approved to do an assessment.

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So they might not actually meet the nice guidelines kind of criteria. So sometimes people are being assessed and as a result, if they wanted to access medication for example, if they've not been assessed by the right person, they can't. But also they tend to be, sometimes these shorter assessments can be a kind of the same report is used again and again and they're not personalised. And I think a good assessment should not only use the kind of diagnostic interview that goes through the kind of questions and explores with someone, they're kind of looking at the different symptoms and examples of that. It should also speak to somebody within their, ideally a parent, but if not somebody else that can speak to what they notice and how they presented as a child. But it should also look at the wider kind of factor. What else is playing a part in this?

(: 16:42

So as we've said, has there been trauma in their life? Had there been other difficult life events as a child, are there medical issues that might be playing a part or contributing? And there's a whole host, it should be a kind of real holistic assessment. And I think that's not just to answer the question of is A DHD there or not? To answer the next question of, okay, so if I have a DHD, what do I do about it and what would help me? And I think so many people come out of an assessment that's less robust and less comprehensive and less holistic with kind of you can try medication or you can try coaching and that's it. Whereas actually there's no focus on, okay, for you it looks like this and this are contributing, this might help if you want to help with that or there's no kind of putting together of a personalised kind of treatment plan of what would help that person. Because just because people have a DHD traits in common doesn't mean they will benefit from exactly the same treatments and recommendations.

Dr Marianne Trent (: 17:44

I guess that they might almost pick and mix, choose different things at different, so it might be for example that you actually don't want to try medication right now, but it might be something that you would consider in future or the other way around you might be like, actually I would really like to experience perhaps what it is like to have less noise, to have less distractions, to be able to perhaps get through a task without being distracted by other tasks or exciting or novel things to do just to experience. I think it was a really nice idea of if you've got a fence and you need to look over the fence, you need to think about what steps you need to get yourself to be the same height as somebody else to be able to perform the same way in the task. And actually it's taking you all that much more effort to get the same performance as somebody else. Is that fair? Is that kind to yourself? Is that compassionate? And my experience of working with clients sometimes is they're like, actually, oh, when I take medication, actually I can meet the targets that I would set for myself a whole heap easier. But it is a personal choice, isn't it? It's not like you're going to get an A DHD assessment and you must have medication. It's always a personal choice.

Dr Kara Davey (: 19:03

Absolutely, yeah. As you said, some people want to try it, some people don't want to try it, some people can't because of certain health things that might be heart conditions or things that exclude it, it's a choice that someone might be drawn towards and they might kind of want to immediately or in the future. But likewise, there are many other options too that can help whether that be therapy, whether it be coaching, whether it be changes to lifestyle factors, whether it be equipment and things, whether it's, one of the things I really like doing with people in A DHD coaching is trying to find out what is the block for you? And it will vary. You could have five people who all come and say, I'm struggling with procrastination. And you might say, okay, what are the strategies to help with that? But actually the reason that each person is struggling might be quite different.

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Yes, they have a DHD, but one is finding it, the block is emotional. One the block is to do with trauma. One is the block is actually they've got too much to do and they're completely overwhelmed or so there might be a whole host of different reasons. One just needs to break the task down or change their environment or, so there's a whole host of different reasons why someone might be struggling with the same thing. And I think that's really nice to look at with someone. You can Google all the strategies you like online, but what is specifically the issue for you and how can we help you move through it, which I think is so much more personalised. And yeah, medication may be a part of that, but it might not need to be. It might just be someone understanding and walking you through that.

Dr Marianne Trent (: 20:35

For me, you and I have discussed in the past that we think I probably do fulfil criteria, but I've never actually got assessed yet for A DHD. For me, actually having structure really helps. So I find myself thinking back to when I was younger and my mum would put all the washing on my bed that had kind of come out of the air and cupboard or whatever, and it would then sometimes end up on the floor. It would kind of be shoved in cupboards. There was no order to that. And actually what I needed was probably someone to come in and sit with me and do it with me or sit and actually now it's time to put your washing away. Could you put your washing away before you go to bed? Or actually I've just put your washing out, go and put that away.

