Attention Deficit Hyperactivity Disorder — more commonly known as ADHD — is a neurodevelopmental condition that affects the way the brain regulates attention, impulse control, and activity levels. While it is often thought of as a childhood condition, a very significant number of adults live with ADHD without ever having received a formal diagnosis. In fact, many people reach their thirties, forties, or even later in life before the pieces finally fall into place and they begin to understand why they have always experienced the world differently.
As a consultant psychiatrist with over 20 years of experience, I have seen this pattern repeat itself many times. A patient sits across from me — often successful, clearly intelligent, sometimes exhausted — and describes a lifetime of struggling to meet their own expectations. They have been called lazy, disorganised, or scatty. They have started countless projects and finished far fewer. They lose track of conversations mid-sentence, forget appointments, and find themselves paralysed by a task that should take twenty minutes. What they have rarely been told is that this is not a character flaw. It is a neurological difference that has a name, a well-understood mechanism, and — crucially — effective treatments.
ADHD in adults often looks quite different from the restless, disruptive classroom behaviour most people associate with the condition. The hyperactivity that is so visible in children tends to become more internalised in adults, presenting as a constant mental restlessness — a racing mind that cannot quieten, a feeling of always being driven but rarely arriving anywhere. Adults with ADHD frequently describe their inner life as chaotic even when their outward life appears calm and functioning.
The attentional difficulties in adult ADHD also take subtler forms. Rather than simply being unable to concentrate, many adults with ADHD experience a pattern called hyperfocus — the ability to become intensely absorbed in something genuinely interesting while finding it almost impossible to sustain attention on tasks that feel routine or unstimulating. This inconsistency is one of the most confusing and distressing aspects of the condition: "If I can spend three hours reading about something I love, why can't I spend ten minutes filing my tax return?" The answer lies in how the ADHD brain regulates dopamine — a neurotransmitter central to motivation, reward, and executive function.
Other common presentations in adults include difficulties with time management (losing track of time, chronically underestimating how long things will take), emotional sensitivity and impulsivity (reacting strongly in the moment and regretting it later), poor working memory (holding information in mind while doing something else), and a pattern of procrastination that is often driven by anxiety about imperfection rather than simple laziness. Many adults also struggle with organisation, losing items, missing deadlines, and maintaining consistent routines — not because they do not care, but because the brain's executive systems, which coordinate and prioritise behaviour, do not work in a straightforward way.
One of the most important things I want prospective patients to understand is that seeking a private ADHD diagnosis as an adult is not unusual, and it is not a sign of jumping on a trend. For many people — women particularly, who are historically underdiagnosed — ADHD was missed entirely during childhood because they masked their difficulties effectively, compensated through sheer effort, or presented without the obvious hyperactivity that once dominated diagnostic criteria.
Adults considering an adult ADHD assessment in Surrey or elsewhere often describe a dawning recognition: perhaps triggered by a partner's comment, a child's own diagnosis, an article, or simply the accumulation of years of quietly struggling. That recognition deserves to be taken seriously. A thorough, evidence-based assessment from an experienced ADHD psychiatrist in Surrey or Berkshire can provide answers that change the trajectory of someone's life.
Receiving a diagnosis of ADHD as an adult carries a distinct emotional weight. For many people, the initial response is one of profound relief — finally, an explanation that makes sense of experiences that have been confusing and painful for decades. This relief is entirely valid and often therapeutically significant in itself. Understanding that your brain is wired differently, and that your struggles have had a neurological basis all along, can begin to dissolve years of accumulated shame.
At the same time, a diagnosis can bring grief — mourning for the version of yourself who might have been identified and supported sooner, or for opportunities that felt harder to grasp than they should have been. I take time to acknowledge this in my clinical work, because the diagnostic conversation is not simply a formality. It is, for many patients, one of the most meaningful conversations they have had about themselves.
Some patients also experience anxiety about what the diagnosis means for their identity, their work, or their relationships. These concerns are all worth exploring, ideally with the support of an experienced clinician who can put the diagnosis into proper context.
