Attention Deficit Hyperactivity Disorder: Diagnosis

Esther McVey Excerpts

Wednesday 1st February 2023 Westminster Hall

[Esther McVey (Tatton) (Con)]

I beg to move,

That this House has considered attention deficit hyperactivity disorder diagnosis waiting times.

It is pleasure to serve under your chairmanship, Ms Nokes, and an honour to open this debate to recognise the importance of early diagnosis of attention deficit hyperactivity disorder, and to draw attention to the current severe delay in the diagnosis of it.

An early diagnosis of ADHD will have a significant impact on an individual’s life: on their development, self-confidence and self-awareness, and their physical and mental wellbeing. For someone with ADHD, a diagnosis can help them understand why they are struggling with life. It allows them to understand their impulsivity, hyperactivity, inattention and sensitivity to the simplest distractions, even to everyday noises.

Instead of having a life in which they feel lost and alone, they can find and understand themselves, and gain a feeling of belonging and control. It is believed that one in 20 adults in the UK has ADHD, according to ADHD Foundation, but only 120,000 have had a formal diagnosis. The charity says that that is because of a combination of poor understanding of the condition, stigma and delays in diagnosis.

Diagnosis is essential, especially when there is an identifiable link between ADHD and suicide: one in 10 boys and one in four girls who have ADHD attempt to take their own life. Early diagnosis can prevent those tragedies and offer an answer to those suffering from the condition.

Today’s debate has come about because of the tenacity of a constituent of mine, Tanya Bardsley. She has been open about the amount of pain ADHD has caused her, her difficulty getting the condition diagnosed and, in particular, the added difficulty for girls and women in being diagnosed. She allowed herself to be filmed last year, and shared that in an ITV documentary, “Me and ADHD”.

Today, Tanya is a very accomplished woman. She runs four businesses, a charity and a household, as well as being a mum and a wife. But it took her almost 40 years to understand her anxiety, depression and impulsivity. In fact, it took her to almost six weeks before her 40th birthday to get diagnosed. Tanya described her ADHD as like having

“17 TVs on in your head. You can’t focus and there’s lots of noise in your head. You feel like you’re being smothered, overwhelmed, like you’re drowning in life. You’re living with this inner restlessness, which is exhausting and relentless.”

So much was that the case that, even before Tanya was 15 years of age, she had tried to take her own life three times. From the age of 18, Tanya was given antidepressants for depression and anxiety. Tanya saw more than 20 doctors, who just kept changing her prescription, but the medication never worked. It was not until she eventually went to see a private psychiatrist specialising in anxiety that she was diagnosed with ADHD. Once Tanya got her diagnosis, she said,

“Finally, I know what’s wrong with me. After years of struggling and on loads of different medications, it now all just makes sense. To be honest with you, I have never felt better.”

Tanya’s diagnosis was very late and that is why she made it her mission, along with others, to ensure that ADHD is diagnosed much earlier in life, in early years of education.

ADHD was first mentioned in 1902, when a British paediatrician, Sir George Frederic Still, found that some children were affected but that they could not control their behaviour in the way that a typical child could. He also noted that it was not because they were not intelligent; it was because they could not control themselves. Over the past century, the understanding of ADHD has increased, as have diagnosis and treatments. It is defined as

“an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”

In 2000, three sub-types of ADHD were recognised and are now used by healthcare professionals: combined type ADHD; predominantly inattentive type ADHD; and predominantly hyperactive-impulsive type ADHD. Six or more symptoms of inattention need to be proved for children up to the age of 16, and five or more for adolescents aged 17 or over and adults. Symptoms of inattention have to have been present for at least six months and have to be inappropriate to the person’s development level—for example, often failing to pay close attention to detail; carelessness with homework, work or other activities; having trouble sustaining attention during tasks or play; often seeming not to listen when spoken to directly; often not following through on instructions; failing to finish chores or homework; and having trouble organising tasks and activities.

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Lady for bringing the matter forward. I deal with this in my office every week of my life, so I am aware of the issue.

