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ADHD and ASD Services (outpatients)

How our service can help you

13 October - ADHD medication supply disruptions: Advice for General Practitioners

On Friday 27 September 2023 the Department of Health and Social Care issued a National Patient Safety Alert regarding supply disruptions with many of the medication prescribed for ADHD (Equasym XL, Xaggatin XL, Concerta XL, Xenidate XL, Lisdexamfetamine, Guanfacine). This disruption has been attributed to a combination of manufacturing issues and increased global demand. Please see the 'more info' tab below for further information.

Update 15 December 2023:

The National Adult ADHD and ASD Clinic and Psychology Service remains paused to new National referrals at present.  We will provide further updates in June 2024.

Please note we remain open to local referrals from Lambeth, Lewisham, Croydon, Southwark and Bromley, Greenwich, Bexley (via Oxleas).

We also remain open to new referrals requesting medical reviews and follow ups for patients with an established diagnosis of a genetic disorder associated with an established behavioural phenotype, for example, 22q 11 deletion syndrome.

All accepted referrals past and up to the date 13 January 2023, will be honoured for assessment and/or treatment as per the referral request, this will include those currently on the waiting list.

As previously notified 18 July 2022:

From Friday 13 January 2023, the National adult ADHD & ASD outpatient clinic and the National adult ADHD & ASD Psychology Service (NAAAPS) are temporarily closed to new national referrals for an initial period of 6 months. Any referrals sent following this time will not be processed or kept on file. This decision is being reviewed regularly. Unfortunately we do not as yet have a date as to when we will be receiving new ADHD and ASD referrals again. Please contact your local Clinical Commissioning Group (CCG) for information on local services available.

Please note we remain open to local referrals from Lambeth, Lewisham, Croydon, Southwark (via A&L) and Bromley, Greenwich, Bexley (via Oxleas). We also remain open to new referrals requesting medical reviews and follow ups for patients with an established diagnosis of a genetic disorder associated with an established behavioural phenotype, for example, 22q 11 deletion syndrome.

We continue to experience an extremely high volume of referrals which unfortunately is resulting in delays in processing. We are working as quickly as possible and appreciate your patience during this time.

Please contact your local teams for access to talking therapies and/or mental health support as required. The Autism Act (2009), NHS Long Term Plan (2019) and other policy and best practice documents clearly state that individuals with autism and other neurodevelopmental conditions should be seen within mainstream services, with ‘reasonable adjustments’ made, wherever possible.

Examples of helpful ‘reasonable adjustments’ for autistic individuals receiving talking therapies can be found in the National Autistic Society and MIND guide here

A range of helpful books on offering CBT for ADHD have been published.

Cognitive-Behavioural Therapy for ADHD in Adolescents and Adults (2012) by Susan Young and Jessica Bramham

Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program, Therapist Guide (2 ed.) by Steven A. Safren, Susan E. Sprich, Carol A. Perlman, and Michael W. Otto

If you are struggling to get support you may wish to contact your local Patient Advisory and Liaison Service.

  • Service Borough Covers: National (Adult services) Treatment type: Outpatient
  • Contact the service

    Site Location: Maudsley Hospital Email: adhdasdadmin@slam.nhs.uk Phone Number: 020 3228 8521 or 020 3228 6791
  • Disabled Access:

    Yes

  • Address: Maudsley Hospital
    Outpatient Department
    Denmark Hill
    Camberwell,
    London,
    SE5 8AZ
  • Business Hours/Visiting Hours:

    Monday - Friday 9-5 excluding bank holidays.

  • Other essential information

  • Conditions: Addictions, Anxiety, Attention deficit hyperactivity disorder (ADHD), Autism, Bipolar disorder, Body dysmorphic disorder (BDD), Childhood degenerative disorders, Conduct disorder, Dementia, Depression, Dissociative disorders, Eating disorders, Learning disabilities, Neuropsychiatry, Obsessive compulsive disorder (OCD), Perinatal disorders, Persistent physical symptoms, Personality disorders, Post-traumatic stress disorder (PTSD), Psychosexual, Psychosis, Self-harm

Interventions

Autism spectrum disorder (ASD) diagnostic assessment

The initial assessment may include an autism diagnostic interview (ADI-R) with a parent or carer, and/or an autism diagnostic observation schedule (ADOS) with the patient. These will be carried out by a neurodevelopmental specialist or other trained member of the clinical team. 

