Autism and ADHD Assessments

Margaret Ferrier Excerpts

Monday 6th February 2023 Westminster Hall

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

It is a pleasure to serve under your chairship, Dame Angela. I thank the hon. Member for Carshalton and Wallington (Elliot Colburn) for opening this afternoon’s debate, and the constituents from Rutherglen and Hamilton West who signed the e-petitions. Although health is a devolved policy area, this issue affects people right across the United Kingdom. It is with that in mind that I speak here today, and I will focus specifically on the impact on women and girls.

Attention deficit and hyperactivity disorder and autism are chronically underdiagnosed and misdiagnosed in women and girls. Primarily that is because, broadly speaking, the conditions present differently than in males. There is also the fact that owing to societal pressures and expectations, women often become adept at masking, developing techniques to hide the conditions from others to avoid being stigmatised, or to feel accepted.

For the most part, women are into adulthood by the time they receive a diagnosis. One of my own staffers is a prime example and she has given me permission to mention this today. She was not diagnosed with ADHD until she was 24, and it was another year before the service she was under could provide her with a treatment plan, because slots were so limited.

Sometimes it is only after women have had their own children, usually sons who receive a diagnosis, that they begin to realise they share the traits and pursue a diagnosis for themselves. Even when that is not the case, diagnosis is often delayed by years because girls and women are highly likely to be misdiagnosed with a mood disorder such as depression, bipolar disorder or anxiety disorders. Both autism and ADHD are often viewed through the lens of mental health, but they are not at root mental health issues. The brain is literally wired differently. It is neurodevelopmental.

The image we conjure up in our minds when we think about ADHD is probably an outdated stereotype—a naughty little boy disrupting a classroom. We are more likely to focus on the H in ADHD—hyperactivity in its most obvious sense. Women and girls are more prone to an inattentive or combined type of ADHD where the hyperactivity is not external but internal. Many women and girls describe a constant and endless stream of thoughts and ideas that never quieten, never stop. Naturally, that is very distracting. So how does that manifest itself?

School-age girls might be dubbed daydreamers. School reports have comments such as, “Bright, but needs to apply herself better”, “Clever, but makes silly mistakes”, or, “Needs to stop chatting”. It is often dismissed as just that: “She needs to try a bit harder, concentrate a bit better”, but rarely is it looked at any closer. That constant over-thinking, never-ending activity in the brain as they start to get older often starts to spark secondary symptoms or conditions. That is where the misdiagnoses of depression, anxiety and more come in. They are treated for the secondary symptoms that are much more easily identified, but unfortunately rather ineffectively. If someone is not looking at the underlying cause, it is just plastering over the cracks.

If a woman or girl does not suspect that they have ADHD or autism, they are reliant on their GP picking up on the signs. In a short 10-minute or so appointment, a GP does not have the time to dig deeper than the surface level and recommend a referral to a specialist service. Those specialist services with psychiatrists qualified to assess, diagnose and support patients are few and far between.

When access to the right support is so life changing and necessary, it is downright depressing for someone to be told that they might have to wait a year, 18 months or two years before they will even get in front of the right person to start the process. The cost of an initial ADHD assessment appointment is somewhere between £500 and £800, but it can be up to thousands and several appointments are often required to make a diagnosis. The average monthly cost of a private prescription for ADHD medication is around £100. The average cost of an autism assessment is around £2,500. Even when we are not facing an economic crisis, those are huge amounts of money that most people and families just cannot spare.

It is important to recognise that diagnosis is just the beginning. People with both conditions benefit from treatments, such as cognitive behavioural therapy, and the state of the waiting lists for those is equally as dire. Sometimes CBT is essential to the development of coping mechanisms and strategies that allow neurodivergent people to get their lives in order for the long run.

The prevalence of illicit drug use in people with undiagnosed ADHD is not spoken about often because of the stigma, but it is essential to understanding what a lack of resourcing in the healthcare system can lead to. ADHD is often treated with stimulants, which are controlled drugs. Stimulants affect the neurodivergent brains of those with ADHD differently from those without it. The length of waiting lists inevitably means that people will want to find alternative ways to relieve their symptoms. People with ADHD are more likely to have addictive personality types, which can lead to tricky territory. Illicit stimulant drugs, such as cocaine and amphetamines, can have a similar positive-feeling effect on the ADHD brain in a way that they do not on others, so when those with undiagnosed ADHD try those drugs for the first time, they may be surprised at the effects. For that reason, cocaine use in university students with the condition is not uncommon. They make the connection and realise they have found a way to relieve symptoms to allow them to study. With earlier access to the right support, that would be avoidable.

It is really concerning that illicit drugs are easier to access than a diagnosis and a treatment plan. We do not want to see situations where, once diagnosed with ADHD, people are not allowed to access the right medication because of previous drug misuse, which could have been avoided with earlier intervention and access to prescribed treatment. It is really important to point out that ADHD medication is carefully monitored through titration and beyond, while self-medication is not.

The petitions are calling for access to urgent support. I wholeheartedly support those calls. So many constituents are under immense pressure as a result of completely unacceptable waiting times. Waiting lists have been creeping up for years. Improving recognition of the conditions in women and girls, which has led to more requests for assessments, may be part of the reason, but the biggest reason by far is the lack of funding.

I hope that the Minister will be in a position to provide more than just assurances. I hope she can provide a funding commitment for those in England. I hope she can tell us what discussions the Government have had with the Scottish Government about service provision and how funding will be replicated in the devolved nations. I hope that the Minister will be able to shed some light on the Government’s work to support NHS boards to recruit and retain expertise.

Children, adults and parents cannot wait endlessly for someone to address what is now beyond a crisis. They deserve better recognition and support, and they deserve it urgently.