When choosing a clinic for the diagnosis and treatment of ADHD, it is important to understand all of the steps involved, and the most common (and costly) mistakes people often make.

Note: While there are exceptions to the parameters outlined below, they are rare. The process as described here is how ADHD screening, diagnosis, and treatment with medication for works for almost all private patients in Ireland.

1. ADHD Pre-Screening: €0 – 89

A few clinics begin the ADHD process with a screening. This is not a diagnostic test; it is simply an indicator of whether you fit the typical profile of someone who goes on to be diagnosed with ADHD. These screenings are sometimes online quizzes; sometimes delivered by a psychologist; sometimes delivered by a person with specific training but not a specialist degree. Screenings are optional, so the cost is not included on the ADHD Clinics Cost Comparison chart. But if you are not convinced you probably have ADHD, this step can save money in the long run.

2. ADHD Testing & Diagnosis: €800 – 1500

This stage is typically delivered in two sessions. The first appointment is usually an hour or two with a lot of questions and information gathering. This includes information about your childhood, so even though you are an adult, you may be asked if a parent can attend (it’s okay if not.) The session also typically includes an in-depth DIVA-5 or similar diagnostic interview to help the clinician determine whether your symptoms match the diagnostic criteria for ADHD. This session is almost always delivered by a psychologist; sometimes it is delivered by a psychiatrist. It must be delivered by a psychologist or a psychiatrist for your diagnostic report to be valid.

The second session is an analysis of your test results from the first session, and delivery of a diagnosis. This session is delivered by either a psychologist or a doctor; if a doctor, that person is usually a psychiatrist. (For simplicity, this Guide just uses the term psychiatrist from here as that is most common in Ireland.) Either way, the session should cover options for your next steps going forward.

Individual reactions to being diagnosed range from the quiet “I knew it!” relief of confirmation to a dramatic re-evaluation of your entire life causing genuine grief and/or anger. If you are struggling, you can find peer groups on Facebook; look for support on the r/ADHDIreland sub on Reddit; or sometimes you can avail of counselling through your ADHD practice at an additional cost.

If your positive ADHD diagnosis is given by a psychiatrist, you may be offered the option of medication and be given a prescription at this session. Otherwise, you will be offered the option to make an appointment with a psychiatrist to kick off the next stage. There isn’t a significant benefit or savings to starting meds here in Step 2 vs waiting for Step 3; either way, if you choose to try medication, you are going to be spending quite a lot more time and quite a lot more money dealing with ADHD meds in the next stage.

WARNING: Diagnostic Reports

Along with your diagnosis, most practices will give you what is called a Diagnostic Report. You must have this report to be able to take your diagnosis to a different practice or doctor. If you do not have this report and you ever need to find a new psychiatrist, you will need to start the entire process all over again and all of your money spent to this point will be lost.

This is especially important if a clinic closes; a psychiatrist retires, dies or otherwise ceases to practice; or a service stops operating. There have been cases where patients were left without access to their diagnosis and had to start from scratch because they couldn’t provide evidence of their original diagnosis.

WARNING: Psychologists and ADHD Medication

One of the most common misunderstandings about ADHD assessment is that a diagnosis automatically leads to access to medication. It is crucial to understand that a psychologist can diagnose ADHD, but cannot prescribe medication. Likewise, your GP almost certainly will not prescribe ADHD medication on the basis of a psychologist’s diagnosis alone. Do not make the common mistake of getting a diagnosis from a psychologist and believing that will give you access to medication. Unless your diagnosis comes from a clinic that offers both diagnosis and treatment, you will still need to find and pay for a psychiatrist who will accept that diagnosis in order to access medication.

3. Psychiatry & ADHD Meds: €300 – 930

It is quite common for people to believe that armed with an ADHD diagnosis, they can now access a magic pill for treatment. Unfortunately this is not the case. If you decide to try ADHD medication, it is exceedingly rare for you to be able to take your shiny new diagnosis back to your GP to get meds. 99.9% of GPs will not do this. You will need to get your prescription from a psychiatrist who will lead you through a process called titration. This means starting on a low dose and gradually adjusting it over a number of weeks until you find the medication and dosage combination that that provides the best balance between improvements and side effects.

