Adult ADHD/ADD Treatment by Psychiatrist and ADHD Coach at Harley Therapy™ London
Definition of ADHD/ADD
ADHD or ADD is the acronym for attention deficit hyperactivity disorder or attention deficit disorder. The disorder is known as a chemical imbalance in the management systems of the brain and experts now believe that this disorder has hereditary, psychological and biological factors. There are three main types of ADHD: ‘combined type’, which has both inattention and hyperactivity, ‘predominately hyperactive’, which has a much greater deal of hyperactivity and impulsive behaviour, and ‘predominately inattentive’, which has the greatest impact on distraction in adults.
Signs and symptoms of ADHD
The symptoms of Attention Deficit Hyperactivity Disorder in adults can be far less obvious, despite their effect, than those in children. Adult ADHD symptoms can be divided into five broad categories:
- Hyper focus. Adults with the disorder may be very focused on a task, particularly if the task is consuming and enjoyable to them
- Impulsivity. Behaviour may be impulsive, such as spending
- Emotional difficulty. Adults may be unable to handle stress or they may easily lose their temper
- Hyperactivity. Adults with the disorder may be constantly fidgety, restless and may require less sleep
- Disorganisation. ADHD adults may easily lose things or forget important tasks.
These symptoms combined can make dealing with Attention Deficit Hyperactivity Disorder very difficult in adult life, and, if left unchecked, sufferers could find themselves with a range of difficulties, such as financial complications, problems at work, relationship problems and physical or mental health issues.
Treatment of ADHD
There is no ‘cure’ for ADHD, but treatment for ADHD is centred around managing the symptoms and enabling the adult to minimise the difficulties that can arise as a result of this disorder. Treatment for Attention Deficit Hyperactivity Disorder can be drug or therapy-based or a combination of the two. An important part of dealing with adult ADHD is to learn self-management skills, which include eating correctly, taking regular exercise and implementing coping strategies (for example list making or colour coding).
Therapy as a treatment may take different forms: general talking therapy, marriage or couples counselling (if indicated), or commonly, cognitive behavioural therapy, where the goal is to identify and change the behaviours that are problematic in everyday life. Drugs are often used as treatment; however, these usually form part of a long-term treatment programme that involves therapy.
Specialist Clinic for ADHD
- Dr Stephen Humphries, 30 years' medical experience, 23 years at consultant level, is expert in ADHD diagnosis and treatment.
- He will conduct a full psychiatric assessment including use of several specialised screening questionnaires.
- He uses the Connors 66 item long scale questionnaire which gives a highly accurate reliable assessment measured on six separate indices and a profile in graphic form which demonstrates both symptoms and severity.
- He discusses the condition and shows representative examples of typical brain scans.
- An accurate diagnosis, profile and assessment report will be provided to you within 14 days, a copy of which we recommend should go to your GP.
- Once established as a diagnosis there is then the offer of a trial of treatment which through its effect on dopamine and noradrenaline levels can markedly and rapidly relieve symptoms.
- Prescription service available as appropriate and indicated by assessment. This will not include medication that needs to be imported.
- Referral for CBT (cognitive behavioural therapy) for ADHD as appropriate.
- Regular follow up and adjustment of dosage and type of medication as clinically indicated.
Dr Stephen Humphries – ADHD Psychiatrist London
Dr Humphries, consultant psychiatrist, is one of the UK's best known psychiatrists for attention deficit disorder, due to his extensive experience in assessment, treatment and medication management. He has practised general adult psychiatry at consultant level within the NHS for over two decades. He worked at the West London Mental Health Trust at Charing Cross Hospital in London as consultant psychiatrist and as a private psychiatrist in London's Harley Street.
Dr Humphries is a recognised consultant psychiatrist with the following insurance groups: BUPA International, CIGNA US/UK and AVIVA.
Watch Dr Humphries explain what Adult ADHD is and how it can be treated.
A Typical ADHD Treatment Plan with Dr Humphries:
On average, an ADHD assessment takes about 90 minutes. Although, sometimes this can be completed in an hour.
We allocate an average of 90 minutes. Sometimes, it becomes obvious in the early part of the assessment that ADHD is not the main issue, or has nothing to do with the symptoms experienced which may be due to another condition.
In such situations, Dr Humphries will advise you that a full assessment for ADHD is not required, and where he can adjust the fee accordingly and fairly in agreement with the patient.