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And then when we've done that, we can do this. Whereas if there's not clear structure, someone might be listening thinking, of course you need to put your washing away before you go to bed. But if I've got into bed and I'm exhausted, I don't want to do that. I just want to put that on the floor. And yes, still now I think thinking back to A levels, actually I was doing really well until I got to A Levels and without the strong foundations and the accountability of GCSE teachers, for me, I had too much too freedom. And what I needed was someone to say, actually, you need to read that book Marianne, and then I want a summary because that would've really held me accountable in a way that I just didn't seem to be able to do for myself to the extent where I got three C's and a D at a level.

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But I do think that I am was capable of far more. And so still now I have to hold myself quite accountable. I use Trello for that. I look at what the component parts of a task are and try not to let all of the task overwhelm me, but to kind of break it down into smaller bits and get those done and kind of give myself deadlines. Do you remember when we published a book in a month in September, 2020? And actually for many people that would be a book in a month, but for me, and we were amazing, a fixed period of time where we'll get a product at the end, let's go, let's go. So yeah, still now I'll trying to think, well, I want that done by that time, so what are my backward steps that I need to do to make that possible?

Dr Kara Davey (: 23:02

Yeah, absolutely. It's so important that accountability. But also as you were talking when we did that kind of, I was going to say competition, it wasn't really a competition, but yes, let's both see if we can write a book in the month of September for both of us. There's that kind of competitive, novel excitement kind of interest. Actually, if it's harder to get motivated to do a task, then great to have someone to do it with, but also to have that bit of competitive element that kind of, oh, at the end of it we're going to have a conversation. Did you manage it or So it creates that kind of motivation that might not be there so much internally. And you're right around structure. And I think this is sometimes one of the differences we see in assessments between people who fit more with that inattentive subtype and those who fit more with the hyperactivity element, the more kind of combined presentation is that often people with that combined presentation and the hyperactivity as much as they know structure would help, they just cannot get it in place.

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Or if they do, it's in place momentarily and then they've suddenly forgotten the system even existed or they've kind of moved on and they often really, really struggle with that. Whereas those with inattentive, and I would say that inattentive often in my experience, overlaps with people who are also some of the time that inattentive is actually people who are autistic as well as A DHD. Then often they have managed to find structure in organisation and they know that it's really helpful for keeping some of that A DHD disorganisation or chaos in check and therefore they're able to stick with that. Or if it is with someone who's got autistic traits as well, sometimes the kind of autism craves more of that structure order organisation and that helps to really keep it in check, which is why often people don't present until maybe later or they present differently. So yes, order and organisation structures really important for A DHD, but sometimes people can't get it no matter how much they try or no matter how much they use those systems. And again, that's why it's really helpful to look at what is the block for this person or why or do they need another outlet for the hyperactivity or do they need external reminders? Do they need another person for accountability? What is getting in the way? Because that will be harder for some people to action than others.

Dr Marianne Trent (: 25:25

Yeah, absolutely. And I think also I didn't realise as a teenager or even as someone in my twenties, how physical exercise and activity would really help me to, I dunno, to optimally thrive. It always felt like a punishment exercise to me, something that you were made to do. And certainly when I was at school, I was made to do it in a pair of red massive briefs with white stripes down the side, so it was humiliating as well. Anyone that went to school in the eighties and nineties would be like, oh yeah, I remember those briefs. But it was never something that I was choosing that I was honouring my body and looking forward to doing. And I know we've had different experiences of exercise. I think you were very active when you were younger. I, I'd never had that. I think perhaps because I've got maybe some dyspraxic tendencies as well.

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Marianne is not very good at this, she's not very good at that. She's not very good at that. My mom didn't ever want to play tennis with me. I was rubbish and poor me, and I think it's only really probably 2020 really that I suddenly had more time at home and I started running and then I started strength training and it's gone from there. And that really, I think especially when I was grieving with my dad, God, exercise would've been so helpful to me, Cara, but it's only really when we begin to learn the way that our bodies and our minds work best that, I dunno, it can kind of give you a different way of understanding yourself I think.

