At Pankhurst Psychiatry, the ADHD assessment pathway includes a detailed diagnostic assessment, careful titration of any recommended medication, and a request for transfer of prescribing to your GP under a Shared Care Agreement once your treatment is stable, in line with national guidance. The process is structured, collaborative, and designed to support you from first enquiry through to long‑term follow‑up in primary care.
Overview of the process
Initial enquiry and screening
Comprehensive ADHD assessment
Feedback, diagnosis, and care plan
Medication initiation and titration (if indicated)
Stabilisation and Shared Care Agreement with your G
This page outlines each step so you know what to expect at every stage.
Ahead of the full assessment you are sent secure questionnaires to complete about your current difficulties, past history, and any previous assessments or treatments. Where possible, a close relative or partner is invited to provide collateral information, as this can give additional perspective on symptoms over time.
You are asked to share any relevant school reports, prior psychiatric letters, or educational psychology assessments, which can strengthen the diagnostic picture. All information is handled confidentially and stored in secure clinical systems.
The assessment is a structured, in‑depth consultation with a consultant psychiatrist, conducted either online or in person, exploring symptoms of inattention, hyperactivity and impulsivity across your lifespan. Standardised tools such as validated ADHD rating scales and semi‑structured interviews (for example, DIVA for adults) are used alongside a full psychiatric, medical, developmental, and social history.
During the appointment, the psychiatrist also screens for co‑occurring conditions such as anxiety, depression, substance use, or autism spectrum traits, as these can influence both diagnosis and treatment planning. At the end of the assessment, a clinical formulation and provisional diagnosis are made, integrating questionnaire results, interview findings, and collateral information.
Following the assessment, you receive clear feedback on whether you meet criteria for ADHD, and any differential or co‑existing diagnoses are discussed. There is time to ask questions about what the diagnosis means for you, including implications for work, study, driving, and day‑to‑day life.
A detailed written report is then prepared, summarising history, assessment findings, diagnosis, and treatment recommendations. This report can be securely shared with you and, with your consent, with your GP or other relevant professionals to support continuity of care.
Where ADHD is diagnosed, treatment planning is individualised and may include:
Education about ADHD and how it affects you personally
Lifestyle and organisational strategies
Psychological and coaching interventions
Medication options, where clinically appropriate
Medication choices are guided by NICE (National Institute of Clinical Excellence) recommendations for ADHD and take into account your physical health, other medications, and personal preferences. Stimulant and non‑stimulant options are discussed, including likely benefits, potential side effects, monitoring requirements, and any specific precautions relevant to your situation.
If you decide to start medication, baseline physical health checks are obtained or arranged (for example, blood pressure, pulse, weight, and relevant blood tests and an ECG where indicated). You receive information about how and when to take the medication, how effects typically emerge, and what to look out for in terms of side effects or unusual symptoms.
The initial prescription is issued by the consultant psychiatrist, and the first follow‑up appointment is booked, usually within a few weeks, to review early response and tolerability. You are given clear instructions on how to contact the clinic between appointments if you have concerns about side effects or other issues.
Titration is the period during which the dose and, if needed, the specific medication are adjusted to achieve the best balance between symptom improvement and side effects. Follow‑up appointments during titration are typically more frequent and may involve brief interim check‑ins to review symptom rating scales, day‑to‑day functioning, sleep, appetite, cardiovascular observations, and any emotional changes.
Together with your psychiatrist, you agree to each change in dose or preparation, with one change made at a time to allow clear monitoring of effects. This phase can be relatively quick for some people and longer for others; the pace is guided by your response, your safety, and your preferences.
Once a pattern of good symptom control with acceptable side effects is established, your dose is considered stable. At this point, the psychiatrist confirms an ongoing treatment plan, including recommended monitoring of blood pressure, pulse, weight/BMI, and mental state, in line with national guidance.
A summary letter is sent to your GP (with your consent) outlining the diagnosis, the current medication and dose, results of baseline investigations, and the agreed monitoring schedule. You are encouraged to keep your own record of medication, dose, and any notable side effects or benefits.
NICE guidance states that, after titration and dose stabilisation, prescribing and monitoring of ADHD medication should usually be carried out under shared care arrangements with primary care. A Shared Care Agreement allows your GP and your psychiatrist to work together so that repeat prescriptions and routine physical health monitoring can be provided locally by your GP, while specialist review remains available when needed.
With your permission, the clinic sends a formal shared care request to your GP that includes:
Confirmation of the ADHD diagnosis
Details of the current medication, dose, and formulation
Baseline investigations and any relevant test results
Recommended monitoring schedule and thresholds for concern
Clear guidance on when to seek advice or refer back to the specialist
Your GP then decides whether to accept shared care; if they are unable to do so, the psychiatrist will discuss alternatives with you, such as continued private prescribing or exploring other local options.
Ongoing ADHD follow‑up and review
Even once shared care is in place, periodic specialist review is 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 your psychiatrist remains central throughout, so that your care feels coordinated and responsive.
Some commonly asked questions for an ADHD assessment and shared care webpage, with brief patient‑friendly answers, could include:
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.
To get started, please contact us directly to arrange an assessment. You will be assessed promptly and will receive a comprehensive assessment report.
Dr. Kevin Pankhurst
Private Consultant Psychiatrist
London & Surrey UK
MB,ChB; MMed(Psychiatry)
