ΒιΆΉΤΌΕΔ

The programme explains from the outset that our investigation was prompted by an email from a mother who was worried about the way her daughter had been diagnosed by a private clinic. Panorama then spoke to dozens of patients and members of staff at private ADHD clinics, who confirmed many of the allegations made in the original email. They told the programme that people were being diagnosed following rushed and inadequate assessments, and that almost everyone who paid for an assessment at a private clinic was being diagnosed with ADHD. There was, therefore, a risk that people were being misdiagnosed and given inappropriate treatment.

Panorama also spoke to senior clinicians within the NHS who expressed concerns about the behaviour of some clinics and the quality of the diagnostic reports they were producing. The clinicians felt they could not safely prescribe powerful, long-term medication on the basis of such assessments. In some cases it meant patients were having to be reassessed by NHS specialist services, which was adding to waiting lists.

In order to test the quality of assessments being carried out by private clinics, it was important for the programme’s reporter to first understand how they should be conducted. NHS consultant psychiatrist Mike Smith, who leads a specialist adult ADHD service, agreed to carry out an assessment because he was worried about the pressure on NHS waiting lists and the quality of diagnostic reports he had seen from some private clinics.

The assessment took place on a day when Dr Smith did not have an ADHD clinic, so it did not prevent a patient on the waiting list from being assessed. Panorama’s reporter answered all of the questions honestly. Following a thorough and detailed assessment, Dr Smith found he did not have the condition and did not meet the clinical threshold for any of the 18 symptoms associated with ADHD.

Panorama’s reporter also gave honest answers to all of the questions about symptoms during his assessments at the three private clinics. However, the assessments were very different from the one conducted by Dr Smith. The assessors appeared to be following a tick-box list of questions and asked few follow up questions. The reporter did not pretend to have ADHD symptoms. Like many people, he sometimes exhibits ADHD-like traits, such as fidgeting. One of the most important aims of an assessment should be to distinguish between these traits and the much more pervasive and impactful symptoms that add up to ADHD. Μύ

A number of conditions - such as anxiety, some personality disorders and the effects of trauma - can present in a similar way to ADHD. Diagnosing ADHD in adulthood relies on an experienced and appropriately qualified clinician carrying out a comprehensive and detailed assessment, in order to rule out all the other possible explanations for symptoms reported by a patient. Experts in the condition told Panorama that this could not be done safely in under two hours.

The National Institute of Health and Care Excellence (NICE) guidelines say that someone should only be diagnosed with ADHD if the symptoms have a serious impact on their life and that a full psychiatric history should be taken. The private clinics featured in the programme did not appear to follow these guidelines and two of the clinics provided statements acknowledging that their own procedures were not followed in issuing medication to our reporter, and that their processes had since been reviewed.

The programme’s findings have subsequently been supported by some of the UK’s leading experts. Dr Ulrich Muller-Sedgwick, a spokesman for the Royal College of Psychiatrists, told Radio 4’s PM programme on Monday 15th May that a good quality ADHD assessment takes three hours. He said he was concerned that co-existing mental health conditions were being missed in rushed assessments and that people may receive the wrong treatment as a result.

Professor Marios Adamou,Μύwho is the longest serving consultant psychiatrist treating adult ADHD in the NHS, told the Today programme on 15th May that 50 per cent of diagnoses from private clinics turned out to be incorrect when they were checked by his specialist ADHD service.

The programme is clear about the fact that there are considerable problems getting an NHS assessment for ADHD and made reference both to the three year wait that one of the contributors faced on the NHS and the five year wait faced by new patients at Dr Smith’s clinic.

Many viewers have suggested it is these waiting lists, and the wider issues faced by people with ADHD, which the programme should have set out to address. For example, the difficulties people sometimes experience trying to get β€œshared care” with the NHS. We recogniseΜύ that the difficulties presented by these issues are important.

However that does not deny the importance and validity of our investigation, in which the failings of these private clinics were clearly set out and raise matters of clear public interest in their own right.

It is important to add that the programme did not seek to question the legitimacy of the condition, or the profound impact it can have on people’s lives, and we do not believe it did so.Μύ Rather it made the point that many people being assessed by private clinics will have ADHD and was also clear about the fact that the drugs offered by the three clinics are a standard treatment for ADHD and that they are safe and effective if properly prescribed.

Panorama’s research uncovered serious failings by some private clinics and we believe there was a clear public interest in broadcasting the findings.

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