Based on a situation where treatment is effective and stable (more complex situations may require more attendances), the following is a typical treatment plan:
Initial 90 minute assessment - £850 (1 month prescription included in appointment fee where appropriate)
Review after 28 days £180-£250 (1 or 2 months prescription included in appointment fee where appropriate)
If stable review in 1-2 months £180-£250 (1-2 months prescription included in appointment fee where appropriate)
Then 2 months prescription without appointment £90
Review every 4-6 months thereafter, either via SKYPE or face to face (2 month prescriptions provided at each consult where appropriate) £180-£250
Prescriptions ordered every 2 months (where appropriate) and as necessary, in place of an appointment, sent by post or collected £90
If the GP agrees to a Shared Care Protocol when stable, the prescriptions can be provided in Primary Care with 3 or 4 months private review £180-£250 (which can include SKYPE or telephone sessions)
None of the above includes the medicine costs to the pharmacist for private medication, which typically are:
Elvanse approx £70-£120 for 28 days depending on dose
Dexamfetamine approx £70-£200 for 30 days depending on dose
Ritalin approx £30-£80 for 28 days depending on dose
Concerta approx £100-£140 for 28 days depending on dose
Adderall (a mixture of different amphetamines) approx £470 for 28 days depending on dose and is only available as the XR form in the UK
All prices are approximate and vary at different pharmacists and depending on dose range/number of tablets.
Dr Stephen Humphries is able to offer initial consultations to diagnose ADHD in adults.
US medicine is available on prescription in the UK: Elvanse (Vyvanse), Ritalin (Methylphenidate), ConcertaXL (Equasym XL, Medikinet SR) Dexamfetamine (Dexedrine) and Adderall. However, the cost of Adderall is disproportionately expensive in the UK (£472 for 28 days and only available as the XR form). Other medications are more reasonable at the cost of £70 -120 a month.
As far as we are aware, a UK prescription cannot be used in the USA, although it may be possible to fill it on-line. Most UK pharmacies can dispense the medication (usually 28 days at a time), but if there is a reason for a larger amount (i.e. travel), up to 3 months can be dispensed in one amount. 3 months supply can also be taken across international borders.
Here are a few tips on Elvanse administration:
Elvanse is a drug 'Lis-dexamfetamine', which for many people offers certain advantages over Ritalin, Concerta or Dexamfetamine. It is a pro drug, which means it is inactive when swallowed and is absorbed through the stomach and small intestine quite quickly. Once in the blood stream it is broken down into the active ingredient, Dexamfetamine. Because it is released slowly in this way it has a span of action from 1 hour after ingestion for up to 16 hours; however, in most people it is 10 to 12 hours. Some people experience much shorter effect times due to their individual metabolism and dose adjustments are usually required. The release curve is quite smooth and should peak around lunchtime tailing off gradually in the evening.
As far as taking Elvanse is concerned, it should be taken as early as possible in the morning and after a light breakfast. On an empty stomach it is absorbed too quickly giving a shorter less smooth effect. After a heavy fatty breakfast it is absorbed slowly and may be less effective. Cereal or toast is ideal. The effect on the first few days varies a lot between individuals. If there is no perceived effect from the first 30mg dose, advice should be sought from our administrators firstname.lastname@example.org who will contact Dr Humphries. Usually a dosage increase is required to establish an effect. If the Elvanse works well for several days then seems to stop, this is usually as a result of down regulation of receptors to Dopamine. This is very common and means simply that the brain cells are altering their sensitivity levels. Again, advice should be sought and a dose adjustment made.
Sometimes people experience an enhanced early effect feeling "wired" or agitated on 30mg. This usually settles in a day or so but dose adjustments downwards can be made with advice. Sometimes the initial dose works well and no adjustment is necessary in the first month, although it may be adjusted at the first follow up appointment.
Elvanse sometimes interacts with caffeine causing a tremor. We advise reducing caffeine intake to avoid this. Elvanse can be taken with other medication such as antidepressants especially SSRI (e.g. Prozac, Citalopram Seroxat and others), as well as Buproprion. With SNRIs (cymbalta, efexor) it may lead to over-stimulation due to excess noradrenaline release.
Elvanse can be combined with short acting Dexamfetamine giving a similar effect to Adderall, which is not used much in the UK due to its high cost.
15mg dose of Elvanse - Break a 30mg capsule onto a dry clean plate. Divide the powder into two equal piles. Put half into a small amount of water in a glass and drink the mixture giving 15mg. Save the remaining powder for the next day.
45mg dose of Elvanse - Take half a capsule as above and one full capsule together.
60mg dose of Elvanse - Take both 30mg capsules together.
Other combinations are possible using the larger capsule sizes of 50mg and 70mg, allowing 25mg and 35mg respectively.
