Sunday Reflections: ADHD, Diagnosis, and the Role of Clinicians
Sunday Reflections: ADHD, Diagnosis, and the Role of Clinicians
By Dr Dheeraj Chaudhary, Consultant Psychiatrist
It is a grey, drizzly Sunday morning—and I find myself thinking deeply about ADHD, diagnosis, and the broader clinical debate.
There are many facets to this conversation, and oversimplified narratives like “ADHD is overdiagnosed” do a disservice to the scale and complexity of the issue. The idea that we are overdiagnosing ADHD is largely a myth. If anything, we are still catching up after decades of underdiagnosis.
Conservative estimates suggest that around 5% of the adult population has ADHD. Yet, hundreds of thousands remain on waiting lists. Without timely assessment and treatment, lives can become derailed. People may still succeed—but often at the cost of four times the effort, stress, and sacrifice.
Many live with co-occurring depression or anxiety. At worst, untreated ADHD contributes to substance misuse, psychiatric crises, and contact with the criminal justice system.
Yes, we use diagnostic criteria—but they should guide, not limit, our clinical judgement. If someone presents with four out of nine symptoms and significant functional impairment, do we say, “Sorry, you missed the cut-off”? The thresholds in diagnostic manuals were never designed as rigid gates, but rather as guidance—liberalised over time to ensure more people can be supported.
It takes 15 years from medical school to becoming an independent Consultant Psychiatrist. During that time, we train our eyes, ears, and minds to recognise clinical patterns, unpick complex symptoms, and understand the nuance of mental health conditions.
This is not tick-box work. It is deep, layered, human work—requiring time, training, and humility. If we reduce clinical work to algorithms and checklists, AI could indeed do the job soon. But that is not what our patients need. They need considered, compassionate care informed by expertise. Patients are not boxes to be ticked; they are people seeking understanding.
Private providers have a role to play—and I hope they can be seen as part of the solution, not a threat. Diagnosing and treating ADHD requires specific skills: training, clinical exposure, and supervised assessment before independent practice.
In my own case, this included:
A year each of CAMHS training at junior and senior levels,
Years of running prison clinics,
Extensive experience diagnosing ADHD in both inpatient and outpatient settings before I began seeing private patients.
I now teach about ADHD—and it takes me a full hour just to cover comorbidities and differential diagnoses. And still, I regularly discuss complex cases with peers.
ADHD is not simple. Diagnosis is not trivial. It demands rigour.
ADHD is not the only specialty facing long NHS waits—cardiology and orthopaedics do too. What is different is the stigma. ADHD remains under-recognised, misunderstood, and even ridiculed in some circles. Few people question the private sector in other specialties—but in psychiatry, especially ADHD, private assessment is often framed with suspicion.
To me, the real issue is not who provides the care, but whether we are doing the right thing.
When I receive a referral, I ask myself:
Am I adding value to this patient?
Am I the right clinician for this particular case?
Can I offer what they need—or should I signpost elsewhere?
I often decline referrals when I feel someone would be better served by a full multidisciplinary team or when I believe I am not the best fit.
But when we can help—when we diagnose appropriately, support someone to stabilise their life, preserve their job, sustain a relationship, or simply understand themselves better—that is deeply meaningful work.
Sometimes the help is medication.
Sometimes it is psychoeducation.
Sometimes, it is just telling someone: “It was not your fault.”
That moment of understanding can be transformative. This is the kind of care we should advocate for—whether delivered in the NHS or the private sector. What matters most is that the care is safe, competent, and compassionate.
There is a broader lesson here too, about how we talk about mental health services. We must move away from false binaries: overdiagnosed vs underdiagnosed, NHS vs private, real vs “fashionable” conditions. These polarising narratives do not reflect clinical reality.
Instead, we need a dialogue based on clinical integrity, lived experience, and shared goals. The question should always be:
What is in the best interest of the patient in front of me?
On this grey Sunday morning, I find hope in the possibility that we, as a profession, can move towards a more nuanced, respectful conversation about ADHD.
One that recognises the suffering of those still waiting for care, values the role of trained clinicians—whatever their setting—and centres on the dignity of patients above all.
Let us make room for complexity, for clinical wisdom, and for better futures—for our patients, and for ourselves.
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