In Northern Ireland, which I know is not the Minister’s responsibility, there is going to be a gap of £110 million in the budget. This is my point to the right hon. Lady: the first sacrifice is often special needs provision, the cutting of which cannot be acceptable because it presents a risk to children who simply need a little extra help at an early stage in life. The risk is that a different way of doing things will be overlooked and the children will be abandoned at the most vulnerable point in their education. The right hon. Lady has said, “Get the diagnosis early,” and I agree with her. Does she agree that the Minister needs to respond positively?

[Esther McVey]

I do indeed, and I believe the Minister will respond positively. As well as early diagnosis in respect of inattention, which the hon. Gentleman and I are saying is important, hyperactivity and impulsivity also need to be seen and recognised.

The criterion is six or more symptoms of hyperactivity or impulsivity for children up to the age of 16, and five or more for adolescents aged 17 or over and adults. Those symptoms have to have been present for at least six months to the extent that they are causing disruption and are inappropriate to the person’s development level. That means a person fidgets, taps hands or feet, squirms on a seat, often leaves a seat in situations in which remaining on the seat would have been expected, often runs or climbs in situations where that is not appropriate, is often unable to play or take part in leisure activities quietly, is often “on the go” and “driven by a motor”, and talks excessively.

In addition, the following conditions must be met: several inattention or hyperactive-impulse systems were present before the age of 12; several symptoms are present in two or more settings, whether that be the home, school or work, with friends or relatives, or during other activities; there is clear evidence that the symptoms interfere with, or reduce the quality of, social, school or work functioning; and the symptoms are not better explained by a different mental disorder.

Quite strict conditions must be met, and we know what the symptoms are. As the hon. Member for Strangford (Jim Shannon) said, there needs to be an early diagnosis. Indeed, the stipulation is that the symptoms have to have been present before the age of 12, so we need that early diagnosis. To enable early diagnosis for a child, there needs to be a clear pathway for referrals from the school or GP to the specialist, but that is not working swiftly enough, although it is essential. The number of people in the UK affected by ADHD is 2.6 million, according to the ADHD UK website. Of those, 708,000 are children and 1.9 million are adults. More than 117,000 individuals receive a prescription for ADHD medicine.

I note that in the papers only this week, concerns were expressed by some in the scientific and medical profession about overdiagnosis, as parents and individuals go online to self-diagnose, but I would say that self-diagnosis possibly came about because people have not been able to see a GP or a specialist and they have gone online. Yes, there could be overdiagnosis, but the bigger concerns are underdiagnosis of those who need a diagnosis, and securing rapid access to a professional to establish what they have and what treatment they need.

I note, too, that the journey for girls and the outward signs for them are very different from those for boys. As such, ADHD tends to be picked up in boys and not so much in girls. The symptoms for boys are more well known. Boys display a sort of naughtiness—a disruptive way of acting, being the class joker or trying to disrupt others. That gets them noticed. However, the symptoms for women and girls do not involve being naughty; rather, they seem more as though they are “away with the fairies” or distracted. Because their behaviour is non-disruptive, they do not get the attention they deserve and therefore remain untreated.

ADHD impacts the lives of those living with it very differently, and they all cope with it differently. However, its impact is significant. Adults with ADHD are five times more likely to try to take their own lives than those without it. That is a tragedy in and of itself, and why a diagnosis needs to be made. Given the impact of ADHD on people’s lives, Tanya and many others are calling for early diagnosis. Tanya was diagnosed when she went private, a luxury that most of my constituents cannot afford. The process usually involves a 60 to 90-minute consultation with a psychiatrist. There is not a scan or diagnostic test as such; people need to meet somebody who can look at their condition.

However, even if a referral is made by a professional, people risk being screened out. Thanks to ADHD UK, I have some local data on the screening out of referrals from the Cheshire area. The reason could be that, because screening is not part of the National Institute for Health and Care Excellence guidelines, people are blocked from receiving an assessment. However, blocking people from an assessment, despite a qualified referral, does not make sense. As we know, it will stop people getting the care they need. In the last three years, 84% of girls put forward for assessment in one part of Cheshire were removed following a local health authority assessment, despite girls being known to be under-diagnosed and despite the higher suicide risks for young girls. To obtain that information, ADHD UK had to submit a freedom of information request to each integrated care board. That is how we found out.

