The Road to an ADHD Diagnosis:
What to Expect, and Why It’s Only the Start
When I was diagnosed with ADHD, just before my 40th birthday, it was like someone had handed me the user manual for my brain. For decades, I’d been trying to “get my shit together” – assuming adulthood would magically bestow the ability to stay organised, be on time, and in control. But adulthood arrived, and I still struggled. My diagnosis didn’t fix everything overnight, but it gave me the language to understand myself. It was a pretty big deal.
At the time I was lucky enough to be able to afford a private diagnosis. Cut to 4 years later and the NHS wait times are even longer, and the money in everyone’s pockets isn’t going as far as it used to.
If you’re in the same position I was just a few years ago, you might be trying to make some sense of what your options are, and what the different routes mean for your money, time and eventual diagnosis. I talked with Dr Fleur-Michelle Coiffait, a clinical psychologist who has spent nearly two decades assessing ADHD and autism in both children and adults. She’s also neurodivergent herself, and was diagnosed at 39. The following post taps into her own personal and professional experience and should be required reading for anyone on the pathway to seeking a diagnosis.
The Late-Diagnosis Wave
“Until 2013,” Coiffait explains, “ADHD wasn’t even in the diagnostic manuals for adults. It was assumed children would grow out of it, which we now know is not true.”
Her career has spanned this shift. She started in 2007, mostly assessing children, but now sees increasing numbers of adults, many arriving at her practice door after a personal or professional crisis. Work-related burnout. Relationship collapse. Mental health struggles.
For others, diagnosis comes after seeing a child or family member go through the process. “They suddenly realise the traits they thought were ‘normal’: being forgetful, disorganised, struggling with focus, might actually point to something else,” she says.
First Steps: Self-Reflection and Screening
Coiffait advises starting with lived experience stories. “Many people have stereotypes about ADHD, such as ‘the hyperactive schoolboys bouncing off walls’ and don’t recognise themselves in that image,” she says. Hearing varied accounts can help challenge those misconceptions.
Self-screening tools exist, but they’re imperfect. They can miss people, particularly women and those who’ve learned to mask their difficulties. The key question is impact: are these traits present most of the time, across life, and significantly affecting daily functioning?
Before approaching a GP, Coiffait recommends noting specific examples. “Go in armed with information,” she says. “It’s sadly common to be dismissed if you ‘seem successful’. I’ve had patients told, ‘You can’t have ADHD, you’re a company director’ or ‘You have a doctorate.’ That’s not how it works.”
Pathway One: The NHS
The standard route begins with your GP. You’ll describe your concerns and, ideally, provide concrete examples. Many GPs will send a screening form after the appointment and decide whether to refer you.
What happens next depends on your area: some have specialist ADHD teams, others use community mental health teams. Waiting times vary wildly: in some places a year is “short”; in others, waits stretch to several years.
Pathway Two: NHS ‘Right to Choose’
If waiting times are daunting, the NHS Right to Choose scheme lets patients in England choose an alternative, pre-approved provider, with the NHS covering the cost.
It’s not a blank cheque. You can’t pick any private clinic and expect reimbursement; it must be on the NHS-approved list. Waits can range from a few weeks to over a year, and some people travel long distances to shorten the delay.
Coiffait urges patients to look beyond just speed. “Providers differ in how they assess. Even with guidelines, there’s no single, standardised process.”
Pathway Three: Private Assessment
Private assessments bypass NHS waits but carry a cost, from around £500 to £3,000. Price doesn’t always equal quality, so it’s vital to check:
- Who will assess you (psychiatrist, psychologist, specialist nurse)
- Their qualifications, training, and experience with ADHD
- Whether they follow recognised guidelines such as NICE standards
- What’s included (interviews, questionnaires, collateral information, feedback, written report)
Only certain professionals – psychiatrists, some specialist nurses, and clinical psychologists – can formally diagnose.
What a Good Assessment Looks Like
According to NICE guidance, best practice for a formal diagnosis should include:
- Multidisciplinary team: ideally more than one professional, to cover both psychological and physical health perspectives.
- Comprehensive history: attention, organisation, activity level, mood, physical health, trauma history, sleep, diet, daily functioning.
- Childhood evidence: symptoms must have been present before age 12. This can come from self-report, school reports, or family accounts — but lack of old documents shouldn’t be a barrier.
- Physical health checks: especially if medication may be considered — e.g., blood pressure, BMI, cardiovascular risk.
- Consideration of co-occurring conditions: higher rates of anxiety, depression, substance use, and other neurodivergence.
Some providers use computer-based attention tests, but Coiffait is cautious. “They’re nothing like real life. Some people with ADHD perform well, especially if they’re also autistic. They should never be the sole deciding factor.”
Before Your Assessment
Coiffait’s advice is simple but powerful:
“Be open about your experiences. Give detailed examples so the assessor can truly understand your life. If you’ve chosen someone skilled and experienced, they can make sense of it with you.”
Remember: diagnosis is not the destination. It’s a fork in the road — the point where you can begin to explore strategies, support, and self-understanding that fit the way your brain works.