Before commencing my 15-week placement at ADHD Direct, I was uncertain about what to expect. I had limited experience within this area of practice, as my previous experience had primarily been within inpatient settings supporting individuals with acute mental health needs. To prepare for my placement, I explored the ADHD Direct website, which provided me with a greater understanding of the service and helped me identify areas I wanted to research further.
Prior to starting my placement, I understood that NHS waiting lists for ADHD and ASD assessments could be lengthy, and that many individuals may experience ongoing difficulties while waiting for appropriate assessment, support and intervention. However, my understanding of ADHD and ASD was relatively limited, and I had assumed that they were distinct conditions with few similarities.
One of the most significant things I have learned during my placement is the extent to which ADHD and ASD can present with overlapping characteristics. I have developed a much greater appreciation of the careful and detailed consideration required when assessing an individual to ensure that their experiences are understood accurately and that the most appropriate diagnosis is reached.
I was also previously unaware of the potential relationship between ADHD medication and the presentation of ASD traits. Through my placement, I have learned that while ADHD medication can support the management of ADHD symptoms, it may, in some individuals, result in certain ASD traits becoming more noticeable. This has highlighted to me the importance of considering the individual as a whole and understanding how different presentations and treatments may interact.
My perception of ADHD and ASD has therefore changed considerably. I initially viewed them as completely separate conditions, without recognising the potential similarities in their presentation. Having gained valuable clinical experience, I now understand that there can be significant overlap between the two, and that distinguishing between them requires specialist knowledge, careful assessment and consideration of an individual’s unique experiences.
The ADHD Assessment
As I had no previous clinical experience of ADHD assessment, I was unfamiliar with the assessment process before commencing my placement. I was particularly surprised to learn that an ADHD assessment can take more than two hours and involves gathering a comprehensive range of information, including information from relevant questionnaires and forms.
The assessment itself is a thorough but relaxed conversation, focusing on different aspects of an individual’s life, including daily living, education and employment, relationships, friendships and childhood experiences. Exploring these areas allows the clinician to develop a clearer understanding of the individual’s experiences and identify both current and historical difficulties that may be relevant to the assessment.
One aspect I have particularly valued during my placement is the patient-centred approach taken throughout the assessment process. Each assessment I have had the opportunity to observe has involved the individual being actively included in discussions about their experiences, with their views and preferences considered throughout. Where appropriate, a plan is developed collaboratively, ensuring that the individual remains involved in decisions regarding their care and future support.
Observing these assessments has given me a much greater appreciation of the time, skill and clinical reasoning involved in understanding an individual’s presentation. It has also challenged some of my initial assumptions about ADHD and ASD and reinforced the importance of approaching every person as an individual, rather than relying solely on preconceived ideas about how a particular condition should present.
Nicole Tibbs