The problem is significant, it is sizeable and it needs to be sorted out, so these are my questions for the Minister. First, will she meet me and my constituent Tanya Bardsley to discuss ADHD and what steps the Government can take to ensure earlier diagnosis? Secondly, will the Government start collecting national data, as is the case for autism, and introduce an ADHD wait list dashboard, as there also is for autism? I thank the Minister for her time today and ADHD UK for all its hard work in getting this data about Cheshire to me and, of course, to Tanya Bardsley.

Arms Trade: Yemen

Esther McVey Excerpts

Tuesday 20th April 2021 Westminster Hall

[Esther McVey (in the Chair)]

Order. I remind hon. Members participating physically and virtually that they must arrive for the start of the debates in Westminster Hall. Members are also expected to remain for the entire debate. I remind Members participating virtually that they are visible at all times both to each other and to us in the Boothroyd Room. If Members attending virtually have any technical problems they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before they use them and as they leave the room, and please take wipes with them and put them in the bin. I remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall. Members attending physically who are in the latter stages of the call list should use the seats in the Public Gallery and move to the horseshoe when a seat becomes available. Members can speak from the horseshoe only where there are microphones.

[Kim Johnson (Liverpool, Riverside) (Lab)]

I beg to move,

That this House has considered the arms trade and Yemen.

It is a pleasure to serve under your chairship today, Ms McVey, and I am delighted to have secured this extremely urgent debate on the arms trade in Yemen. I thank hon. Members who are present here, and those attending virtually, for speaking today.

Liverpool is a proudly international city, and I am proud to have grown up in, and now to represent, such a diverse place, where there is a history of solidarity between our many communities. The Yemeni community in Liverpool, as with so many linked to our docks, has a long and rich history. It is often said in the city that Yemenis are the Scousers of the Arab world. Long before the war in Yemen started, Dr Najla Al-Sonboli came to Liverpool to complete her masters and PhD at the Liverpool School of Tropical Medicine, alongside many other Yemeni medical students. She made Liverpool her home for many years, before returning to Yemen. When the war broke out in 2015 some Yemeni medics such as Najla were offered a chance to return to safety in the UK. However she, like the others, decided she had a duty to remain and help treat the sick and suffering in the dire humanitarian crisis brought on by the war.

The community in Liverpool sprang into action. A tiny Liverpool market stall based at Granby Street market in Liverpool 8, run by a small group of fantastic women from Toxteth, began fundraising for the al-Sabeen children’s hospital in the Yemeni capital Sanaa. Dr Najla is at the heart of that incredible, selfless work at the al-Sabeen hospital. Her work, supported by staff from the Liverpool School of Tropical Medicine and the women running the Habibti stall, has helped to meet the needs of one of Yemen’s only remaining free-to-access medical facilities that is still open. The staff there have had no salaries for more than five years. Many have suffered deeply, with some dying of cholera or covid, or from the bombings. They are doing everything they can to continue serving their patients. Some nurses even walk for two hours to reach the hospital, because they cannot afford the bus fare.

The money that the Habibti stall raises—even moving online to keep funds coming in during the pandemic—keeps the hospital going and ensures access to vital supplies, such as PPE, medicines, blankets and clothes. On top of the humanitarian crisis in hunger and war casualties, the conflict has resulted in a large-scale public health crisis. Severe, acute malnutrition has exacerbated a spiral of infectious diseases including the worst cholera outbreak ever recorded, with more than 2.5 million suspected cases since October 2016. Coronavirus cases are hard to track. Oxfam has reported that thousands of people are likely to be dying from undetected covid cases, as health facilities are overwhelmed and infrastructure is on its knees.

Nearly every patient who comes through the hospital’s doors, from neonatal babies in the intensive care unit to children as old as 15, and their families, are in desperate need. When Dr Najla was last asked what support she needed, the Liverpool fundraisers expected calls for PPE, extra antibiotics and perhaps an increase in expenses for the staff; but no, her answer was one word: food. I ask the Minister to take a moment to consider that devastating situation and the road that has led there, including many choices made by the present Government. The hospital has had a massive increase in patient numbers, having taken in people from all over the country, and has been targeted in air raids in which at least four people have died.