ADHD Treatment Results
Here is some feedback from one of Dr Humphries' patients about the positive effects of Attention Deficit Hyperactivity Disorder treatment (18 June 2013):
- Less fidgety, less anxious.
- Much calmer in my head :) - much more serene!
- No anger bouts, able to deal with my son calmly.
- I finished a number of boring jobs!
- Increased social skills/awareness.
Dr Humphries, as quoted in 'Mentally Healthy' magazine (November 2011):
What The Experts are Saying
According to one Harley Street doctor and psychiatrist, the UK is slowly catching up with the US in acknowledging that the illness does not go away with age and that ADHD brain changes do persist well into adulthood.
Doctor Steve Humphries, a general psychiatrist at Harley Therapy, who has witnessed the increase in adult sufferers seeking treatment, said: “I have only really approached [ADHD] in my practice during in the last few years. Prior to that, I was a little sceptical about the condition. [But] I started to see a lot of people asking for treatment, particularly Americans who are more advanced in their awareness of the condition than we are in the UK currently [and] a recent audit shows that approximately 80% of adults with diagnostic symptoms of ADHD have a positive response or an extremely positive response to the current methods of treatment. People often learn how to manage their symptoms from childhood. But when they are stretched in higher education or highly skilled jobs, they find that their symptoms overwhelm them. It’s at this point that some people seek treatment for the first time, even though the condition may have been present since childhood.”
Humphries has worked with adult sufferers of ADHD for several years, and believes that today there is a “sizable case load” proving that the core symptoms can be significantly alleviated through a mixture of therapy and medication.
Diagnoses and Treatment
To diagnose the disorder in adults most reputable doctors and psychiatrists will first use the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Criteria checklist, published by the American Psychiatric Association. Humphries says: “I then use the Wender Utah Rating Scale (an aid to assess adults' retrospective account of the childhood occurrence of symptoms associated with ADHD) to identify childhood symptoms and further understand the condition in the adult.
Once completed, I conduct a detailed psychiatric assessment face to face. A possible diagnosis is then followed by an offer of a month’s therapeutic trial of treatment. I principally treat people using medication, which aims to increase brain dopamine levels, which relieves the core symptoms. This treatment alone can be very effective but may also be backed up with Cognitive Behavioural Therapy and diet and exercise.”
Some people have described the changes they’ve seen in themselves as "miraculous" Humphries says. “They improve in their concentrational levels, their procrastination reduces and in some cases treatment has completely changed their lives."
Further reading on Adult ADHD
London Psychiatrist Services
- £850 Comprehensive ADHD Assessment lasting 1 hour 30 minutes. Payment required in advance by Dr Humphries. (Includes ADHD questionnaires, diagnosis, treatment plan & full report.)
- £180 Follow up appointments (20 mins). £165 when held via SKYPE
Dr Stephen Humphries
Areas of Expertise in Psychiatry
- Panic Disorder
- Eating Disorders
- Bipolar Disorder
- Personality Disorders
- Obsessive-Compulsive Disorder OCD
- ADHD (Adult) and ADD
Colleague Feedback (June 2014) on Dr Humphries
"Stephen Humphries's dedication to clients is demonstrated in his detailed reports and on going assessment. I have been in the fortunate position to work with many of his clients. They all speak very highly of how at ease he makes them feel, his professionalism and on going support. I have also have referred clients to Dr Humphries, the feedback is always very positive and many say in enhances there on going therapy"
"I have found him to be friendly and approachable. In one instance I sought his counsel in order to share an issue related to risk - he afforded me time and space to outline the actions I had taken. I felt supported and validated in this discussion and was glad of the opportunity to share the issue with someone with significant experience in this area."
"He is incredibly helpful, approachable and supportive on all matters I have needed to discuss with him."
Patient feedback (June 2014) as part of 360 feedback report
- "Dr Humphries is an excellent doctor."
- "Dr Humphries was accessible when needed and responded promptly to queries."
- "Excellent psychiatrist. Very good at hearing one out, understanding and patient. Highly respects one's individuality and person. Has been immensely helpful."
- "Dr Humphries made me feel very at ease within moments of stepping into his office. A very lovely and understanding gentleman."
- "Good assessment and treatment package. Excellent appointment."
- "Treated without looking, or watching time for next patient - satisfactory."
- "Very happy with Dr H."
- "Excellent. Very Attentive."
- "Dr Humphries is very polite and thorough, happy with his care."
- "I am extremely happy with Dr Humphries, he is obviously very intelligent as well as having an excellent bedside manner."