Although you might not associate attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) as being related to one another, they...
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that includes an impairing and invalidating degree of inattention, hyperactivity, and impulsivity. This can be manifested in difficulties with starting and organising tasks, problems with sustaining focus and effort, difficulties with regulating stress and emotion, issues around short term memory, and with self-control and emotional regulation. The cluster of symptoms that characterises ADHD can lead to academic difficulties, and problems with focus at school or at work.
Much like other areas of mental health, the collective symptoms of ADHD have until the last few decades been unacknowledged as a condition. Until very recently in the UK and much of Europe, psychiatrists were reluctant to diagnose ADHD in adults, perhaps for the fear of medicalizing laziness or other constitutional problems. ADHD sufferers achieve less in almost every domain of their life and most do not come to our attention until there is a significant ‘ultimatum event’, either at work, college, in relationships, or worse still, in the criminal justice arena. ‘Ultimatum event’ event means that the situation has become so dire that ‘unless you do something, it’s [insert the situation] over’.
However, this is not to say that people with ADHD are ‘doomed’. If anything, people with ADHD have amazing minds, and the reason for this is because neural pathways in the brain get redirected; if a deficit exists in a certain area, such as attention, your brain is will find other ways to make this happen. This allows these individuals to be exceptionally creative and highly successful. Dr. Becky Spelman advises all those with ADHD to “pick something you like and channel your energy into it”.
ADHD Diagnosis & Assessment
It is uncommon for ADHD to present itself alone, and often there are other co-morbid conditions. These range from depression, anxiety, adjustment disorders, and substance abuse to neurological disorders such as tics, or rarely, Tourette’s. As a consequence, the assessment of ADHD symptoms cannot occur in a vacuum and must be considered as part of a comprehensive assessment process.
Any treatment plan for ADHD therefore must be based on a comprehensive diagnostic evaluation: the clinician should be able to document that the patient meets the criteria for a diagnosis of ADHD, being aware of possible concomitant medical or psychiatric conditions. This is where a medical doctor (MD) is of tremendous value. Symptom-based assessment is a framework for knowing how to help someone get better at day-to-day living. The real challenge of helping patients is to target the areas where they have problems. This is why all modern assessment tools focus on disruptions in clean-cut ‘domains’ or areas of life affected, and the degree of such impairments.
Sub-Types of ADHD
Daniel, G Amen, MD, a child and adult psychiatrist employed single-photon emission computerised tomography (SPECT) brain imaging to identify the type of ADHD his patients were presenting. What this has led to, is a list of seven sub-types of ADD, each requiring its own particular plan. It should be noted that this has not yet been made official by DSM-5.
1. Classic ADHD
This is the most common and easily identified of the seven sub-types of ADD. Scans of the brain tend to show that the individual question will have normal activity at rest, and decreased activity when peak concentration is required. This is especially true within the prefrontal cortex area. Those who suffer from Classic ADD have decreased blood flow in the prefrontal cortex, cerebellum, and the basal ganglia – with the ganglia being the main producer of dopamine. Symptoms of Classic ADD include being inattentive, distractibility, disorganised, restless and impulsive. Procrastination can also be a major issue.
2. Inattentive ADD
Inattentive ADD, along with Classic ADD has been known since the 1980s. Inattentive ADD is also associated with low activity in the prefrontal cortex and less than optimum dopamine levels. As such, symptoms can and do overlap to a significant degree with Classic ADD. These include, short attention span, distractibility, disorganisation, and procrastination. However, people who lie on this part of the ADD spectrum are not hyperactive or impulsive. Instead, they tend to be introverted and daydream a lot – often attracting the term ‘space cadets’ from uninformed observers.
3. Over-focused ADD
Those who are diagnosed with over-focused ADD present with all the classic ADD symptoms. However, in addition to this, they also have great difficulty shifting their attention from one task to another. As a result, this can often see an individual get stuck – or locked – into negative thoughts patterns or behaviours. Other symptoms include obsessing, excessive worrying, being inflexible, and frequently becoming oppositional in conversations. This is due to the deficiency of serotonin and dopamine, which, when brought back to functional levels in the brain, often reverses many of these symptoms, entirely.