Dr Kara Davey (: 27:03

But again, I think that's really important is that people with a DHD neurodiversity, often people don't just have one type of neurodiversity. It's not uncommon for people with a DH, ADHD to have dyspraxic tendencies and if you have those experiences of being told you're rubbish or you have been in a school that makes you do every single type of exercise and actually maybe you only enjoy one out of the 10 you've been forced to do. A lot of people then come away feeling like, Ugh, I don't like exercise. It's aversive. It is related to more difficult experiences, but if you can find the motivation, I may hate a lot of sport, but I really enjoy dance or you can find the one thing that you do enjoy, then a lot of people, yeah, it's a really, really helpful outlet and it's great for physical wellbeing, it's good for channelling hyperactivity and sometimes I will do an A DH ADHD assessment with someone and they'll say, oh no, I didn't have any hyperactivity as a child.

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And they'll go to list every club that they did after school and they're like, oh, I was in the rugby club, I was in the football club, I was in the network club and they list everything that they did and it was being channelled elsewhere. No wonder it didn't show in other ways because it was kind of really being channelled. But yeah, it is really important to find the exercise that lights you up. And that's the same with A DHD generally find something you are good at or find something you enjoy and you will become good at it. Find your passion and you will absolutely thrive in it. And as you say, if you've got a DH ADHD traits, you're so good at what you're doing, you found your zone of genius, you found the thing you love and you throw yourself in it and we can see the results as a result of that. If you were in a job you didn't enjoy, you probably wouldn't be presenting it as productive and able to do things in the way that you are.

Dr Marianne Trent (: 28:53

Yeah, I think when I've been in jobs that I don't enjoy, I create extracurricular responsibilities for myself so that I don't have to do the job. So I think just before we met I was working for Argos head office and I really enjoyed my colleagues. We had such a great time, it's a really nice team, but I was really quite bored of logging in at 9:00 AM logging out at 5:00 PM and taking customer service calls and so I could log myself out of the system and not be accountable. I would take on Excel spreadsheet duties to look at team performance and stuff, then my data would be completely skewed and it would be useless to anybody. But having something extra to keep myself busy in quite a mundane job really, I guess in terms of stimulation, I needed more. I needed other stuff to be going on under the desk so that I could sit still in this really boring repetitive role. I can still say it, good afternoon, store support, Marianne speaking, how can I help? Sometimes when I go to pick up the phone that still wants to come out, it wasn't enough. I needed more.

Dr Kara Davey (: 30:11

Yeah, absolutely. And again, that's not uncommon. The DHD brain is often moving quickly. There's lots going through your mind and doing something mundane isn't enough. It will be looking for more than that. So yeah, I mean it is helpful that you were able to create ways to stay in that, but that's what you might see in the classroom with the child who's always doodling or the child who looks like they're not listening because they're doodling, writing, drawing, whatever. They're distracted by something. Actually they're probably looking for more stimulation because it's not enough and their brain is kind of craving more. So yeah, that's not uncommon

Dr Marianne Trent (: 30:48

And sometimes that is treated negatively as well. Always filling with pounds, always rocking on a chair, never seems to be paying attention, staring out the window looking at this, doing that. Whereas in actual fact they may still be able to tune into exactly what you're saying, but they're just doing other things as well so that they can, I dunno, show you respect so they can pay attention but they need more. I think when we're looking at schools for example, I know we're not talking about children now, but what behaviours are exhibited when sitting still is expected? And I think it's just useful as a question for all of us to think about when I need to sit still, am I right with that? Do I need to do other things? Do I need to sit like this or sit in constrained ways or rock or fiddle, a little thing that I fiddle with off the front of my diary here. Sometimes just having a little look at what it takes for you to show up in the world.