I tell this story not just because of the fierce pride that I have in my community and the actions that they have taken to support vulnerable people trapped in a hellish war, but because too often this conflict is reduced to numbers, framed in humanitarian crisis. That conceals the truth of the political decisions that created this catastrophe—political decisions in which our Government have a considerable amount of influence. I turn now to the crux of this debate: this Government’s unwavering commitment to keep supplying Saudi Arabia and its coalition allies with arms and training that have repeatedly been proven to violate international law and without a doubt are fuelling this invisible and protracted crisis.

Since the war began six years ago, nearly a quarter of a million people have been killed by the conflict, the blockades and the resulting disease and food shortage. The published value of UK arms export licences to Saudi since the war began is £6.8 billion, but the opaque and secretive open-licence system means that the true value is much higher, with some estimates as high as £18 billion. Research by Oxfam has shown that the medical and water infrastructure in Yemen has been hit hard during air raids—almost 200 times since 2015, equating to one raid every 10 days—affecting hospitals, clinics, ambulances and water drills, tanks and trucks. Dr Najla from the al-Sabeen children’s hospital has herself had to move home several times.

Figures from the Ministry of Defence’s own tracker database show that the Government are only too aware of these alleged instances of breaches or violations of international humanitarian law. I could take this opportunity to ask why—the evidence is laid bare—this Government continue to sell arms to members of the Saudi-led coalition even as the US and Italy have suspended their arms sales and several other countries have restricted them, but I have asked them that many times before, as have many of the hon. Members present at the debate today.

I could also ask why, despite the fact that 80% of the population in Yemen need humanitarian assistance, with 50,000 facing famine conditions and a further 5 million only one step away, the UK has taken steps to nearly halve the amount of aid that it has pledged to Yemen. Other G7 countries have increased their aid budgets. The UK Government, faced in Yemen with what they agree is the world’s worst humanitarian crisis, have cut their aid budget by 60% this year to £87 million, and £43 million of that will go as cash for food to alleviate the famine and £22 million to address malnutrition. Children now have irreversible stunted development because of malnutrition. The cut in aid will impact seriously on this, with remaining funds going to prevent economic collapse and support the peace process.

The decision to cut 60% of aid was taken by all Ministers in the Foreign, Commonwealth and Development Office on the grounds that the UK needed the money to recover from covid expenditure—while the Government were handing out billions of pounds in contracts to Tory donors, family members and their mates. The announcement came mere weeks after they granted £1.35 billion-worth of arms licences to Saudi Arabia. I could ask the Minister whether he considers it the utmost hypocrisy that the UK is the penholder on Yemen at the United Nations Security Council. It has taken food from the mouths of starving children with one hand while, with the other, handing fighter jets, bombs and missiles to Saudi Arabia and its allies—that has resulted in 60,000 airstrikes in Yemen by the Saudi-led coalition, and 30% have hit civilian targets—and profiting directly from the unimaginable suffering of the Yemeni people. I could ask the Minister how he sleeps at night, knowing that the Government could do so much more to alleviate the suffering of so many millions.

Funding of relief agencies’ work in Yemen ended on 31 March—a decision made in November—and agencies are still waiting to find out what support they will get. But we have asked these questions for years. We know their answers; they have become wearily familiar. Shrouded in spin, they are shameful excuses. The reality is that this Government have a choice—to be part of the problem or to be part of the solution. The fact that the Government continue to license billions of pounds-worth of military equipment and that they continue to cut aid are devastating symptoms of a deeper problem: their lack of interest in ending this conflict. That is what we have to challenge, and I welcome the fact that hon. Members from across the House are here today. That shows that there is a will, and where there’s a will there’s a way.

As the penholder on Yemen at the UN, the UK is a crucial player on the international stage. With the right political intent, we could make a major stride in ending the fuel blockade, improving the humanitarian situation and getting the key players around the negotiating table to agree the terms of a just, inclusive and sustainable ceasefire.

I want to end my contribution by turning to the escalating situation in Marib, which is teetering on the edge of a cliff and threatening to unleash yet another wave of unimaginable misery, death and protracted conflict. Two million internally displaced people, most living in refugee camps, are at risk. Hundreds of thousands will be forced to flee, with catastrophic humanitarian consequences. The community of Liverpool understands that. No more excuses. Will the Minister go back to his Government and ensure that they commit aid that will significantly alleviate the humanitarian crisis, and ban arms exports to the Saudi-led coalition?

