• Therapist Bethany Ashley-Smith, who has additional training in working with and assessing ADHD, shares her thoughts on the BBC's recent Panaroma investigation ADHD: Private Clinics

  • We have therapists who specialise in working with ADHD – find them here 

The BBC's recent Panorama ADHD: Private Clinics investigated how ADHD assessments are made, questioning how robust these assessments are and whether there is a risk of wrongly prescribing powerful medication. ADHD has become something of interest, debate and controversy in the UK, and the documentary has divided opinion. 

Personally, I felt as though I was watching it as two people – the professional who has insight, education and training in ADHD; but also as the patient who felt scared, intrigued and frustrated at their own life experience, looking for answers through her own journey to ADHD diagnosis.  

I have been a mental health nurse for 20 years, and trained as an addiction psychotherapist 14 years ago. Over the last five to seven years I have noticed a significant increase in the volume of clients that were either diagnosed with ADHD or awaiting assessment, and at the same time I started to become very aware that I had limited knowledge and experience in neurodiversity. 

When it came to my own potential diagnosis I really had to consider my beliefs around the condition. I recalled my own disbelief that I could have a condition that was associated with badly behaved children that couldn’t sit still. I was also curious – maybe there was some help available for areas I struggled with? As a mental health professional I was aware of how powerful medication can be, and also the risks and side-effects that come with all medication – especially a controlled drug

I also had to accept my own lack of knowledge, which was uncomfortable given I routinely worked with clients who had the diagnosis, and accept the potential that the professional who may assess and diagnose me may also be lacking in true understanding of the condition. I was intrigued by this and following my own diagnosis I have continued training and researching into ADHD.

BBC Panorama's ADHD: Private Clinics had lots of value. It highlighted the importance of robust assessment – ADHD has a set of symptoms that can manifest in various ways, but also can look like symptoms of other conditions that must be taken into consideration when diagnosing. I am very aware of how it could feel if you have been diagnosed, or are waiting for diagnosis, that you cannot trust the process, and that trust when obtaining healthcare is paramount. 

I undertook training at with The UK Adult ADHD Network (UKAAN) with King's College Hospital last year and qualified to assess and treat ADHD. Since training I have chosen not to assess as a lone practitioner as part of assessment is also ensuring the individual doesn’t have another diagnosis: c-PTSD (complex trauma), bipolar disorder, and Autism can all look very similar. My training does not qualify me to diagnose other conditions and therefore Ive chosen to use the training to enhance my understanding of ADHD, as well as informing my therapeutic approach. I continue to refer to trusted psychiatrists who can do an ADHD assessments when this is indicated or requested.

Today my client group is made up of mainly ADHD clients, as well as clients with other neurodiversity. My clients keep fresh in my mind the power of diagnosis and correct treatment, which can be life-changing when appropriately and carefully prescribed. However I have also journeyed with clients that have not had robust assessment or early medication management and seen the struggle and additional complexity this can add, which can lead to further disappointment, as well as being potentially unsafe.

BBC's Panorama has given food for thought to those interested, intrigued or who are questioning a current or future ADHD assessment. Here are some thoughts suggestions for practitioners working with clients who have or are querying having an ADHD diagnosis:

For individuals considering assessment:

  • I recommend when researching a suitable private assessment researching the individual's qualifications and experience, rather than the clinic offering the service
  • Always speak with own GP as first port of call – they often have some knowledge of specialists of assessment pathways or can give advice on where to start 
  • ADHD is a neurological condition so will have been there since birth. If considering an assessment it can be useful to chat objectively with family members to help reflect on childhood difficulties. This is something that is usually requested by clinicians also when robust ADHD assessments take place
  • Listen to your own instincts when contemplating whether to have an assessment or not – you are your best expert
  • Diagnosis and assessment can be incredibly useful in understanding how and why you feel, behave or have symptoms in the way that you do – regardless of diagnosis. It can enable a forward journey.
  • Remember the strengths and beauties that ADHD has: empathetic, dynamic and loving to name a few. Embrace your uniqueness!

For clinicians:

  • Remember your role and capacity with the client, as well as own experience. If a client has come for therapy focus on presenting symptoms and signpost if they require support with diagnosis and treatment. Explore some ethical and robust clinicians to refer to should a client ask for support or assessment or ADHD 
  • Remember ADHD can mean that usual helpful advice such as sleep hygiene, or nutrition support can work differently if you have a neurodiversity as brain chemistry works differently. Use the client as the expert and work through collaboratively practical suggestions that haven’t worked or do work, and keep an open mind
  • Overwhelm and rejection sensitivity is a real thing for ADHD clients – sometimes a space to blurt and get things out can allow for a client to make sense of feelings. Allow time for this, and validate feelings
  • ADHD diagnosis can often come with a grief of how life could have looked if diagnosis had taken place in childhood. A space for this can help achieve acceptance and adapting to life to positively manage symptoms moving forward
  • Support client in knowing its OK not to be good at everything, and in fact acknowledge some things you just need help with, and find ways to ask for help when needed with ease
  • Most importantly remember all of superpowers that come with ADHD: ability to hyper-focus, being creative and dynamic and super empathetic are some fabulous, exciting and most of all loveable qualities to have that make ADHD clients unique

Bethany Ashley-Smith is a verified Welldoing therapist in Bromley and online

Further reading

Therapy was invaluable in learning to live with my ADHD

Diagnosed with ADHD at 51: my story

What Geena Davis learned from her ADHD diagnosis