Dr Kara Davey (: 31:46

Absolutely, and I think that's the thing, thinking about children but also adults in the workplace, actually the more someone is forced to do it the neurotypical way or try to get someone to sit still, be quiet, do things in line with something that doesn't fit with them, the more you're going to see a child who struggles and often then a child might end up being labelled as naughty or difficult or someone in the workplace might be considered kind of difficult when actually they're just trying to conform to standards that don't fit and don't work for them rather than being able to adjust and think what does someone need for children? Often in the classroom it might be like, right, can they do a few laps of the playground because they need to burn off a bit of energy before they're able to then sit still and to be able to listen or So yeah, I think that's really important to think about accommodations if you want someone to be able to thrive rather than labelling them as kind of naughty or not doing what they're told as if it's a kind of conscious choice.

Dr Marianne Trent (: 32:48

Absolutely, yes. Can we think about what people's options might be if they did want to explore an A DHD diagnosis? I'm guessing most areas of the country will have some sort of NHS provision. Is there a right to choose pathway and then of course private options as well?

Dr Kara Davey (: 33:07

Yeah, so if you are considering an A DHD assessment for you or for your child, the first step if you want to go down a kind of NHS route would be to contact your GP surgery. Most GPS will ask you to fill in, there are different questionnaires depending on if it's an adult or child and different practises have a different one, so check with your gp, but they normally do a screening questionnaire to look at does it look like there are symptoms present? And then you can be referred for a assessment in your local NHS team as long as they feel you meet the criteria. In some areas of the country, the weight is about five years for that. It varies depending on where you are, but actually the weights for N hs assessments are quite big at the moment. Now we know more and more about how it presents and more and more adults are looking back and realising that they've always had it.

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So yeah, they're quite long wait lists. There is a right to choose pathway as you mentioned, and that's the same for children as well, which is you can choose a provider that's a private provider that is funded by the NHS, so there will be some private options, so it's worth asking your GP surgery. They might say, okay, there's only a two year wait list instead of a five-year on right to choose. Some areas it's quite fast, some areas it's not. It is a real postcode lottery, so you can go down the right to choose kind of option. Again, if you think a child might have autistic traits as well as A DHD, you might want to look carefully at the providers that they give you a choice of because some will do both and some won't. So you might find that you pick a provider and actually they don't have a full understanding of say, autism and that affects how they feel about the assessments.

(: 34:45

That's something to look at. And then some people will say, actually the wait is too long. My child needs to have an assessment before, for example. I think you need to, trying to remember, I think it's two years before someone's G CSEs, they have to have a diagnosis in place to have any accommodations in their GCSE exams. So for some people they might notice tendencies in their child, their child might be struggling, and the wait list means that they would then not get accommodations in exams like extra time or someone reading out the questions or things that would support them. So they might say, I don't want to wait that long or I can't wait that long. It's impacting wellbeing and they might choose to go privately instead or they might feel more confident in a private diagnosis being more holistic. And so yeah, some people might choose then to go private and again, you've got bigger companies that might do sorter and lower cost assessments and then you've got more individuals that specialise in it that might do a more in depth and personalised assessment.

(: 35:44

It is worth thinking if people are wondering about medication, if you go for right to choose or private, sometimes that will be accepted by your gp, sometimes it won't. Even if your GP says go with this provider from right to choose, they might then say, we're not accepting shared care to pay for medication, but other GPS will take it. It's not an absolute no. So it is worth speaking, every GP has their own rules. They can make up their own rules of whether they accept shared care or not. So it literally varies and sometimes people might have a diagnosis, their GP says, no, I won't accept shared care, and they ring up the other GP in their area 10 minutes down the road and they say, oh we do. And so they just swap GP surgeries. So sometimes it's as simple as exploring in the area.

(: 36:28

But yeah, in terms of medication privately you might be able to access a prescriber through the, so when we do assessments, we're on a prescriber pathway, which means our reports, any reports done within the practise are accepted to be over quality standard and a prescriber will look and be able to prescribe medication. And if you get medication privately, again, you might be able to then stabilise on a dose and go back to your GP and say, will you take over shared care? So there are lots of options. It is a bit confusing. Children's assessments tend to be better done, so I would recommend getting someone local who does it face-to-face rather than online for children's assessments, for adults assessments. It's okay to do online as long as they meet the other kind of guidelines.