4. Temporal Lobe ADD
This sub-type includes all of the classic ADD symptoms, but in addition, also presents with Temporal Lobe (TL) symptoms. The TL, located underneath your temple, is involved with memory, learning, mood stability, and visual processing of your environment. As such, people with this sub-type experience difficulty with learning, memory, and behavioural issues, such as being prone to anger, aggression and mild paranoia. As the issue, in this case, is the TL, the goal of treatment is to soothe neuronal activity and stop the nerve cells from over-firing or firing unpredictably.
5. Limbic ADD
Again, this sub-type includes all the Classic ADD symptoms, but in addition, also presents with a chronic low-level sadness that underpins a person’s general demeanour and outlook on life. However, this is not to be interpreted as depression. It is more of a state of pessimism or a “glass half full.” Individuals on this part of the spectrum will experience low energy, recurring feelings of hopelessness and worthlessness, as well as self-esteem issues. These symptoms are caused by too much activity in the limbic part of the brain – the centre of mood control – and decreased activity in the pre-frontal cortex, whether at rest or in a state of attempted concentration.
6. Ring of Fire ADD
This sub-type is regarded as a more extreme form of the Classic ADD variant. An individual on this part of the spectrum would present with all the usual core symptoms. In addition, they might also experience hypersensitivity to their environment – especially noise, light and touch. They might also go through extended periods where their interactions with others are rooted in oppositional behaviour (confrontation). They might also present with unpredictable moods, talk faster than normal, and be prone to excessive worrying and obsession. This is caused by excessive amounts of activity in the cerebral cortex and other areas of the brain.
7. Anxious ADD
Anxious ADD includes all the core symptoms of Classic ADD. In addition, an individual with this diagnosis might be prone to feeling anxious, tense, and also present with physical symptoms such as headaches and stomach aches. They will often think the worst and can fall into a state of catastrophising. There is also the likelihood of them freezing in anxiety-provoking situations, especially when there is the potential that they might be judged. The scans used by Dr Amen on his patients often show high levels of activity in the basal ganglia – responsible for producing dopamine. This differs from other sub-types of ADD, which usually present with low levels of activity in this area.
Myths about ADHD
Myth 1: ADHD Isn’t a Real Condition
There has been a lot of debate about the validity of ADHD as a legitimate mental health issue. But the truth of the matter is ADHD has been recognised by the National Institute of Health, Centres for Disease Control and the American Psychiatric Association as a medical condition. It’s not a fictionalised disorder, but in fact, a very common one amongst children.
Myth 2: It’s a Male Only Condition
Although the condition is more prevalent in boys than in girls – males are twice as likely to receive a diagnosis of ADHD – it’s not a male-only problem. With a few rare exceptions, mental health issues are rarely gender-specific. The reason for the misconception is how the symptoms manifest in each sex. Boys can be more hyperactive, while girls can appear more distant, making a diagnosis harder to make.
Myth 3: All People with ADHA are Hyperactive
Intense hyperactivity is seen as the defining trait of ADHD, but it’s only one symptom of a broader set of characteristics that point to the presence of the condition. In fact, there are several forms of ADHD. One variation known as ADD doesn’t involve any form of hyperactivity at all and is more centred around the attention span and retention of information.
Myth 4: People with ADHD are Lazy
One of the least compassionate assertions is that people with ADHD lack motivation and can’t apply themselves. The solution is often presented that they simply need to buckle down and focus more. The issue is that ADHD isn’t an attitude problem. It’s a neurological issue that affects attention-span and mental acuity.
Myth 5: People with ADHD Can’t Focus (Ever)
Even though one of the hallmarks of ADHD is the lack of focus, it doesn’t mean that focus is completely absent. There is a ‘deficit,’ but not a complete inability to concentrate at all. In fact, many sufferers are able to enter into a state of ‘hyperfocus.’ While academic pursuits may be a problem, an individual can lose themselves in creative activities.
Myth 6: ADHD is just a Phase in Childhood
Many people believe that ADHD is simply a stage of life. But as we’ve touched on, it’s not an attitude problem. The roots go much deeper. Although the symptoms may become easier to manage in adulthood, they never completely go away, although they become less pronounced and change in intensity.
