Docs Archive - Psychology & Counselling in Malvern, Worcestershire

ADHD Assessment FAQ

Dr Abigail — Wed, 01 Feb 2023 13:48:01 +0000

Our ADHD assessment & fees

Our gold standard ADHD assessment closely follows the UK recommended NICE guidelines. Our assessments are completed by a Psychologist with specialist ADHD training. They are comprehensive and incorporate multiple clinical interviews with multi-observer perspectives on childhood and present symptoms. This includes:

– Full mental health assessment
– 8 Psychometric tools/ questionnaires
– Developmental history
– Psychiatric history
– Exploring differential & comorbid diagnoses
– Formal ADHD interview tools
– 2 – 2.5 hours of direct clinical interviews with a Senior Psychologist
– QB check of real time struggles in attention, disinhibition and hyperactivity (optional)

Our ADHD Assessments have three distinct stages:

Stage 1. Pre-Assessment Admin. This includes a screen to check if an assessment is warranted. The fee is charged at the end of Stage 1 should the screen show evidence to continue to the full assessment.

Stage 2. Eight formal assessment tools/ questionnaires. Six are self report and two are for observers: someone who currently knows you well, and someone who knew you in childhood.

Stage 3. 2.5 hours of clinical interviews with a qualified and experienced Psychologist.

Optional Extra: Real time test of attention/ inhibition/ hyperactivity using specialised QB check software (Additional £195)

A detailed Clinical Report will be provided (around 15 pages) plus letters for reasonable adjustments for study and work.

The fee for our three stage adult ADHD assessment is £850. We also accept payment through Bupa Health Insurance.

Should you elect to have, or be advised to have the additional QB check appointment (as an objective measure), this is an additional £145.

We only presently offer ADHD Assessments for adults. We have Medication Prescribers who offer ADHD medication to ages 11 years and above.

What is a QB Check Appointment

Using the specialised ADHD Assessment QB Check Software provides additional evidence, in real time, of executive function struggles compared to someone matched to similar age and gender.

A visual ‘real time’ map of abilities in attention, inhibition and hyperactivity are shown graphically.

Many clients find this visual, objective measure of executive functioning extremely validating of their difficulties; as it shows their abilities compared to age matched peers.

This tool also allows us to gather further information, if the main assessment is inconclusive due to a lack of childhood evidence or significant differential diagnoses.

It is undertaken in a separate remote appointment, lasting up to 40 minutes. A practitioner will be present on the phone/ video call during the whole QB check appointment to support you in the process.

What are the benefits of having an ADHD assessment?

For many clients, a comprehensive ADHD assessment provides clarity on difficulties and struggles experienced for many years.

On many occasions, long standing struggles can be seen in a different light. A thorough assessment can dispel negative labels of ‘laziness’ or ‘inadequacy’ (that have sadly been used), removing these punitive blaming stores with a more positive and constructive reality; that the ADHD brain is wired slightly differently and needs to be understood in this way.

An assessment may also reveal difficulties that are not due directly to ADHD such as depression, communication struggles, autistic traits, trauma, or anxiety. Enabling a clear focus on areas of impairment, possible further assessment and strategies for positive change.

Our assessments particuarly focuses on how things can be improved. In our report we make recommendations on areas in which therapy could be helpful, and the type of therapy most likely to create improvement in your mental health and day to day functioning.

How long does the assessment take?

Once an enquiry is made, we aim to send out Stage 1 information within 3 working days.

Stage 1 and Stage 2 can be completed at your own pace. This is often around 1 week, as some of the questionnaires are for family to complete.

Stage 3 can begin once all the psychometrics and questionnaires are complete. This includes a clinical interview lasting 2.5 hours. The outcome will be provided at the end.

Why do we require information from other people?

NICE guidelines stipulate that a comprehensive ADHD assessment needs to have both current and historical information from the client and also from an observer (or more than one observer). Multiple perspectives make the ADHD assessment more robust and thus more accurate.