ADHD rarely travels alone. A substantial proportion of adults with ADHD also experience anxiety, depression, or both. This overlap is not coincidental. Years of underperforming relative to one's own potential, of feeling overwhelmed by tasks that peers seem to handle effortlessly, and of receiving critical feedback from teachers, employers, or family members can erode self-esteem and create fertile ground for anxiety and low mood. In some cases, anxiety or depression may actually be masking underlying ADHD, or the two conditions may be amplifying each other in ways that make both harder to treat.
This is one of the reasons why a high-quality ADHD assessment must include a careful screening for co-occurring conditions. Understanding whether anxiety is a standalone diagnosis, a consequence of living with unmanaged ADHD, or a combination of both changes the treatment approach significantly. I screen comprehensively for co-occurring conditions as a standard part of every assessment, and I take time to explain my clinical reasoning to each patient.
When you contact Pankhurst Psychiatry to arrange a private ADHD assessment in Surrey or Berkshire, you will be asked to complete a set of validated pre-assessment questionnaires. These are established, clinically recognised tools — including rating scales for ADHD symptoms, mood, and anxiety — that provide a structured baseline and help me make the best possible use of our time together. You will also be asked to provide some background about your history, including your experiences in childhood and education where relevant.
If a school report, letter from a teacher, or account from a parent or partner is available and you are comfortable providing it, collateral information of this kind can be genuinely useful — though it is not a requirement for assessment. Many adults seeking a private ADHD diagnosis do so without any childhood documentation, and this need not be a barrier.
The core of a proper ADHD assessment is a structured clinical interview, which typically takes 120 minutes. This is not a tick-box exercise. I take a detailed developmental history, exploring how symptoms have presented across different periods and contexts of your life, how they have affected your relationships, work, and wellbeing, and what other explanations may or may not account for them. The aim is to build a thorough clinical picture — one that honours the complexity of your individual experience rather than reducing it to a symptom checklist.
Following the assessment, you will receive a detailed written report setting out my clinical findings, my diagnostic conclusions, and my recommendations for treatment. This report belongs to you. It can be shared with your GP, employer (if you choose), or any other treating clinician, and it forms the basis for any ongoing care.
Not all ADHD assessments are created equal. A robust assessment will take a full developmental and psychiatric history, use validated rating scales, screen carefully for conditions that can mimic or coexist with ADHD, and be conducted by a clinician with genuine expertise in adult psychiatry. I am an ADHD psychiatrist in Surrey with over two decades of clinical experience, and I am able to offer the kind of nuanced, considered assessment that distinguishes a meaningful diagnostic conclusion from a superficial one.
The first and arguably most important component of ADHD treatment is psychoeducation — which simply means developing a clear, accurate understanding of what ADHD is, how it affects you specifically, and what you can do about it. Knowledge is genuinely therapeutic here. When patients understand the neuroscience behind their difficulties — why starting tasks feels so hard, why time feels different, why emotions can feel more intense — they often experience an immediate shift in how they relate to themselves. Self-blame begins to give way to self-understanding.
Research consistently supports the role of lifestyle factors in managing ADHD symptoms. Regular aerobic exercise is among the most robustly evidenced non-pharmacological interventions, with studies showing meaningful improvements in attention, mood, and executive function. Sleep quality, diet, and structured daily routines also play important roles. I work with patients to identify realistic, individually tailored strategies — not prescriptive rules, but practical tools that work with the ADHD brain rather than against it.
Cognitive Behavioural Therapy adapted for ADHD (ADHD-CBT) can be highly effective, particularly for the patterns of procrastination, avoidance, emotional dysregulation, and low self-esteem that often accompany the condition. I can provide guidance on appropriate psychological therapies and, where needed, can work collaboratively with psychologists and therapists to ensure a joined-up approach to your care.
Medication, where appropriate, can be genuinely transformative for adults with ADHD. The medications used to treat ADHD work, broadly speaking, by increasing the availability of dopamine and noradrenaline in the brain's prefrontal circuits — the areas most involved in attention, planning, and impulse control. There are two main classes: stimulant medications (such as methylphenidate and lisdexamfetamine) and non-stimulant options (such as atomoxetine and guanfacine), all of which are recommended within NICE guidelines for adult ADHD.