During titration, you will have regular check-ins with your provider to discuss whether your ADHD is improving and to check on things like sleep, appetite, mood changes, and other side effects. You provider will also need regular reading of your blood pressure and heart rate, and some will require an ECG.

Some people find the right medication and dose quickly, while others need to try several different combinations before finding what works best for them. The process is rarely as short or a seamless as many people going into it expect it to be:

• It is normal for your prescriber to start you on a non-stimulant first, and then change you to a stimulant if the first drug is not helping you.
• It is normal to have to change drugs or increase doses several times.
• It is not unusual for there to be a honeymoon phase, where everything is working really well on the initial dose… and then it stops working.
• If you menstruate, it is also not unusual for a drug to be effective during one phase of your cycle and then feel like it is not there at all during another phase.

All of this should illustrate that finding the right drug and the right dose is a process. You should expect it to take 6 to 12 weeks, with multiple check-ins with your psychiatrist. (Less commonly, these check-ins may be with a staff member, but they will still have to go back to the psychiatrist to get sign off on any med changes.)

For this reason, the ADHD cost comparison chart assumes you will need four appointments with your prescriber. The costs for these appointments are included on the chart and used in calculating the financial total for each clinic. If you are very lucky and need fewer check-ins, congratulations: you will spend less than expected and save some money. (The chart also lists the cost for additional reviews in case you need more, but those prices are not included in the clinics total cost figure.)

WARNING: Required Heart Checks

Stimulants can raise heart rate and blood pressure. They can also put you at risk if you have an underlying heart condition you may not even know about. Psychiatrists will require you to get your blood pressure, heart rate, and sometimes an ECG before a trial of meds can begin. Almost none of them offer this service through their clinics, so it will likely be your responsibility to arrange this, typically through your GP or a walk-in clinic. You will need to cover the costs for this unless you have a medical card and a cooperative GP. Charges for this vary and are not included in the cost comparison chart.

After the initial check, some practitioners will allow you to use an at-home blood pressure cuff and heart rate monitor.

WARNING: Schedule In Advance

Unfortunately it is not unusual for a patient to start a medication, need to change, and then discover their psychiatrist is booked out for the next six weeks. Always book the next review at the time of your last appointment when you can.

4. Shared Care Transfer (or not)

Once you are stable on a medication dose that is working for you, your ADHD practice can do what is called a Shared Care Plan. This basically transfers your prescribing to your GP. However, not all GPs will write prescriptions for ADHD meds; a fair number refuse. It is entirely at each GP’s discretion.

• If your GP will not accept a Shared Care plan, your ADHD practice can continue to write prescriptions for you. There will be a monthly cost for this; prescription renewal charges are listed on the ADHD Clinic Costs Comparison.
• If your GP will accept a Shared Care plan, the prescription will be covered by the medical card if you have one. If you don’t have a medical card, your GPs standard prescription renewal cost will apply.
• Regardless of who is prescribing for you, if you do not have a medical card, ask your pharmacist to sign you up for the Drug Payment Scheme. The DPS will cap the costs of all medications for your entire household at €80 per month. (If your drugs are less than this, you will pay less.) Everyone qualifies for this.

ADHD stimulants are highly controlled drugs. Under Shared Care, your GP needs to basically be in a cooperative arrangement with your psychiatrist to continue to write your medication prescriptions. Your GP can only continue an existing prescription, so if you need a dose change, or a drug change, you will need to go back to your psychiatrist.

WARNING: Ongoing Psychiatric Reviews

Even after your care is transferred to your GP, your psychiatrist may require periodic reviews of your medication. Your GP may also require these reviews. Costs of reviews and typical frequency per provider are included in the ADHD Clinic Costs Chart.