We are not taking new patients at present, sorry.
Dr Davies has over 10 years experience in diagnosing and treating Attention Deficit Hyperactivity Disorder (ADHD) in adults, in both NHS and private clinics.
What is ADHD?
Many of us have problems with attention, hyperactivity or impulsiveness at times. In people with ADHD these problems are there most or all of the time, and have a substantial impact on ability to function in multiple ways. ADHD is classed as a neurodevelopmental condition. Put simply, it is thought that parts of the brains of people with ADHD have developed a bit differently and work a bit differently. Genes that affect how dopamine works in the brain are known to play a role. But there are probably many different genes that can be involved (over 100 at the last count). This could explain why the condition shows itself differently in different people. It could also explain the overlap with other neurodevelopmental conditions such as autism, dyslexia and dyspraxia (developmental coordination disorder). People with ADHD are more prone to develop problems with anxiety and depression, low confidence or start to use street drugs or gamble. There has been recent research about how people with ADHD are more likely to sustain fractures, crash their cars, develop diabetes and startlingly, die on average 7 years earlier than people without ADHD. The hope is that treatment will begin to address these impairments. The good news is that overall, ADHD responds better to treatment than just any other mental health disorder you can think of.
Who gets ADHD?
ADHD tends to run in families and heritability is about 70%. It shows itself by age 12 usually, and affects 3-5 % of people of school age (up to 1 in 20). Of people who have this condition as a child, around half will still have it as a young adult. If a person has ADHD, it will almost always be present from childhood. But sometimes it is not picked up until adulthood – especially if the problem is more inattentiveness than hyperactivity. Historically, more males have been diagnosed with ADHD than females – but it may show itself differently in women and get missed. Nowadays, many adult adhd clinics are seeing more new women patients than men.
How is ADHD diagnosed?
There is no blood test or brain scan that can diagnose ADHD. The diagnosis is made by a careful assessment of symptoms and how they affect the person. It takes at least a couple of hours, and information from people who know the person well is needed. Often assessments such as DIVA are used. Really they are just a collection of standardised questions about symptoms. Many NHS and private clinics send out pages and pages of forms, and they won’t see you unless you fill them all in. We think this is really silly because people with ADHD are mostly not good with long forms (Secret – a lot of the forms don’t get read at the NHS Clinic when they are sent back!). Most of our patients have already done forms and lots of research by the time to they look for a private appointment. DIVA (Diagnostic interview in Adults in ADHD) – The DIVA5.0 is s structured diagnostic assessment based on the DSM5 criteria. It takes an additional hour or so. It’s useful if you need a higher level of diagnostic certainty – for example for an Occupational Health or legal report, if the clinical picture is complicated or if the clinician is inexperienced. The DIVA might be needed if you want shared care (but very few GPs around Cardiff offer this) or if you might want someone else to take over your treatment in future (but whether private or NHS, they are likely to want to do their own assessment). For many patients whose priority is to start treatment by a cost-effective route, a DIVA is not needed (and the NICE guidelines do not specify use of the DIVA is required). A detailed clinical interview with an experienced clinician covering all the important areas is fine in most cases. Maybe one of the reasons waiting lists have become so long is that we spend too much time on minutiae. It doesn’t take 3 hours to diagnose Schizophrenia, OCD or Alzhiemer’s – so why ADHD?
What about QbTest? This has been introduced in some NHS clinics including Cardiff (as well as in private clinics) as a screening tool. In basic terms, you look at dots on a computer screen while a web cam tracks your eye movements to see how well you are concentrating. It would be great to think that a computer could diagnose ADHD reliably, without all that talking. But a 2023 meta-analysis (number-crunching of data pooled from published research) concluded that QbTest was only “acceptable” at telling if someone did or did not have ADHD. The study concluded that QbTest “should not be used as stand-alone screening or diagnostic tool, or as a triage system for accepting individuals on the waiting-list for clinical services”. So, we don’t offer QBtest. If you want good a screening test before booking an appointment, the ASRS-5 has just 6 questions and was developed for the World Health Organisation. It is quick, free and is surprisingly accurate (Sensitivity 91%, Specificity 96%, according to the admittedly limited research).
Who can diagnose ADHD?
The NICE guidelines say “A diagnosis of ADHD should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise”. The NICE Guidelines also recommend medication over other non-medical treatments in adults who are impaired by ADHD. GPs do not start medication for ADHD so it will usually be a Psychiatrist who starts medication (but some Nurses and Pharmacists can prescribe too, Psychologist don’t). Unless you are sure that you don’t want medication, you might want to find someone who is both experienced in diagnosing ADHD, and who can prescribe. Dr Davies can assess and prescribe.
Is ADHD Over-diagnosed?