There will be an appointment to consider the ADI/ADOS results with a clinical psychologist, clinical nurse specialist or consultant psychiatrist. This will include a medical and psychiatric history taking. We will also consider potential co-morbidities and differential diagnoses. This appointment will usually include discussion with the patient about the diagnostic outcome. 

Attention deficit hyperactivity disorder (ADHD) diagnostic assessment

The initial assessment will include a diagnostic interview (DIVA) with the patient and informant(s) to identify potential ADHD symptoms and impairments. This will be carried out by a neurodevelopmental specialist or other trained member of the clinical team. 

There will also be an appointment to consider the DIVA results with a consultant psychiatrist or senior clinical nurse specialist. This will include medical and psychiatric history taking. We will also consider potential comorbidities and differential diagnoses. This will also usually include discussion with the patient about the diagnostic outcome. 

Brief assessment - ADHD

We can assess patients diagnosed elsewhere with ADHD, either in childhood or adulthood. We would need details of previous diagnostic assessments and any treatments at the time of referral. Our assessment focuses on the existence of current symptoms and impairments related to ADHD and any current differential diagnosis and treatment recommendations. 

This assessment is for patients transitioning from child and adolescent services. But it can include patients assessed privately or abroad, for whom GPs are being asked to continue treatment. However, if the patient’s mental state or presentation has altered significantly they may need a full assessment. Examples include queries about emerging comorbid condition/differential diagnosis, or about their prior ADHD diagnosis. If there has been no review in the past 12 months then they may need a full assessment. 

ASD – medical review assessment

A consultant-led review of a patient’s response to medication prescribed for co-morbid mental health conditions, in the context of the patient having an ASD. This may include review of the management of side effects or the appropriate use of second or third line agents for mental disorder. This review does not include a second opinion of diagnosis. We make recommendations to the local referring team. 

Second opinion diagnostic assessment

An extended assessment to review previous assessment documents in addition to the standard assessment protocol detailed above. 

Outreach diagnostic assessment

ADHD and ASD assessments described above where clinicians travel to the patient’s home or alternative local venue. We offer this where the patient is unable to travel to the Maudsley Hospital. This could be due to physical or mental health reasons, or where patients are detained. 

 

Treatment

Initiation and titration of medication for ADHD

Initiation and titration of medication for ADHD symptoms from assessment within the clinic until the dosage is stabilised. At this point primary and secondary care would continue to prescribe the maintenance dose. A nurse (non-medical prescriber) or a consultant psychiatrist will deliver the prescribing appointment. 

ADHD treatment optimisation

A consultant psychiatrist or nurse will undertake this appointment. They will monitor the patient's response to pharmacological ADHD treatment and provide further treatment recommendations to local services. This would usually need two or three sessions over 12 months. 

ADHD annual reviews

Annual appointments to monitor response to pharmacological ADHD treatment and provide further recommendations to local services, in line with NICE guidance.

Eligibility criteria

  • 18 years and over (three months before the 18th birthday is a transition patient)
  • Suspected or diagnosed attention deficit hyperactivity disorder (ADHD) in adulthood
  • Suspected or diagnosed autism spectrum disorder (ASD) in adulthood
  • We consider people with an alcohol addiction or problem if there is evidence they will engage with their local services to address this
  • Genetic or chromosomal abnormalities including, but not limited to, 22q deletion syndrome (VCFS), neurofibromatosis, Turner syndrome, Klinefelter syndrome, Down’s syndrome, fragile X syndrome, and single gene defects

Exclusion criteria

A known addiction to street drugs, where they are using at the time of referral and not engaged with local services to address this
Current major mental illness and no available developmental history

Outcomes

 

  • Improved access to diagnostic assessment of attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) for adults
  • All patients assessed for ADHD and/or ASD will receive a comprehensive diagnostic report with recommendations within four weeks of their last assessment appointment
  • Follow-up reports (for patients having their ADHD medication initiated or reviewed by our clinic)

Service user outcomes (ADHD)

  • An accurate diagnosis and an appropriate treatment plan
  • Treatment recommendations for GPs and local community mental health teams (CMHTs)
  • Improved awareness of national support services post diagnosis through signposting.
  • Patients reporting improvement in symptoms after treatment, measured through clinical outcome ratings. This includes: improved concentration and attention, decreased hyperactivity and impulsivity, improved interpersonal relationships, occupational performance and improved quality of life

Service user outcomes (ASD)

  • Improved understanding of their ASD symptoms and why they experience certain difficulties
  • Improved interpersonal relationships and occupational performance
  • Improved quality of life
  • An accurate diagnosis and an appropriate treatment plan
  • Treatment recommendations for GPs and local CMHTs
  • Improved awareness of national support services post diagnosis through signposting. For example, National Autistic Society and support groups for people with ASD

Care Options

This is an outpatient service which does not provide case management. Management of the patient’s physical and mental health will remain with the GP or referrer as appropriate. We provide appropriate crisis management information on all clinic documentation.

