Part 5: The BBC Panorama adult ADHD investigation was as bad as I expected
Somehow, this was even worse than the article.
Hello again. I just finished watching the BBC Panorama “exposé” of the private ADHD healthcare sector and it was just as bad as I expected.
This post will be more stream-of-consciousness than the last. My most substantial points were made in that article anyway. If you haven’t already read it, click here and come back when you’re done.
The program starts with a “tip” from a parent concerned that her daughter received a diagnosis over the Internet, with the appointment lasting less than she thought was reasonable.
How does she — or, for that matter, the presenter, Rory Carson — know the appropriate length of time for an ADHD assessment?
Carson saw an NHS practitioner for an assessment that lasted three hours — with the implication being that this is a normal and appropriate length of time. Except it isn’t.
Some trusts say an assessment can last up to 90 minutes, while others say between 1-2 hours.
Put another way, Carson wasn’t forthright about how long an assessment should take. From everyone I’ve spoken to — including those diagnosed on the NHS — three hours is an unusually long time, and I wonder if the lengthy appointment was primarily for the benefit of the cameras.
Carson’s assessment with ADHD360 lasted 75 minutes, so roughly in line with the NHS trusts I found that provide estimates of the appointment length.
The program implies that online assessments are less reliable than in-person appointments. Again, there’s no basis for this. One US study of telemedicine mental health services during the Covid-19 pandemic showed a higher rate of patient satisfaction and treatment completion compared to in-person appointments.
Also, some NHS trusts do adult ADHD assessments over the Internet. Awkward.
The program leans heavily on a “whistleblower” from Harley Psychologists who insisted that patients were getting their diagnoses rubber-stamped without any clinical scrutiny.
How would she know? How can we trust her judgment? The report doesn’t say whether she was a clinician, or if she worked in another part of the organization.
Carson treats the pre-screening checklists as though they were a marketing tool designed to convince people they need a diagnosis. He doesn’t mention they’re an actual diagnostic tool — most likely the Adult ADHD Self-Report Scale (ASRS) V.1.1.
Similarly, he’s aghast that the clinicians seem to be operating from a checklist or script. Except, adult ADHD has a well-defined criteria in the DSM-V (or as hyperkinetic disorder in ICD‑11).
Any questions, in order to be clinically useful, would have to align with those definitions. It therefore makes sense to have a script or checklist. Would you prefer the clinician simply wings it each time?
Carson raised an eyebrow at the idea that a nurse, psychologist, and pharmacist could assess someone for ADHD.
NICE guidelines state that any qualified medical professional with relevant training can perform ADHD assessments, although a psychiatrist needs to be the one dispensing the medication.
Some NHS trusts — like Tees, Esk, and Wear Valleys NHS Trust — use nurse-led assessments!
More clinicians are a good thing. At a time of high demand for ADHD assessments, you don’t want to artificially constrain the supply of diagnosticians. And one study shows that ADHD clinics that use pharmacists in conjunction with psychiatrists can deliver good clinical outcomes and high patient satisfaction.
Carson repeatedly refers to “powerful stimulants” throughout the report. Let the record show that the Harley Psychologists psychiatrist suggested starting him with Concerta XL — a slow-release, non-amphetamine stimulant, and almost certainly in a low dose as part of a titration protocol.
A starting dose of Concerta XL as about as close to being a “powerful stimulant” as Carson is to being a good journalist.
I’m now going to refer to coffee as a “powerful stimulant.”
Nothing was said about the debilitating nature of ADHD, and we didn’t hear from those who had a good experience with these companies — which shouldn’t be hard, because I know at least two people who received their initial diagnosis from ADHD360 (one paying out-of-pocket, the other though NHS Right To Choose) and are satisfied with the level of care they received.
All the other criticisms mentioned in the previous article stand. Carson’s reporting was sloppy, unnuanced, and deeply uncurious. The comparison between private providers (who didn’t know he was a reporter) and the NHS doctor (who did) is deeply unfair and reveals nothing of use.
Worse, he doesn’t actually explain how an ADHD diagnosis works. Like I said in my previous article, it’s a subjective interpretation of information provided by the patient and their family members. The clinician makes a determination by talking and listening. There’s no valid reason why ADHD diagnoses can’t be made virtually.
The private ADHD360 service was a target for much of Carson’s misdirected ire, and many of the patients I know feel deeply anxious that their diagnoses — which allowed them to access life-improving medications — will be invalidated or treated as suspect by other clinicians.
I can’t begin to stress how much harm lazy, unnuanced, and unsophisticated reporting like Carson’s can do. Everyone involved in this travesty of journalistic malpractice should feel deeply ashamed of themselves.
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Also I think notably, none of the 'bad diags' in the piece were actually confirmed as to whether they did, in fact, have ADHD.
A daughter diagnosed fast .... well, hypothetically, what if it had been absurdly obvious?
And likewise the reporter. I know he's 'sure' he doesn't have ADHD, but 80% of adults with ADHD don't actually know.
If I asked 4 doctors to diagnose me with something, and 3 said 'yes, you meet the criteria' and the only one that didn't was the one I primed to give me a negative diag... I'm really not sure I'd be trusting that one dissenting view!
If this reporter did, in fact, fill out an ASRS, meeting the DSM-5 ADHD diagnostic criteria, then he has ADHD, and the 'session' is actually more like a formality to assess whether he's right or not, or if there's other explanations.
And if he lied about it.... well, yeah. OK. Defrauding a doctor isn't exactly a 'big win' either, now is it?
Great post. ASRS is not a simple "checklist" to be mentioned incidentally by the journalist. The BBC reported 1.5 million have ADHD: https://www.bbc.co.uk/news/uk-england-44956540 Sounds reasonable. Panorama? The episodes opens with "thousands"