It is certainly diagnosed a lot more than it used to be. All of us at some time are restless, inattentive or impulsive. So it can be easy to convince yourself you might have ADHD. Haven’t we all wished we could concentrate for longer, get better grades,or be more organised? Yes! Does this mean we all have ADHD? No! If you have never lost your keys or phone, or been late for work or lost track of what someone is saying – well done! Most of us have done these things now and again, but it does not mean we have ADHD. People with ADHD experience the symptoms often, and in more than one setting. Importantly, there must be “clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.”(DSM5TR). It is important to understand this, because some patients come to an appointment convinced they have ADHD, and can be disappointed – even cross – to be told the doctor is not convinced they have it. That said, for people who do have ADHD, the condition can restrict many aspects of life – work, study, relationships, family, leisure, health and more. Treatment can be life-changing.
ADHD Treatment
Medication can be very effective – even life-changing- for adults with ADHD. This is particularly so with moderate to severe ADHD. In mild ADHD effects can be small or negligible. Almost always, medication requires specialist input (and Dr Davies can issue private prescriptions for the condition). In theory, a GP will take over prescribing when the patient is on an effective dose of the right medication, as long as there is continuing specialist review – so called shared care. But many GPs in South Wales won’t do this – even when an NHS specialist has made the diagnosis.
ADHD coaching is also popular and there are some great self-help materials and support groups. There are forms of CBT (cognitive behavioural therapy) that have been adapted for helping with ADHD.
Private ADHD treatment in Cardiff
Sometimes, a diagnosis is all a person will want, or their employers or University may need confirmation of the diagnosis so that adjustments can be made. For those who choose medication, Dr Davies is able to prescribe long-acting stimulants (such as methylphenidate, lisdexamfetamine), Atomoxetine as well as sometimes other drugs. Dr Davies does not usually prescribe short-acting amphetamine-based drugs. Adderal is not prescribed in the UK.
Please note that Dr Davies sees patients aged 18 and over, and is not qualified to assess or treat children.
Costs
Dr Davies believes in being up-front about costs
New patient appointment ADHD –
Assessment with DIVA – detailed report – DSM5 criteria- 2.5 hrs clinic time – £900
Some clinics charge less, but they might load extra pricing on to the fees for follow up.
Follow-up
ADHD dose adjustment appointment £120
(up to 15 mins, includes prescription if needed)
Private prescription fee £30
(outside appointment)
Review and take-over treatment – £360
(For patients already diagnosed with ADHD by someone else,
with a copy of the assessment).
Insurance – Sorry, we are no longer taking payment through any health insurers.
You would need at least 2 or 3 follow up appointments (maybe more) over the first few weeks after starting on treatment, to get to the right dose for you (“titration”). Once you are on effective treatment that suits you, specialist follow up every 6 – 12 months is usual. If Dr Davies sees you privately, he can’t give you an NHS prescription – just a private prescription. With a private prescription, you will need to pay the pharmacy for the medication and this might be £40 – £100 or more for a month’s supply. Your GP might agree to take over prescribing once you are on a stable dose (shared care). Prescriptions through the NHS in Wales are free. So if your GP takes over prescribing, you won’t pay for the medication. We suggest involving your GP from the outset, and asking him/her for a referral. Dr Davies’s experience in South Wales is that many (though not all) GPs will not get involved with shared care prescribing – regardless of whether it’s with a private or NHS specialist.
So, if you have private assessment and treatment for ADHD, the cost of specialist appointments and medication is going to be £2,000 or more in the first year. That is a big commitment. But it is similar to the cost of, say, a private knee arthroscopy procedure lasting less than an hour. ADHD treatment can be very effective and sometimes life-changing.
If comparing prices, it’s worth noting that some providers have reduced the cost of initial assessment but doubled follow-up costs, which can really add up over time.
After titration – Repeat Prescribing – Stimulant Medication for ADHD
If you are staying on the same dose of stimulant medication, we can arrange for prescriptions to be posted to you at regular intervals, or to your chosen pharmacy. Alternatively, we can send the regular prescriptions to an online pharmacy who will post the medication directly to you. Prescriptions will be written around the 15th of the month before they are needed. So, your prescription for November will be written and posted mid-October. We will ask you to set up a standing order for £30 per month. The advantage of this will be that you will not need to have to worry about re-ordering and you should get your prescription in good time. This is especially important if the pharmacy needs to order the medication or if stocks are low.
Ad-hoc repeat requests – If you prefer not to have a regular order, you can still request repeat prescriptions month by month but please allow at least 7 days before your prescription runs out.
Annual review – We recommend that you have an annual review appointment about your medication.
Medication Breaks and long term medication We also recommend that every 2 years that you have a short break of about 2 weeks from medication, at a time that suits you. This is to check whether you still need the medication. Although many patients do stay on these medications for a several years, this should only happen if you definitely need them and if the benefits outweigh the risks, for you. While on the medication, you may find you can establish new habits and routines that will last after you stop the medication. Taking stimulant medication for years and years could increase the risk of developing brain disease later in life or put a strain on the heart. Dr Davies will be pleased to discuss longer-term use of stimulant medication and brain health more generally at your annual review appointment.
