After your diagnosis

What nobody tells you after diagnosis

Most guides about ADHD stop at the point of getting assessed. This page covers what actually comes next: titration, ongoing prescribing, medication reviews, and the long-term relationship with whoever is managing your care.

An ADHD diagnosis is the beginning of a process, not the end of one. The steps that follow are where people are most often left without clear information.

After diagnosis: your main options

No medication: some people manage well with strategies, environmental adjustments, and support alone
Medication: the most evidence-based treatment for ADHD in adults and children, and the route most people pursue after diagnosis
Psychological support: CBT adapted for ADHD can help with strategies and emotional regulation, though NHS availability in Scotland is limited

Who will look after you, and will it be the same person throughout?

One of the most commonly misunderstood aspects of private ADHD care is who is actually responsible for your care at each stage. In many clinics, the answer changes after diagnosis.

The assessing clinician carries out your diagnostic assessment and produces your report. Depending on the service, this may be a consultant psychiatrist, a clinical psychologist, or another qualified specialist.

Your ongoing prescriber may be a different person. Some clinics use the same clinician throughout; others separate the diagnostic and prescribing roles, with a nurse prescriber or a different clinician managing titration and reviews after diagnosis. This is a common arrangement in private ADHD services and does not in itself indicate lower quality of care, though it is not always clearly explained upfront.

Nurse prescribers are registered healthcare professionals qualified to prescribe ADHD medication. Many have extensive experience in this area. Their role in your care may differ from that of a consultant psychiatrist, and it is worth understanding what escalation routes exist if your situation becomes more complex.

Before starting with any provider, ask: who manages my prescribing after diagnosis, will I see the same person at each appointment, and how do I raise concerns between scheduled appointments?

Titration

Titration is the process of finding the right medication and dose. It typically involves:

Starting on a low dose
Increasing gradually at intervals, usually every one to four weeks
Monitoring for effect and side effects at each stage
Settling at the dose that gives the best balance of benefit and tolerability

Titration can take weeks or several months depending on how you respond to medication and whether the first medication tried is the right fit. Some people need to try more than one medication or more than one formulation before finding what works.

During titration, you should have access to your prescribing clinician to discuss how you are getting on. Ask your provider how quickly they respond to queries (by phone, email, or patient portal) and what their process is if you are struggling with side effects between scheduled appointments.

Medication reviews

Once medication is stable, ongoing reviews are typically scheduled every six to twelve months. These reviews exist to:

Check the medication is still effective
Monitor for side effects over time (including blood pressure, pulse, appetite, sleep, and mood)
Adjust the dose if your needs have changed, for example if your workload, sleep patterns, or life circumstances have shifted significantly
Renew the prescription and ensure clinical oversight continues

Doses do change over time. This is not unusual or a sign that something is going wrong. ADHD symptoms fluctuate with context, and what worked at one point in your life may need adjusting as things change. The relationship with a prescribing clinician ideally involves honest conversations about this, not just prescription renewal.

Medication for ADHD

ADHD medication falls into two main categories:

Stimulants (first-line for most people):

Methylphenidate (Ritalin, Concerta, Medikinet, Equasym, Xaggitin)
Lisdexamfetamine (Elvanse)
Dexamfetamine

Non-stimulants (used when stimulants are not suitable):

Atomoxetine (Strattera)
Guanfacine (Intuniv), licensed for children and adolescents

The choice of medication depends on individual factors including age, other health conditions, and your response to each option. Your prescribing clinician should discuss the options with you rather than defaulting to one without explanation.

For clinical detail, the NICE guideline NG87 is the authoritative UK reference.

Shared care

Shared care is the arrangement by which your NHS GP takes over prescribing ADHD medication that a private specialist has recommended. All NHS prescriptions in Scotland are free, making this a significant practical step for many people.

In practice, GPs vary considerably in their willingness to enter shared care. The quality of the clinical letter from your private provider matters greatly. A thorough, personalised letter from a psychiatrist who has clearly engaged with your history will carry more weight than a brief or template-based note. This is one of the main practical differences between different private providers.

Some GPs will not accept shared care at all, for reasons ranging from practice policy to unfamiliarity with the medication. Others will, particularly if they receive good clinical correspondence.

Shared care is also not permanent. If you change GP practice, it does not transfer automatically. You will need to request it from your new practice. If the GP who established your agreement leaves, a new GP may not continue it without prompting.

Full guide to shared care →

If shared care is declined

If your GP will not accept shared care, you have two practical options: continue with private prescribing, or explore whether your health board has an NHS pathway for follow-up after private diagnosis.

Private prescribing involves paying a prescription fee charged by your clinic or prescriber (costs vary between providers; some Scottish clinics charge from around £30, others more) plus the cost of the medication at a pharmacy. Private prescriptions can be dispensed at any pharmacy, including standard high street pharmacies. Medication costs vary between pharmacies and it is worth comparing. Together these costs can be significant, particularly during titration when appointments are more frequent.

This is a structural problem in Scottish ADHD care, not a reflection on the individual. Several health boards are reviewing their shared care policies, though progress has been uneven.

Ask your provider to write a detailed clinical letter to your GP explaining the diagnosis and the monitoring arrangements
Contact Patient Advice and Support Service (PASS) for independent advice on your rights
Ask your health board directly whether an NHS follow-up pathway exists for privately-diagnosed patients. Some do