When will I know the outcome?

The outcome of the assessment will be discussed during the end of your second clinical interview.

A positive diagnosis of ADHD is only given if information presented during the assessment meets criteria according to the DSM-5 on what constitutes ADHD. Please note, we are unable to offer a refund should the outcome of the assessment be different to what was expected.

On rare occasions there may not be enough evidence to offer a definitive diagnosis e.g. if some of the historical information is unavailable. If this is the case, we will discuss this outcome in the report.

Further appointments following the assessment will be charged at the Clinician’s usual hourly fee.

What if the outcome is unclear?

An ADHD assessment is an exploration of symptoms/ behaviours and their impairment, across the lifespan, compared to a set ADHD diagnosis criteria.

Sometimes other conditions can mask or mimic these symptoms. As trained Clinicians, we try our best to explore all differential diagnoses that could account for your symptoms. However sometimes the assessment outcome may still remain unclear.

If the outcome is inconclusive we will recommend a QB check using real time software to assessment inattention, hyperactivity and impulsivity. This is an additional £145.

If the results are still inconclusive we will provide details on what other factors could be creating your symptoms, and include in the report a plan for treatment and further support.

What happens after the assessment?

Once the assessment has taken place, you will be provided with:

1. A Full Clinical Report, then if a positive ADHD diagnosis is made:

2. A reasonable adjustments letter for work

3. A reasonable adjustments letter for study

You are welcome to consider medication and/ or psychological therapy with an Associate within our team, or you are welcome to take our reports to another service.

Will my NHS GP accept the report?

NHS GPs are under guidance to accept only reports and assessments they believe are accurate and valid, and follow all guidelines.

We believe our assessment and report will be accepted as valid by your GP as we meet criteria set out in the Hereford and Worcestershire Integrated Care Board (who provide guidance to GP practices).

We recommend speaking with your GP prior to your assessment should you have any concerns. We are happy to have direct contact with GPs to confirm how we meet all appropriate criteria.

How do I receive medication for ADHD?

We have a Prescribing Pharmacist, ADHD specialist who can initiate, review and manage dose titration, for clients where medication is deemed suitable.

The ADHD diagnosis must have been made by a Psychologist within Malvern Hills Private Practice (MHPP) or by a Psychologist registered to our Partnership Program.

Please contact us on contact@malvernhillsprivatepractice.co.uk if you are unsure whether your Psychologist is registered with our Partnership Program.

Fees for a Medication Assessment are as follows:

1.Initial Medication Assessment (50 mins) – £295

2.Follow up (30 mins) – £147.50

3.Repeat prescriptions (outside of Assessment/ Follow up) – £30

Please allow at least 3 follow up appointments to fully stabilise dose and type of medication. There will also be a fee for the purchase of the medication, from the pharmacy.

Once you are stable on medication, our prescriber will write to your GP to request a shared care arrangement.

ADHD coaching / therapy

Medication for ADHD is known to be most effective when combined with targeted psychological treatments that address emotional and behavioural issues and teach new coping skills.

We offer the following psychological support and interventions:

Education around ADHD and understanding role of executive functioning in everyday life
Handouts to share with family/ improve relationship understanding
Coping strategies/ goal setting/ problem solving/ accountability
Improving sleep/ lifestyle changes
Improving self esteem
Activities to enhance functioning
Using Cognitive Behavioural Therapy to improve core beliefs that may have developed such as “I am not good enough”
Using EMDR to heal past hurts, rejections and humiliations that may have occurred during times
EMDR to increase confidence and improve self esteem
Compassion Focussed Therapy to address the impact that ADHD can have on an individual’s wellbeing.
Dialectical Behaviour Skills for managing emotional dysregulation and impulsive tendencies
Treatment of depression, anxiety or trauma that are often co-occurring with a lifetime of ADHD struggles
Opportunity to meet with our dietician to consider the impact of food and nutrition on brain functioning, emotional regulation, medication metabolization and executive functioning.-

Psychological interventions are based on a fee per session. We offer a range of prices depending on therapist seen. Please see our team page for more information on individual charges per session.

