The HSE has said that more training is needed for health care professionals in adult psychiatry working in the area of Attention Deficit Hyperactivity Disorder (ADHD), writes Mark O'Flynn.

It comes after a charity which provides supports for people with ADHD said that around 200,000 people are affected by the condition, but the number of people actually diagnosed with ADHD is much lower.

ADHD is a neuro-developmental disorder that can present difficulties in day-to-day functioning for a person with the condition. 

The three main symptoms associated with ADHD are inattention, hyperactivity and impulsivity. A person with the condition shows severe and pervasive symptoms over a long period of time. 

ADHD can be managed but the most suitable treatment can only be determined after a person receives a diagnosis following an assessment by either a clinical psychiatrist or a psychologist.

Ken Kilbride, CEO of HADD Ireland, said one-in-four of its queries are adults asking what is the best way to get an ADHD diagnosis.

Speaking on RTÉ’s This Week programme, Mr Kilbride said: "Quite simply we run a support line and people phone in and our number one support call is adults looking to get information on how to get a diagnosis.

"So one-in-four calls to our support line is an adult saying, 'How do I get a diagnosis?'"

Services for children with ADHD are currently in place, and they include assessment and psychological supports which are available through the Child and Adolescent Mental Health Services (CAMHS) under the HSE.

People under the age of 16 also have access to medication under the Long Term Illness Scheme. However, anybody over the age of 16 must apply for a Medical Card under a hardship case.

Once a person is over the age of 18, they can no longer avail of services provided by CAMHS.

Currently, the HSE, in conjunction with the College of Psychiatrists of Ireland, is developing a National Clinical Programme for adults with ADHD. The aim of the programme is to provide specialist services for adults with ADHD.

Dr Margo Wrigley, clinical lead of the programme, said that one of the aims of the programme is to provide training for people working in adult psychiatry in the area.

She said: "Currently in the adult mental health services for psychiatrists and most of the other disciplines, there isn't formal training for people who are working in adult psychiatry in ADHD. 

"So a big part of the focus of this clinical programme will be to ensure that anyone who is working in the area is properly trained. And one of the things we will be doing as a clinical programme is to have an oversight function," she said.

Speaking on the same programme, Dr Alan Murtagh, Consultant Psychiatrist at St John of God’s Hospital said that ADHD can be treated through multimodal therapy, a combination of psychological or occupational treatments, and medication.

He said that many people will need ongoing treatment once they turn 18, and that resourcing is a big factor in people accessing services. He also said that there is a variation in terms of familiarity with ADHD across Ireland.

"I think the biggest factor that explains the variation and the difficulty in accessing general adult and community and mental health services is actually resourcing," he said.

"When that is addressed, I think it will be much easier for people to access those services."

The terms of reference for the programme also aims to deal with adolescents who will no longer be able to access treatment for ADHD that are provided to those under the age of 18. 

Dr Wrigley said that one aim of the programme is to set up a route for young people with ADHD to transition into the appropriate adult services. This could include the appointment of a case manager in CAMHS six months before the 18th birthday.

She also said that a pilot scheme for the National Clinical Programme will be rolled out at the end of this year. 

Dr Wrigley said that the scheme will consist of two to three particular geographically based teams. The full run-out of the programme will require about ten teams in order to provide coverage for all of Ireland. 

"From our point of view, we need to do it right. We need to have the right structures. It needs to be deliverable within an Irish context. It has to be a bespoke service for Ireland, but grounded in best evidence-based practice," Dr Wrigley said.


Case study: 'I hadn't felt quite right for many, many years'

Catherine Mary lived with symptoms of ADHD for years, but did not know anything about the condition.

When she was in her late 30s, she went to her GP who then referred her on to a clinical psychiatrist. Seven months after her initial referral from her GP, Catherine Mary was diagnosed with ADHD.

Catherine Mary said: "I hadn’t felt quite right for many, many years. By the time you get through your 20s, 30s and 40s, you can see the same cycles - certain common themes recurring all the time. The one common denominator all the time seemed to be me.

"But at the time there was always a feeling of overwhelm, of absolute bare-faced panic. There was a consistency in losing things, forgetting things. You forget things, you turn up to the wrong meetings, you get the times wrong. But when that happens, five, six, seven, eight, nine times a day, the volume of just messing up at certain times … That’s kind of the external manifestation of it.

"There was the internal side of overwhelm, anxiety, absolute fear, and yet at certain times I could consistently let people down, I’d let myself down. There was just no rhyme or reason sometimes."

Speaking on RTÉ’s This Week programme, Catherine Mary said that she decided to seek private treatment in order to get a diagnosis. She said that in terms of cost, she spent around €3,000 on consultation fees, which was before she started on a medication plan.

"I had the means [to go private] and I really felt at that stage it was just relentless and you’ll do anything really to try and make some kind of sense of what was going on.

"But it didn’t solve everything once I had the diagnosis. There was an element of relief because it made sense. It really, really did make sense," added Catherine Mary.