[Esther McVey (in the Chair)]

Before we come to other Back Benchers, I remind everybody that we will start the Front-Bench speeches at 5.30 pm. We have an incredible number of Members who want to speak, so time will be limited in order to get everybody in. We will start with three-minute speeches, but they will probably have to reduce to two minutes.

--- Later in debate ---

[Tahir Ali (Birmingham, Hall Green) (Lab) [V]]

The Saudi-led war in Yemen has been raging since 2015. Since the beginning of the conflict, more than 100,000 people have been killed, including about 20,000 civilians killed or injured in direct attacks. The war has also created one of the worst man-made humanitarian crises in the world today, with about 24 million people in severe need of humanitarian relief and 4 million people displaced from their homes.

Over the course of the conflict, many gross violations of human rights have been committed by both sides. In particular, the Saudi-led coalition continues to carry out indiscriminate attacks on civilians and bomb civilian infrastructure in Yemen. Homes, schools, markets, mosques, weddings and funerals have all been targets. Shamefully, they have been doing so using arms supplied to them by the UK.

As a major defence trade partner, the UK has sold to Saudi Arabia a range of aircraft missiles and bombs that have subsequently been used to attack and kill civilians in Yemen. It a source of immense shame that the UK has played such a fundamental part in the murder of civilians. That is why I, along with many others in this country, am calling for an immediate end to all arms sales to Saudi Arabia. We must do all in our power to bring this horrendous conflict to an end. Ceasing our arms trade with Saudi Arabia is an obvious and important starting point. The UK should play an active global role in upholding and protecting human rights, and work alongside international organisations to broker sustainable peace in Yemen.

The political and humanitarian situation in Yemen is intolerable for the civilian population, with multiple groups fighting for control of the country at the expense of civilians. That has resulted in serious human and civil rights abuses committed by Houthi groups as well as Saudi-backed forces. With no legitimate democratic solution in sight, it is essential that the United Nations and other international organisations help to build a lasting, peaceful and democratic transition.

It is in our interests to stop all arms sales to Saudi Arabia immediately and unconditionally and, instead, work towards facilitating a negotiated peace between the Houthi rebels in Yemen and the Saudi-backed coalition.

[Esther McVey (in the Chair)]

Moving forward, the time limit on speeches will be two minutes. I call Marco Longhi.

--- Later in debate ---

On resuming—

[Esther McVey (in the Chair)]

I call Mick Whitley.

--- Later in debate ---

[Kevin Brennan (Cardiff West) (Lab)]

I want to take this opportunity to remind colleagues of the human consequences that the arms trade and conflict in Yemen can have on people. Four years ago, in April 2017, my constituent Luke Symons was stopped at a Houthi checkpoint in Sana’a and detained. He has been held in prison ever since for no reason other than that he holds a British passport.

Luke’s is a very typical Cardiff story in many ways. The rapid growth of Cardiff as a coal exporting port in the late 19th and early 20th centuries brought many Yemeni and Somali sailors to the city. Luke comes from one of those Cardiff Yemeni families who still have relations in the country. On a visit to Yemen in 2014, he met his future wife and settled there before the conflict broke out. They desperately tried to leave, but were unsuccessful before Luke was detained.

I appeal to the UK Government to redouble the efforts they have already made to secure Luke’s release and secure safe passage for him and his wife and child to the UK. I thank the Foreign Secretary and the Minister for the Middle East and North Africa, the right hon. Member for Braintree (James Cleverly), for their efforts so far.

I also appeal to Luke’s Houthi captors, during this holy month of Ramadan, to release him. His grandfather, Bob Cummings, who has a deep and abiding love for the people of Yemen and the middle east from his time as a merchant seaman, has campaigned tirelessly for Luke’s release. Luke’s grandmother, Sheila, who played a big part in his upbringing, is very ill and deeply worried about his welfare. It would be an act of mercy and compassion and would show the Houthi leadership in a good light if, after four years of this sad affair, that young man of 29 years, who is simply caught up in events and has committed no crime, could be reunited with his wife and child and wider family. That is the plea from the family to his Houthi captors, and I sincerely hope it will reach them and their hearts.

[Esther McVey (in the Chair)]

We have managed to get all the Back Benchers in, but the Front Benchers will have to shave down their time to four minutes and then eight minutes.