What is the cancellation/ refund policy?

If you request a refund after paying the fee (prior to starting the assessment), we will need to deduct the Stripe card fee before providing a refund.

Once you have completed Stage 2, should you require a refund, this will be provided minus £200 to cover admin and scoring of all Stage 2 questionnaires.

Once stage 3 has begun we are unable to offer any refunds of the assessment fee.

Stage 3 clinical interviews cancelled with less than 24 hours’ notice prior to starting, will incur an additional fee of £300 to cover the Psychologists time. If incurred, this cancellation fee will need to be paid prior to any further assessment sessions being booked. If we manage to fill the assessment with another client, this fee will not be charged. However due to the last minute nature of the cancellation, this may not be possible.

If someone else is paying for your sessions (i.e. a family member, friend or a company) and they enquire about your attendance, we may provide limited information pertaining to which sessions have been attended/ cancelled.

For Health Insurance Clients: Please note that your Health Insurance does not cover cancellation fees. If cancellation fees arise we will invoice you directly and require payment by card.
We are unable to offer a refund should you be unhappy with the clinical outcome of the assessment.

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Emotional Nutritional Intervention Program (ENIP)

Dr Abigail — Wed, 01 Feb 2023 13:46:55 +0000

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Sleep Problems

Dr Abigail — Thu, 12 Jan 2023 11:26:22 +0000

Insomnia, trouble relaxing, night waking, un-refreshed sleep, nightmares

Are you struggling to fall asleep? Or maybe waking up repeatedly at night? Or sleeping for 8 hours but still feel unrefreshed?

You may be struggling with a sleep disorder, defined as a “medical disorder of a persons sleep pattern”. Sleep disorders are serious as they can interfere with daily functioning, increase low mood anxiety and irritability.

There are different types of sleep disorders for example insomnia (chronic difficulty falling asleep or maintaining sleep) sleep apnea, nightmares, night terrors, circadian rhythm disorders and many more.

Insomnia is a frequent difficulty we see in our practice. In the UK 1 in every 3 people in the UK are affected.

Some of the symptoms of insomnia are:

find it difficult to fall asleep
lie awake for long periods at night
wake up several times during the night
wake up early in the morning and not be able to get back to sleep
not feel refreshed when you get up
find it hard to nap during the day, despite feeling tired
feel tired and irritable during the day and have difficulty concentrating

Many people get insomnia on occasion without serious consequences. However for some people the problem can last for months or even years.

Persistent insomnia can have a significant impact on your quality of life. It can limit what you’re able to do during the day, affect your mood, and lead to relationship problems with friends, family and colleagues.

Psychological intervention can be very helpful in identifying and removing triggers for poor sleep. Sleep Hygiene is a whole approach to managing sleep concerns and utilised alongside psychotherapy been shown to help sleep disorders.

Another example are night terrors or nightmares. Often nightmares are intrusive material that is unprocessed in the conscious. Specific therapies called “nightmare re-scripting” are extremely helpful in reducing and stopping nightmares.

Night terrors are neurologically driven and certain behavioural techniques are very helpful in reducing their occurrence.

If you would like to know more about the treatment of sleep difficulties with psychological approaches please book a free telephone consult with Dr Abigail using the online diary.

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Escape Emotional Eating

Dr Abigail — Thu, 12 Jan 2023 11:19:00 +0000

Psychology has powerful tools to change eating behaviour

motional eating can range from struggling to stick to the desired diet, through to feeling out of control and binging. Emotional eating can cause deep distress and shame. The long term implications are serious with an increased risk of diabetes and heart disease due to unwanted weight gain.

There are proven psychological interventions to escape from emotional eating. Many people are unaware that there is an evidence-based treatment plan to escape from emotional eating.