Before any medication is initiated, I carry out baseline physical checks — including blood pressure, heart rate, and weight — and take a careful medical history to ensure the chosen medication is safe and appropriate for you. Based on the assessment, an ECG may be required prior to starting treatment.
I then work with you through the titration process — that is, the careful, gradual adjustment of your dose over time to find the level that gives the best balance of benefit and tolerability. Titration requires patience, honest communication and regular monitoring. It is not a one-visit process, and I support my patients throughout it.
Once you reach a stable regimen — meaning a dose and frequency that reliably helps you without unacceptable side effects — the next step is often a shared care agreement with your GP. This is a formal arrangement in which your GP takes on the prescribing and routine monitoring of your medication, while I remain available for specialist review. Shared care agreements benefit patients by making ongoing care more convenient and integrated, and I liaise directly with GPs to ensure these arrangements are smooth and well-supported.
Your GP then decides whether to accept the shared care agreement: if they are unable to do so, I will discuss alternatives with you, such as continued private prescribing or exploring other local options.
ADHD management is not a one-off event. Even after reaching a stable regimen, life changes — a new job, a relationship breakdown, a change in health — can shift how your ADHD presents or how well your treatment is working.
Even once a shared care agreement is in place, periodic specialist reviews are required to ensure treatment remains effective, safe, and appropriate for your circumstances over time. These reviews may be less frequent than during titration but provide an opportunity to revisit goals, consider dose adjustments, address life changes, and review any co‑existing mental health difficulties.
You are encouraged to contact the clinic sooner if you notice a significant change in symptoms, side effects, physical health, or personal situation that might affect your ADHD management. Collaborative communication between you, your GP, and myself remains central throughout, so that your care feels coordinated and responsive.
You will never be left to manage alone.
If you have been wondering whether ADHD might explain some of the struggles you have carried for years — the chronic disorganisation, the racing thoughts, the sense of never quite fulfilling your potential — you deserve a proper answer. A thorough, compassionate private ADHD assessment with an experienced consultant psychiatrist can provide that answer and, with it, a clear path forward.
I work with adults across Surrey, Berkshire, and London who are seeking clarity about their mental health, often for the first time. Whether you are just beginning to consider the possibility of ADHD or you have been convinced for years and simply never had the opportunity for a formal evaluation, I would be glad to hear from you. Please do not hesitate to get in touch with Pankhurst Psychiatry to arrange an initial consultation — it could be the most important conversation you have about yourself.
1. What is an ADHD assessment?
An ADHD assessment is a detailed consultation with a psychiatrist to explore whether your difficulties with attention, organisation, or impulsivity are due to ADHD or another condition. It usually involves structured questions, rating scales, and a review of your history from childhood to the present.
2. How long does the assessment take?
Most full ADHD assessments last between 90 and 120 minutes. This allows enough time to cover symptoms, background, other mental health conditions, and to answer your questions.
3. Do I need any documents before the assessment?
It is helpful to bring any previous reports (school reports, educational psychology, prior psychiatric letters) and a list of current medications. If possible, a parent or partner can complete questionnaires or attend to provide additional background.
4. Can ADHD be diagnosed in adults if I was never diagnosed as a child?
Yes, ADHD can be diagnosed in adults, even if it was not recognised at school, as long as there is evidence that symptoms were present in childhood and continue to affect you now. The assessment looks carefully at how your symptoms have shown up over time at home, at school, and at work.
5. Will I receive a written report?
Yes, after the assessment, you receive a detailed report summarising your history, assessment findings, diagnosis, and treatment recommendations. With your consent, this can also be shared with your GP or other professionals involved in your care.
6. What if I do not meet the criteria for ADHD?
If you do not meet the criteria for ADHD, the psychiatrist will explain this clearly and discuss any other difficulties that may be contributing to your symptoms. You will still receive a report with recommendations for support or further treatment where appropriate.
7. Will I be offered ADHD medication straight away?
Medication is only recommended if ADHD is diagnosed and it is clinically appropriate for you. You will first have a chance to discuss non‑medication strategies, your preferences, and any physical health issues before deciding together on treatment.
