Clinician Experiences of the Pathways to Adult ADHD Diagnosis

Adult ADHD care in the UK remains fragmented, inconsistent and often under-resourced, despite rising demand and increasing public awareness (Asherson et al., 2022; Smith et al., 2023). While national guidance outlines a clear framework for healthcare provision (NICE, 2018), implementation across services and regions remains highly variable. A qualitative Systematic Literature Review (Chapter 2) explores healthcare professionals (HCPs) perspectives on barriers to accessing care for adults with ADHD or Autism Spectrum Disorder (ASD) in the UK. The results emphasise widespread concerns about underdiagnosis, limited training, diagnostic overshadowing and inadequate support postdiagnosis. Using qualitative methodology, the empirical study presented (Chapters 1; 3-5) begins to address the identified gap in research on HCP perspectives specific to adult ADHD pathways. Twelve UK-based HCPs specialising in ADHD were interviewed and analysed using Reflexive Thematic Analysis (Braun & Clarke, 2019) within a critical realist framework (Bhaskar, 1979; Fryer, 2022). Five main themes were identified: (1) A strained system, (2) Referral, primary care and General Practitioner (GP) barriers, (3) Diagnostic mismatch, (4) A pariah diagnosis? (5) Solutions and facilitators. Participants described systemic issues, including lack of training, gatekeeping, fragmented commissioning, and the neurotypical design of assessment tools. Post-diagnostic care was widely described as absent or tokenistic, with many professionals questioning the ethics of delivering a diagnosis with no follow-up support. The final theme highlighted examples of good practice and offered reflections on how adult ADHD care might be improved through greater integration, flexibility, and investment in existing models of care. The study contributes new insight into how adult ADHD care is experienced by practicing professionals, and how clinical and structural change might be enabled through more a national ADHD strategy, and relational, joined up, and inclusive approaches to care.