Therapy can also help with increasing will power, rebuilding self-esteem and incorporating helpful strategies to reach desired goals.

Using food for emotional support can lead to a downward spiral – eating to escape the sadness that came from eating, the day before, to escape from sadness.

Some people mask their emotions so well with food that they don’t even notice feeling sad anymore. They just notice the overeating and this in itself causes shame, fear, and weight gain.

This cycle is addictive and can increase in severity over time.

There are proven psychological interventions to escape from emotional eating. These are based on Enhanced Cognitive Behavioural Therapy.

Sessions follow a clear plan based on a plan designed by Dr Fairburn. The plan is practical, evidence-based and effective.

To learn more I recommend purchasing this very helpful book by Dr Fairburn. The intervention is clearly outlined.

It is possible to follow this guide on your own and this might be enough to help you escape from emotional eating.

However, if you find you need further support then please contact me and we can work through the treatment plan together at a pace that suits you. Or we can undertake an assessment to see what the most powerful treatments for your difficulties may be, as sometimes trauma can be underlying over eating and this needs a different approach.

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Stress & Tension

Dr Abigail — Thu, 12 Jan 2023 11:10:15 +0000

Learn to calm your mind and soothe your body

Stress and tension can manifest in outbursts of anger, difficulty sleeping, feeling shaky, reduced appetite as well as many other symptoms. Some people experience an increase in physical pain, migraines, lowered immune system or an increase in tummy troubles.

Therapy can help you turn the body’s stress response off, and thus reduce the physical manifestation of the tension – even in the midst of the troubles.

It’s a bit like taking control of the direction of your boat in a storm, by lowering the sails. It doesn’t stop the storm but makes it possible to navigate towards your goals, and reduce damage to your boat (or body).

Learning to be physically calmer in the face of life’s troubles means that- despite the external stress – you are still able to sleep well and care for yourself; ultimately making you stronger and more able to bear stress.

Rather than waiting for life to get easier, therapy can help you learn to manage your internal stress and tension. The pain of life can become a little easier to cope with, and a sense of resilience can blossom within you.

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The Most Important Quality in a Child Therapist

Dr Abigail — Wed, 11 Jan 2023 11:02:52 +0000

This is what I believe to be one of the singularly most important qualities in an effective child therapist. Whatever type of therapy they are offering (CBT, EMDR, Family therapy etc.) connection is the key to learning and healing.

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EMDR Therapy: Example with a Client in Clinical Practice

Dr Abigail — Wed, 11 Jan 2023 10:57:41 +0000

EMDR: Eye Movement and Desensitization Therapy is a very effective form of therapy for a range of conditions including anxiety, depression, trauma, chronic pain, eating issues, phobias and more.

Dr Abigail Pamich, Consultant Clinical Psychologist outlines how EMDR can be used with a (hypothetical) client in Clinical Practice, to find resolve from an issue with confidence at work.

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Is EMDR Therapy Effective? The truth from experience and research

Dr Abigail — Wed, 11 Jan 2023 10:47:33 +0000

EMDR: Eye Movement and Desensitization Therapy is a very effective form of therapy for a range of conditions including anxiety, depression, trauma, chronic pain, eating issues, phobias and more. Dr Abigail Pamich, Consultant Clinical Psychologist outlines some of the research for the effectiveness of EMDR, how and why she finds it so effective in her psychology practice.

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Trauma & Hurt

Dr Abigail — Tue, 06 Dec 2022 12:15:22 +0000

An emotionally painful past event - that impacts your present

Trauma can come from adverse childhood events or more recent events. It can be from something horrific and life threatening. Or trauma can come from more day to day experiences like a car accident, bullying or humiliation, or a horrible medical intervention (or watching a loved one being very unwell). Such traumas, if not resolved, can have far-reaching personal consequences.