Myth 7: ADHD is Caused By Poor Parenting
ADHD is not the result of environmental factors. It’s caused by an abnormality in brain chemistry. Since many of the symptoms are behavioural, it can be a logical assumption to make. But the condition never has or will be the result of what parents did or did not do for them children.
ADHD Throughout Life
Whilst many people associate the term with children and adolescents, ADHD is not something people ‘grow out of’. The condition appears in patients before the age of twelve, persists for at least six months, and causes problems in at least two environmental settings, such as home and school (in other words, the condition is not environment-specific or related to trauma). While many children with ADHD no longer display symptoms when reaching adulthood, up to 50% of individuals have symptoms that persist into the adult years.
Without treatment, ADHD will stay with a person regardless of age, although it may seem to evolve or change as the patient makes lifestyle choices that accommodate their condition, believing them to be indistinguishable aspects of their personality. Someone with undiagnosed ADHD may find physical and active work more fitting as this doesn’t require an extended period of sitting down and as such their condition may have limited career prospects.
Many people with ADHD have experienced periods of their lives when they attempted to “self-medicate” for their problem behaviours with alcohol, illegal drug use, or other damaging factors. Research into ADHD has given us a greater insight into the condition, and as such a wide range of treatments are now available, some utilising cognitive therapies and others taking advantage of medications, an option made available by a psychiatrist’s ability to prescribe medications.
ADHD coaching is a non-medical approach that helps both children and adults with ADHD take control of their lives. While medication can help with core symptoms such as difficulty focusing and hyperactivity, coaching is particularly useful in addressing secondary symptoms such as procrastination, time management, and organization. Approximately 62% of children with ADHD are treated with medication, while only 55% receive any kind of psychological therapy. Although medication is a viable treatment option (and sometimes necessary), it has been suggested if evidence-based behavioral interventions were more accessible, it could potentially decrease the reliance on medication for ADHD treatment. The evidence base for ADHD coaching, whilst still young, looks promising, and preliminary studies and anecdotal evidence suggest positive outcomes.
ADHD coaching offers a supportive and non-judgmental space for people with ADHD to discuss any troubling feelings, whilst also encouraging self-advocacy and autonomy in their care. It comes in different styles, but most are rooted in a deep understanding of ADHD and its impact on executive functioning. Rather than a coach dictating solutions, a Socratic method of questioning is often used, encouraging clients to find their own insights and actions. As such, coaching is a collaborative process that involves identifying the specific areas of life that are being affected by ADHD and managing these to better fit with the client’s personal values and goals. The sessions are typically conducted weekly, and individuals and coaches work together to review progress, identify challenges, and develop strategies for overcoming them.
To begin, the main issues at hand will be discussed, as well as the client’s goals. The client and coach will then develop a concrete, step-by-step plan to achieve these goals, adjusting the plan as needed as the sessions progress. Similarly to CBT, the use of homework assignments or action plans are typical ways to consolidate learning, where the client can practice newly learned skills or strategies in real-life situations. Strategies may include the development of mindfulness techniques, task delegation, and prioritizing exercise or diet, which can promote self-efficacy, clearer judgment, and self-esteem. The idea is to help the clients build a robust toolkit for managing their ADHD.
Please note below the discount fees for our bulk sessions of ADHD coaching, though you can also pay per session (at the chosen therapist’s rate).
£750 for 10 sessions with a Junior Practitioner (usually £80 per session)
£1,260 for 10 sessions with a Psychotherapist (usually £140 per session)
£1,530 for 10 sessions with a Psychologist (usually £170 per session)
When paying the discount bulk fee, please note the fee is non-refundable if you do not use all the sessions.
The National Institute of Clinical Excellence (NICE Guidelines) considers cognitive behavioural therapy (CBT) based therapy to be an important complementary treatment for adults with ADHD, as it contributes to an improvement in symptoms and can be used effectively alongside other therapies such as relaxation and stress management.
CBT may be a good choice for adults with ADHD when:
- Your preference is not to have drug treatment.