Dr Marianne Trent (: 37:15

Thank you. That's really interesting, really helpful for people to take on board and consider their options. I know it's probably quite a big question with perhaps quite a lot of range, but if someone's looking into, for example, a private A DHD assessment for an adult, is there a sign of a price range for that that people might be able to expect?

Dr Kara Davey (: 37:39

I mean, yes, but it does depend. It depends on how someone prices it. So there is quite a range sometimes in how long an assessment will take if you go in depth with someone, if someone has had a lot of difficult life experiences or it's more complex, it's going to be a longer assessment. So some people will price an A DHD assessment as a kind of a one-off fee. They might say, okay, it's a thousand pound or it's 1500 pounds, or you might get a one-off bulk price. Other people might say it depends on the length of the assessment. So within our practise we do it by an hourly rate because that means that for some people, otherwise they will be paying a high fee and they're not requiring that amount of time. It feels really unfair for them. So it's actually done much more on how long does this actually take and we're kind of charging you a fair rate based on that, so therefore it could fluctuate.

(: 38:31

But yeah, approximately I think the bigger companies who are doing a faster assessment and they might not be a psychologist or psychiatrist, they might be someone who's just doing assessments, I think you can get them probably from about 500. For most people who are going to a psychologist or a psychiatrist, you would be expecting a thousand, 1,500 more kind of rate and sometimes higher than that. Again, higher if you're doing a combined assessment. So if someone is assessing for autism, two, it's going to take longer and an autism assessment must be done with two an MDT. So multidisciplinary team, there must be two professionals doing that, which means obviously there's a higher cost to do that. But yes, that's a kind of ballpark figure.

Dr Marianne Trent (: 39:19

And I wouldn't be hosting this Aspiring Psychologist podcast if I wasn't advocating for qualified regulated, fully kind of professional indemnified experienced clinicians. And so I do think there's so much to gain by going for what seems like a slightly higher price, but you're getting that experience and you're getting that ability to look across the lifespan holistically, drawing in all those different possible hypotheses and situations and clinical or nonclinical presentations. So just to advocate for the qualified regulated providers such as yourself, Cara.

Dr Kara Davey (: 39:59

Yeah, and I think it's really important that somebody also part of an A DHD assessment is also being able to something called differential diagnosis. Look at does this best fit with an anxiety presentation? Does it best fit with bipolar presentation? Does it best fit with a DH adhd or what else could this be and what are the other possible explanations? And the problem with some people who aren't qualified and don't have that experience in other areas is also that sometimes they then go, ah, I think this is anxiety for example. And what we have a lot is that people come to us saying, we've been dismissed by another practise because they didn't really listen or they didn't really know how A DHD presents in people who are kind of higher functioning or in that kind of more female presentation, a lot more inattentive or so people have been completely dismissed and at the end of it they're like, well, someone saw me for half an hour and they said no, but they didn't even ask the questions or, so you might have spent 500 pounds to be told no when actually it hasn't even been fully explored to really understand what's going on.

(: 40:59

There have been occasions I've done an assessment, I'm like, oh, this doesn't feel quite so in line with what I expect with A DHD. And then I hear more and more of autistic type traits coming along and I'm like, ah, that has mastered that. Also, as a psychologist, you are formulating and you're like, does this make sense when I've got all of the information or someone who doesn't get all of the information and hasn't got the experience in formulating in that way, might miss it and people can then end up feeling really, if they're sure they have a DHD and they're told no when they do, actually, that can be a really unhelpful experience and costly to then have to pay twice.

Dr Marianne Trent (: 41:35

Yeah, absolutely. We don't want people to be in the position where they're having to pay twice to get the service that they need and deserve. Cara, are there any common misconceptions about A DHD and adults?

Dr Kara Davey (: 41:49

Well, I guess you've got the whole kind of, at the moment, lots of people are saying everyone has a DHD or is it being overdiagnosed or, so I think there's something around people feeling that it's kind of trendy or it's a way to access extra support or, so I think there's some misconceptions from some people that it's a desirable thing to have or that people are looking for it because of the kind of things they might get as a kind of support with it. I mean, I think most people you speak to with A DHD would say that even if there are massive strengths associated with it, which there are for some people, being able to to lean into your passion, it has great strengths, but at the same time, I think most people would say the reason that they're seeking an assessment is because it's had an impact, whether that is on their functioning, whether it's on their self-esteem, whether it's how they viewed their self, whether it's the comments made by others.