Trauma can be defined as an experience that is negative and upsetting. This can be from the break up of a relationship, bullying at work, a car accident… anything really that is aversive to you.

Traumatic experiences are often deeply distressing and memories can haunt a traumatised person, whether in unexpected intrusive memories or dreams.

Post-traumatic Stress Disorder (PTSD) is when a person’s alarm system stays switched on after the trauma has passed. The person feels on edge all the time and struggles to function due to the physical side effects. This can have long-standing cognitive, emotional and physical consequences.

Not everyone who has traumatic experiences have PTSD, yet such experiences can still underpin emotional well-being. For example, experiencing bullying at work can be traumatic. It can undermine resilience, knock self esteem and create a fear cycle of people and work itself. This would be considered a trauma and can be treated successfully with therapy by helping you move past this event and take away the emotional pain associated with it.

Therapy has been shown to be extremely effective in helping people heal from trauma.

In our service, we specialise in treating trauma of all kinds. We work with major trauma and PTSD. We also work with more commonplace traumas such as bullying, divorce, death, family breakdown, relationship hurts, abuse, neglect, trauma arising from medical treatment etc.

Some of our team are also trained in EMDR which is extremely helpful in overcoming minor and major trauma.

EMDR stands for Eye Movement Desensitisation and Reprocessing. It is a psychotherapy that has been around since 1987 and has received an abundance of supportive research. It has been shown to be extremely effective in treating trauma (PTSD) and trauma related conditions such as specific fears, anxieties and depression; that are traced back to early painful memories.

It is recommended by the UK’s National Institute of Health and Clinical Excellence (NICE) and is offered across the country in NHS mental health services.

How does EMDR work?

Eye movements, similar to those during REM sleep, will be recreated by asking you to watch the therapist’s finger moving backwards and forwards across your visual field, while you recall the painful memory. This utilises the bodies natural ability to process painful memories, mimicking the natural healing process of REM sleep. The same effect can also be achieved with hand tappers.

For more information please see our EMDR page

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Sadness & Depression

Dr Abigail — Tue, 06 Dec 2022 12:09:55 +0000

Treatment and support for different types of low mood

Sadness is an emotion that can be described as being down, blue, sorrowful or mournful, low in energy and maybe tearful. It is often the result of being hurt or experiencing a loss or unmet expectations. Sadness is a natural response to loss. In therapy, sadness has a particular treatment approach.

However depression is very different to sadness, and needs to be treated differently in therapy. Depression is a condition that affects the whole person, emotionally, physically and cognitively. Often when people are depressed they have very negative thoughts about themselves (i.e. I am worthless), about the future (it is hopeless) and about others/ the world. This self hatred is not so often present when sadness is around.

If you are sad we can usually manage to distract, or do something to change our sad mindset – whereas depression can feel like a heavy blanket covering you from head to toe. It can infect your emotions like a virus to the point that you stop feeling anything and live in a vortex of numb detachment. This state is called ‘Anhedonia’. A person with depression will find it very hard to ‘snap out of it’ (despite a desperate desire to feel differently).

Depression can bring a sense of darkness to life, like a black cloud hanging over you. Activities that were once enjoyable hold no interest anymore. You may be more tearful, or angry, have changes in your sleep, eating and energy.

Therapy is about a journey of recovery, of claiming back the real you from depression and building a life of value

In our service we consider the potential the biological, psychological and social triggers for depression, and design your therapy accordingly. For example, stressful life events can sometimes trigger depression. Such things as a marriage break ups, isolation, prolonged work stress, living in an uncaring relationship, neglect or abuse in childhood.

However depression can be triggered by internal physical problems such as poor diet, drugs/ alcohol, excessive stress, hormone issues, lack of certain vitamins/ minerals, Celiac disease, poor sleep, physical illness, ageing brain. It is important that your therapist rules out physical causes for your depression.

Full recovery from depression is possible. Research has demonstrated that a personalised therapeutic approach is extremely powerful in overcoming depression.

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