- You aren’t satisfied with drug treatments you’ve tried in the past.
- You find it difficult to take medication.
- Your symptoms are mild to moderate rather than severe.
- You are concerned you may misuse the substance based on a history of substance misuse.
A variety of CBT techniques such as verbal self-instructions, problem-solving strategies, cognitive modelling, self-monitoring, self-evaluation, and self-reinforcement can be helpful in treating children with ADHD. Although a wealth of research has been conducted using these different types of cognitive-behavioural interventions, no clinically important changes have yet been demonstrated on either behavioral measures or academic performance in children with ADHD.
Recent research by psychologists has also demonstrated that CBT for adults with ADHD is ‘highly effective’. As psychological treatment of ADHD is very much in its infancy, this is a rather tall claim. The early and relatively methodologically unsound studies of psychological treatment did however consistently show improvement in symptoms, improvement in skills and improvement in productivity. Dr. Becky Spelman is an advocate for improving executive functioning and quality of life, rather the solely focusing on symptom reduction.
With regards to ADHD, a number of medication options are available. Randomized Controlled Trials have consistently demonstrated the effectiveness of stimulants to reduce the level of ADHD symptoms in children and adults suffering from ADHD. Many patients with adult ADHD (or any attentional disorder for that matter) will enter therapy either thinking about medication or currently taking medication. Any psychological treatment, therefore, has to help them integrate the experience of taking a pill to assist with focus and restraint. Naturally, some people find it difficult to take medications routinely and others have been unsatisfied with the progress of medication-only treatments.
The end goal of psychiatric intervention is to improve the lives of patients. For children, this could mean allowing them to take advantage of the opportunities ahead of them in education. For adults, it may widen their suitability in job markets and open up career opportunities that were previously never considered.
Our Approach to Treating ADHD & Assessment Fees
At the Private Therapy Clinic, we use a psychometric screening tool, such as the CAARS Conners Adult ADHD Rating Scale, in combination with a clinical interview that explores the patient’s interactions and behaviour in various areas of their life, including their personal life, their relationships with their family members and close friends, and their academic and work performance. By exploring these three crucial areas of life, our psychologist or psychiatrist acquires the information necessary to make a clear diagnosis.
Our detailed assessment has two essential elements: during the first contact, the adult or child in question, and their guardian or parent if relevant, is invited to discuss their concerns and worries with the practitioner. Working together for a period of up to two hours, the Psychologist and client explore their family and personal history using a proven assessment tool.
In the case of children with suspected ADHD/ADD, their carer is also asked to arrange for a teacher or other professional at the school to fill out a detailed questionnaire and return it to our office. The material gathered in the questionnaire is further examined in the context of the information acquired during the first session.
While ADHD can often be treated effectively without medication, in some cases medication can help—often in the short term—to manage problem behaviours. In these cases, one of our Child or Adult Psychiatrists can provide a prescription.
Time required: 90 minutes
Assessment and report fee: £640
Time required: 75 minutes
Assessment and report fee: from £650
£250 for follow up appointment including prescription
£90 if the client wants a repeat prescription outside of the session
Who can I speak to further about ADHD/ADD assessments?
Understanding.org. (2019) 8 Common Myths About ADHD.Retrieved on 11th February, 2020 from, Link
Healthline. (2019) Debunking 5 Common Misconceptions About ADHD.Retrieved on 11th February, 2020 from, Link
WebMD. (2019) Adult ADHD Myths and Fact.Retrieved on 11th February, 2020 from, Link
Very Well Mind (22nd Nov 2019) Understanding Dr. Daniel Amen’s 7 Types of ADD. Retrieved on 18th June 2021 from, Link
ADDitude (19th Mar 2021) Dr. Amen’s 7 Types of Attention Deficit Disorder. Retrieved on 18th June 2021 from, Link
Ahmann, E., Saviet, M., & Tuttle, L. (2017). Interventions for ADHD in Children and Teens: A Focus on ADHD Coaching. Pediatric nursing. 43. 121-131.
Drah, H. (2023). 31 ADHD Statistics & Facts to Raise Awareness in 2023. MedAlertHelp.org. Link
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