8. What is “titration”?
Titration is the process of gradually adjusting the dose (and sometimes the specific medication) to find the smallest dose that gives good benefit with manageable side effects. This involves regular follow‑up appointments to review symptoms, side effects, blood pressure, pulse, and sleep and appetite.
9. How long does titration usually take?
The titration phase typically takes a few weeks to a few months, depending on how you respond and how quickly doses can be safely adjusted. The pace is guided by your clinical response, any side effects, and your personal circumstances.
10. What side effects should I expect, and how are they monitored?
Common side effects can include reduced appetite, difficulty sleeping, or changes in heart rate and blood pressure, though many people tolerate medication well. You will be given clear information about potential side effects and have regular monitoring of physical health and mental state, with an opportunity to adjust treatment if problems arise.
11. What is an ADHD Shared Care Agreement?
A Shared Care Agreement is a formal arrangement where your GP takes over repeat prescribing and routine monitoring of your ADHD medication, while the specialist remains available for advice and periodic review. It allows your treatment to be delivered closer to home, with clear roles for primary and secondary care. As part of this shared care, you must continue to have a 6 monthly or annual reviews with your psychiatrist.
12. When can my GP take over prescribing?
Shared care is usually requested once your diagnosis is confirmed, baseline checks are completed, and your medication and dose are stable. At that point, your psychiatrist writes to your GP with a detailed summary of your diagnosis, current treatment, and monitoring plan.
13. What happens if my GP does not agree to shared care?
If your GP cannot accept shared care, this will be discussed with you so that alternative options can be considered, such as ongoing private prescribing or exploring other local services. The aim is always to find a safe, sustainable way to maintain your treatment.
14. Will I still see the psychiatrist once shared care is in place?
Yes, periodic specialist reviews are required to ensure that your treatment remains effective and safe and that it continues to meet your needs. The frequency of reviews will depend on your individual circumstances and can be discussed as part of your care plan.
15. Can I contact the clinic between appointments if I have concerns?
You will be given information on how to contact the clinic if you experience troublesome side effects, a sudden change in symptoms, or practical problems with medication. In an emergency or acute physical health issue, you should follow standard urgent care pathways via your GP, NHS 111, or emergency services as appropriate.
16. Is ADHD treatment compatible with my other medications or health conditions?
Before starting medication, your psychiatrist will review your medical history and current medications to check for potential interactions or risks. In some cases, additional tests or liaison with your GP or other specialists may be needed to ensure treatment can proceed safely.
17. Can I be assessed if I also have anxiety or depression?
Yes. Co-occurring anxiety and depression are very common in adults with ADHD, and assessing for them is a standard part of my evaluation. Having these conditions does not exclude you from an ADHD assessment and may in fact make the assessment more important.
18. Can women present differently to men?
Yes. Research consistently shows that women with ADHD are more likely to present with predominantly inattentive features, and more likely to have developed sophisticated masking strategies that conceal their difficulties from others — and sometimes from themselves. This contributes to significant underdiagnosis in women.
19. What is the difference between ADHD-I, ADHD-H, and ADHD-C?
These refer to the three presentations recognised in diagnostic criteria: predominantly Inattentive (ADHD-I), predominantly Hyperactive-Impulsive (ADHD-H), and Combined presentation (ADHD-C), where both attentional and hyperactive-impulsive features are prominent. The inattentive presentation is particularly common in adults and is frequently missed.
20. Is ADHD a real condition in adults?
Absolutely. ADHD is a well-established neurodevelopmental condition recognised by all major psychiatric and medical bodies, including the World Health Organisation (ICD-11) and the American Psychiatric Association (DSM-5). It does not disappear at adulthood — research suggests that symptoms persist into adult life in the majority of people diagnosed in childhood.
Contact me directly to arrange an assessment — most patients are seen within four weeks, and a full written report is provided after the first appointment.
Dr Kevin Pankhurst
Private Consultant Psychiatrist
Surrey, Berkshire & London
MB ChB; MMed (Psychiatry)
Esher: Esher Groves, 13–17 Church Street, Esher, Surrey, KT10 8QS
Maidenhead: Berkshire Grove Hospital, White Waltham, Maidenhead, SL6 3TN
Guildford: 3 Saxton, Guildford, Surrey, GU2 9JX