Our experts

Charlotte Blackmore: Read more

Dr Anastasios Galanopoulos: Read more

Dr Natasha Liu-Thwaites: Read more

Professor Gráinne McAlonan: Read more

Alexandra Nolan: Read more

Dr Adanna Onyejiaka: Read more

Dr Susannah Whitwell: Read more

Amanda Debnam Read more

Dr Stefanos Maltezos Read more

Clinic address

Bethlem Royal Hospital

Monks Orchard Road, 

Beckenham

BR3 3BX

More info

ADHD medication supply disruptions: Advice for General Practitioners

On Friday 27th September 2023 the Department of Health and Social Care issued a National Patient Safety Alert regarding supply disruptions with many of the medication prescribed for ADHD (Equasym XL, Xaggatin XL, Concerta XL, Xenidate XL, Lisdexamfetamine, Guanfacine). This disruption has been attributed to a combination of manufacturing issues and increased global demand. Please see the prescribing guide for information about treating patients whilst the medication shortage continues: Prescriber Guidelines (PDF)

Immediate Action Required

Effective immediately, prescribers are advised “not to initiate new patients on products affected by this shortage until the supply issues resolve”. At present, the supply disruptions are expected to resolve at various dates between October and December 2023.

Affected Medications

The following medications are currently subject to supply disruptions:

Methylphenidate:

  • Equasym XL® 10, 20, and 30mg capsules
  • Xaggitin XL® 18 and 36mg prolonged-release tablets
  • Concerta XL® 54mg prolonged-release tablets
  • Xenidate XL® 27mg prolonged-release tablets

Lisdexamphetamine

  • Elvanse® 20, 30, 40, 50, 60 and 70mg capsules
  • Elvanse® Adult 30, 50 and 70mg capsules

Guanfacine

  • Intuniv® 1, 2, 3 and 4mg prolonged-release tablets

Recommendations for Ongoing Prescribing

  • For cases involving ongoing prescribing, it is essential that prescribers liaise with local pharmacies to verify the availability of existing stock. Alternative medications such as methylphenidate immediate-release tablets or dexamfetamine tablets remain accessible. Thus, prescribers can make appropriate adjustments to the medication regime to align with the overall therapeutic dose.
  • Please be advised that a new shared care document is not required for this action.
  • Please do keep in mind that existing stocks may not be sufficient to meet the increased demand caused by other shortages.
  • We sincerely apologise for any inconvenience this disruption may cause. To alleviate the impact, a comprehensive guide containing clinical recommendations for switching between products is attached for your reference.

Waiting list information

People who are currently being offered an appointment have waited approximately: 3 years  [lasted updated 20 December 2023]  

In the past five years, across the UK, there has been increased demand for autism and ADHD services. This is partly because more and more people are realising they may be autistic or have ADHD and, understandably, want to be formally assessed. This means, however, that, with more people trying to access the same number of services, people have to wait for their assessments longer. We recognise the current waiting times are unacceptable, as people should be receiving care and recognition in a timely manner. Our service is doing everything it can to reduce these waiting times. Despite this, our current waiting time is a number of years. We appreciate that this information is not precise. We are not able to give a more precise prediction, as the factors affecting the wait times are, at the moment, still changing (for example, the number of people accessing our service is still increasing).  

Because we understand that it can be difficult to wait for such an important appointment (especially without a clear idea as to when exactly it will take place) we have come together to give you more information and suggest further resources while you wait. We welcome any feedback, including around language, content, and design. Please find the link to the feedback form at the end of the guide. 

Taking care physical health needs.pdf [pdf] 249KB

Taking care mental health needs.pdf [pdf] 942KB

Taking care general wellbeing.pdf [pdf] 318KB

Introduction to Neurodevelopmental Conditions.pdf [pdf] 104KB

Pathways to diagnosis.pdf [pdf] 953KB

Further resources.pdf [pdf] 267KB

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