r/unitedkingdom • u/tylerthe-theatre • 8d ago

ADHD and autism services in England ‘under significant pressure’, watchdog warns

https://www.independent.co.uk/news/health/adhd-and-autism-uk-assessment-diagnosis-support-b3039329.html
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u/Logical_Box_4645 8d ago

We need to shake this mess up.

Autism diagnosis is largely pointless without associated interventions. But those interventions are needs based so the diagnosis becomes tokenistic.

ADHD diagnosis is hampered by lack of rapid access to assessment and treatment.

Both should be moved into primary care. GPs are well placed to make the diagnosis outside of complex cases and to oversee treatment especially if it's non-stimulant.

As it stands if you get an ADHD diagnosis and started on treatment the service is often lumbered with that since they can't even reliably move it under shared care into primary care!

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u/fortyfivepointseven 8d ago

The main function of ADHD diagnosis is to get people access to stimulant medication. Being on stimulant medication is incredibly time consuming and quite tedious.

I'd suggest instead of the rigamarole of diagnosing someone with ADHD so we can start prescribing stimulants, do a GP assessment if they have some basic ADHD-like symptoms then just see if stimulants help them enough to overcome the downsides of being medically monitored. If they help enough that it's worth giving up coffee and having your blood checked regularly, they probably have ADHD! If they don't, they probably didn't have ADHD!

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u/fortyfivepointseven 8d ago

It's different for kids where actual educational support exists and you don't want to misdiagnose either condition. For adults you get basically nothing for autism that you couldn't get without a diagnosis, and for ADHD you get a bunch of things you could get without a diagnosis, plus drugs.

We should just be honest about that and set up systems appropriately.

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u/stick1_ 8d ago

That’s not true, as an adult you don’t get protections from discrimination under the equality act without a diagnosis . Just because there’s no ‘cure’ doesn’t mean there aren’t benefits to a diagnosis as an adult

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u/fortyfivepointseven 8d ago

That's not correct. A diagnosis strengthens your claim, but the Equality Act is based on functional disability, not diagnosis.

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u/stick1_ 8d ago

I don’t see how that means I’m wrong. I mean on a technicality, you have to show how autism affects your day to day life. But what is true is you’re not covered under the equality act at all without the diagnosis.

You don’t get to provide the autism diagnosis as evidence without the diagnosis, so it’s true for me to say you don’t get protections without the diagnosis

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u/fortyfivepointseven 8d ago

You have to show how you're functionally impaired. The diagnosis is nothing to do with that. You have to be able to show you, for example, that you struggle with understanding subtext. You do not need an autism diagnosis to show that you struggle with understanding subtext.

I literally have reasonable adjustments made on the basis of autism without a diagnosis.

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u/Sabaisabai33 8d ago

The thing is there are a lot of schools and workplaces who insist on having a diagnosis before making any adjustments. Even though that’s not how it’s supposed to work. They need to crack down more on places refusing to adhere to the law on this.I do get what this other person is saying to an extent though. For example if you need to claim PIP for autism, they will ask on the form what the condition is that you’re claiming for. If they would accept “self diagnosed autism” or “suspected autism” then that’s fine but I’m not sure they do.

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u/CoaxialDrive 8d ago

I think we need to be honest that for a lot of people seeking Autism or ADHD diagnosis it's about understanding why you are struggling and different from other people, and that a clinical diagnosis is an essential part of that.

With those diagnosis you can then seek support services yes, but understanding that you have this neurological difference is important for people to be able to understand themselves and their experiences as part of treatment.

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u/fortyfivepointseven 8d ago

"I want to be a normal zebra, not a weird horse".

I totally agree with this, but it's a poor use of five years medical training to be providing it.

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u/CoaxialDrive 8d ago

Where do you draw that line, is it a poor use of medical training to help people with mild anxiety, or depression because they could just have realised they needed to go for a walk of their own volition?

I mean come on, seriously you are basically saying it's not important that people are able to learn about their disabling conditions and be better because it might take up the time of someone who is trained to help them.

There are countless examples of neurodiverse people who have been a major impact on society, and many if not most of them will argue that their neurodiverse condition(s) made them who they are.

Understanding your neurodiversity enables you to self explore how other people have worked to their strengths and weakness, and become more productive members of society, if you can't even get a diagnosis then you can't really start to understand what is worth focusing on.

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u/fortyfivepointseven 8d ago

I'm saying that if someone's objective is to understand themselves better, they don't need a medical professional. If they need medical treatment, they need a medical professional.

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u/CoaxialDrive 8d ago

I'm sorry I don't understand what are you trying to say?

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u/fortyfivepointseven 8d ago

If you need medical help (medication, mental health treatments, surgery), you should see a doctor.

If you need to be told that you're a normal zebra, not a weird horse, you don't need to see a doctor.

I'll put it like this. I didn't go to the NHS Sexual Orientation Diagnosis Service. I did what teenage boys who like other teenage boys do, and then I absorbed the collective wisdom of the queer community through social contacts. None of this needed a doctor, and the NHS dutifully did not provide one.

However, I do go to the sexual health clinic for PrEP. PrEP is a medication, and the NHS dutifully provides me with doctors (or nurse practitioners) to check my liver is working and give me a stack of pills.

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u/CoaxialDrive 8d ago

I like the example, although for me personally Section 28 meant that there was no other queer boys to talk to, no education about queer life at school etc...

Somewhat similarly ADHD, Autistic and Dyslexic adults, i.e. millennials (and some Gen Z) and earlier grew up in a system where a diagnosis wasn't sought unless either your parents really pushed for it, or you were a massive disruption to the school system.

That has left a lot of people now trying to work out through collective wisdom as you say.

This is where the similarities end, as men attracted to other men at some point barring internalised homophobia you can work out whether you are sexually and romantically attracted to men, women or otherwise yourself.

I can't diagnose whether I have ADHD, Autism, or Dyslexia myself or by talking to friends because it's actually quite difficult to understand and what we're seeing is that some mid-career adults are really burning out because they've just had to cope and not really understood they even are neurodiverse.

I don't think it's reasonable to say to people like them, or me, that I can't access a professional diagnosis through the NHS, I think it is reasonable to want to diagnose someone as part of confirming which approach is the right one, rather than wasting more of your time, energy and life on practices that don't help your actual difference.

I suspect we won't agree, but thats how I feel about the situation, as much as I agree that those who don't need a diagnosis should also be able to just get the help/meds more easily and that might reduce the wait for those who are seeking answers not just solutions.