Rising ADHD Diagnoses and Safety Concerns with Private Clinics
A surge in ADHD diagnoses, particularly in the UK, is coinciding with growing concerns about the safety of assessment and treatment practices within some private clinics. Doctors are warning that a reliance on remote-only consultations and insufficient physical examinations could put children at risk.
The Increase in ADHD Diagnoses
The number of patients receiving prescriptions for ADHD medication is steadily increasing. In Greater Manchester, 15,743 patients received prescriptions for central nervous system stimulants and other ADHD-related drugs in the year leading up to March, a rise from 13,142 the previous year . Nationally, England has seen a 19% increase in ADHD medication prescriptions, with 278,000 patients receiving prescriptions in the same period . This rise is attributed to increased awareness and improved access to assessments, but also places a strain on existing services.
Concerns Over Remote Assessments and Physical Examinations
A key concern raised by clinicians is the increasing prevalence of video-only consultations for ADHD assessments. Doctors warn this practice leads to “widespread and unsafe practice” where children are diagnosed and medicated without adequate physical examinations . National Institute for Health and Care Excellence (NICE) guidelines mandate a full physical assessment, including cardiovascular history and a heart examination, before starting treatment .
Rashad Nawaz, a consultant paediatrician, has reported cases of children with previously undiagnosed heart conditions being prescribed stimulants by online providers without any in-person checks . He identified three children with heart murmurs, one of whom was diagnosed with a ventricular septal defect (VSD) – a hole in the heart – after referral to a paediatric cardiologist .
Greater Manchester’s Response
In response to these concerns, NHS Greater Manchester has implemented a new “safety first” pathway requiring face-to-face assessments and physical health checks before ADHD medication is prescribed . This change maintains the “Right to Choose” scheme, but effectively prevents providers from initiating treatment without demonstrating a robust in-person clinical assessment.
Challenges with Access and Service Quality
Demand for ADHD assessments is exceeding service capacity, with waiting lists in Greater Manchester expected to surpass 25,000 people . The current “first-come, first-served” system can lead to unequal access to care and the level of support varies across the region . There are also concerns about the potential “deskilling” of the workforce, with professionals trained in adult care treating children without sufficient paediatric experience .
The Role of Stimulant Medication
While concerns exist regarding safety, research from the University of Southampton suggests the benefits of ADHD medication outweigh the risks of increased blood pressure and heart rate . Commonly prescribed stimulants include methylphenidate (Ritalin) and non-stimulant alternatives.
Recent research indicates that ADHD medications primarily act on brain networks controlling wakefulness and reward, rather than attention itself .
Looking Ahead
The increased demand for ADHD services and the associated safety concerns highlight the need for continued improvements in access, quality, and regulation of care. The changes implemented in Greater Manchester represent a step towards prioritizing child safety, but ongoing monitoring and adaptation will be crucial to ensure all patients receive appropriate and safe treatment.