(: 42:45

Also, I think this idea that people would want to do it or it's desirable, I think is a massive misconception. Most people are finding it hard and finding that difficult. So those kind of comments are really tough. I think one of the things I notice around medication is for people who are quite perfectionistic in doing whirling roles that they're in, even if they're kind of under the surface feeling this kind of imposter syndrome, a lot of people think that medication will almost take away the symptoms, and I think a lot of people don't have so much of an understanding of the medication might help initially with increasing productivity and all of those things, but actually it can also lead someone to be more likely to burn out in that if they're already pretty productive and they lean into being more and more productive, people can be overly productive and actually they can struggle as a result of wellbeing. So I think sometimes as well, when you are, there's a misconception around medication is the way to go or this is what I need to do, I need to be more productive. And actually for someone, they might not need to be more productive, they might need to be focusing more on wellbeing and how do I conserve energy levels or motivation. Yeah, and I don't think people always talk about the downside of if you become too productive, is there a point at which there's a ceiling to that and there might be an impact.

Dr Marianne Trent (: 44:08

Yeah, absolutely. Very good considerations. I think people also worry that if they were to take medication that it would change them, that there'd be a different person. What do you think about that, Cara?

Dr Kara Davey (: 44:21

Yeah, I've heard that a lot. People who say, I don't want to try medication because what if it changes me as a person, or I mean, haven't spoken to someone who's tried medication who actually says that, who says I feel different. Some people will say that for a lot of people, medication improves kind of emotional dysregulation, like the kind of emotions being up and down, but actually for some people it's the opposite. Some people find that they feel more dysregulated with it, but I don't think, I haven't spoken to anyone who says, I feel different as a person. I don't feel like me or I feel so quick to kind of respond to other people now that a lot of people either find medication helpful or they say, I wasn't nearly as helpful as I thought. Or there's the risk, as I say, of burnout, of overdoing it. But I haven't really spoken to anybody who's tried medication and said, no, I don't feel like me anymore, and I need to come off it. So I think you're right. That is a misconception really.

Dr Marianne Trent (: 45:22

That's really good to know. Thank you so much for your time today. Could you tell us where the best place for people to learn more about you and your work might be?

Dr Kara Davey (: 45:32

Yeah, so I have a couple of different websites, but I will link in the, I'll send across you to link in the notes just my link tree, which takes people to the website to free resources. I have a free Facebook group where I share top tips, so everything is on the link tree, so I'll share that with you. It is in the name of Dr. Davey, a DH ADHD coaching. But yes, feel free to reach out if we can help you further.

Dr Marianne Trent (: 45:59

Amazing. Thank you so much for your time and sharing your absolute nuggets of wisdom with our audience.

Dr Kara Davey (: 46:07

You are very welcome. Thank you for inviting me.

Dr Marianne Trent (: 46:09

You are welcome. See you soon. Bye. Bye. Oh, thank you so much for watching, and thank you again to my guest, the lovely doctor Cara Davy, I hope you found it helpful. If you have, I would love it if you would rate and review the show, follow the show, like subscribe, comment, share the content with people who you think it might also help, that really is the kindest thing you can do for any creator that you rate. Please do go and follow Cara on her socials or check out her link Tree. As she mentioned, the books we mentioned in that challenge were my first book, the Grief Collective Stories of Life Loss and Learning to Heal and Cara's book, there's a Rainbow Baby in My Mommy's Tummy, is a resource to help young children who've experienced the stillborn or late miscarriage loss of a sibling, and then there's a new pregnancy around, and it's to help children understand what has happened and hopefully to feel more confident and hopeful for a happier outcome in future. It's a lovely book and it gets great reviews, so please do check out that book and the Grief Collective in the description or show notes if you think either or both of those might be helpful to you or someone you are working with. If

Jingle Guy (: 47:31

This podcast, you'll be on The Psychologist podcast, Dr.