Welcome to Rainbow-Mandala

Duration 

RMC practices a Neurodiverse Affirming assessment.
We allow 3 hours for this aspect, typically the average duration is about 2.5 hours.

This aspect is a relaxed and yet structured approach which allows clients the freedom to 

engage in a conversation style assessment.  

We encourage a partner or adult family members to be present in the clinical assessment, if the client wishes this to be so. Clients can also find it helpful when completing the self report electronic questionnaires to share the questions, for a perspective from another trusted adult.  

Clients are encouraging to take a comfort break at any stage.

Our team are very aware that individuals with neurodiverse presentations may benefit from

movement and a comfort break from the assessment for a brief period.
For video consultations we encourage our Clients to be in a physical space where they feel safe and at peace. 

This may be, for example, a certain chair, sofa, blanket and tea that allows an individual to be relaxed and talk freely.

The ADHD clinical assessment explores :

1. Executive Functioning

This investigation explores symptoms across Self Organisation, Self Restraint, 

Self Motivation, Self Regulation of Emotions, & Self Management to Time.

Executive Functioning challenges encompasses:

Difficulty with focused and sustained attention

Hype-focusing , Distractability, Procrastination, 

Verbal & cognitive impulsivity, Behavioural Impulsivity, 

Difficulties with emotional regulation & Rejection sensitivity, 

Planning & prioritisation, Time Blindness 

Working Memory, Inner Restlessness, Insomnia & Sleep hygiene

The clinical assessment uses :

Barkley Deficits in Executive Functioning Scale (BDEFS)

Difficulties in Emotional Regulation Scale (DERS)

Rejection Sensitivity Questionnaire (RSQ)

2. Clinical Interview

This activity is conducted using the :

DIVA-5, The Diagnostic Interview for ADHD in adults

The Adult ADHD self-report Scale (ASRS) 

Insomnia Severity Scale 

 
3. Functional Impairment 

Functional impairment is central to ADHD and consequences and difficulty functioning in certain areas of daily life are for the most part what triggers the request for an ADHD assessment.
This activity is explored using :

The WEISS Functional Impairment Rating Scale .

Impairment typically occurs across Family, Work, Education, Life Skills, Self Esteem ,Relationships

4. Mental Health Disorders

The symptoms of ADHD are common in other mental health disorders.
An evaluation will consider whether the symptoms belong to ADHD, another mental health condition, 

another physical health condition, or if they represent more than one disorder. 

ADHD can be present with other mental health disorders. 

The clinical assessment uses the: 

SCID-5, The Structured Clinical Interview for DSM-5.

Screening for Trauma, Autism, Bipolar Mood Disorder,

Borderline Personality Disorder, Anxiety & Depression.

A referral to a Clinical Psychologist may be required if the 

Clinical team identify a possible Intellectual Disability.

Our diagnostic approach does not include the use of neuropsychological tests. 

Further information

Psychiatrists are specialists in diagnosing, and treating the range of adult mental health and psychiatric disorders. See ADHD diagnostic frameworks.

The Psychiatrist confirms the diagnosis of ADHD. 

Psychiatrists are trained in understanding how medication works on the brain and body and any interactions or potential complications between different medications.

Dr Lewis will collaboratively discuss ADHD medication:

1. How it works.  
2. Long & short acting.  
3. Benefits & effectiveness. 
4. Explore the results of your ECG, urine drug screen and blood pressure test results.
5. Review all medications you are prescribed with the aim of assessing if there are potential side-effects.

Explanation of ADHD medication 

How ADHD medication works 

Finding the correct dose 

With stimulant medication is fundamental to gaining benefits of longer attention, less distractibility, greater focused attention, less difficulty with starting and finishing activities that are boring, long, tedious, repetitive, difficult, needing a lot of thought or preparation or do not offer an immediate reward.

The optimal dose 

For ADHD medication is not determined by height or weight, but is determined by how efficiently the medication is metabolised in the GI tract, how efficiently the medication is metabolised and how efficiently the medication passes across the blood brain barrier.

The correct dose is specific to each person and one person may require a much higher dose to obtain the same benefits as another individual. Some people may experience mild physical side- effects, and so an approach of gradually testing out a gradually increased dose, incrementally, is required.

Dr Lewis has created a comprehensive Improvements & Side Effects Diary to help monitor your progress and decide on the most suitable dose of ADHD medication. 

The easy to read diary includes explanations and answers to any common occurring side effects which sometimes present while a person in adapting to the medication at different doses.

Our approach follows an established approach of diluting medication in water, and by using a plastic syringe, gradually increasing the amount of the solution every three days.

Adults with attention-deficit/hyperactivity disorder (ADHD) have difficulty in self-management,

 including organisation, planning, initiating and completing tasks on a timely basis, tracking 

and shifting tasks, self-monitoring, and self-inhibition.  

These are termed “executive functions” (EFs) which, can be viewed 

as “those self-directed actions needed to choose goals and to create, enact, 

and sustain actions toward those goals (Barkley, 2012).

This difficulty in self-regulation typically results in reduced productivity, inefficiency, missed deadlines, 

poor planning, “careless” errors, and losing and forgetting things as a result of disorganistation.

 In some (particularly those with the combined form of ADHD), reduced inhibitory control 

may also lead to emotional dysregulation and inappropriate verbal and/or physical behavior in interpersonal interelationships.  Over the lifetime of the individual, these difficulties contribute to failure to achieve goals—personally, academically, and occupationally. These failures in turn likely contribute to the high rates of anxiety and depression in adults with ADHD

The diagnostic clinical assessment is conducted using a semi-structured clinical interview, which explores the presentation as an Executive Functioning Deficits Disorder.

ADHD is a neurodevelopmental disorder that manifests in something called executive dysfunction.

Executive dysfunction causes your brain to have difficulty selecting and monitoring your 

behavior to reach your goals.
It affects task management, scheduling, awareness of time, goal setting, and concentration.
A better way to think about and detect these symptoms are as problems with executive functioning (EF).

Executive Functioning encompasses working memory, self-inhibition, resistance to distraction, 

attentional shifting, organising, planning, self-monitoring and time blindness.

The term “Attention Deficit“ is unhelpful and leads to confusion and misunderstanding of 

exactly what this presentation is.

Hyperactivity is one of the many aspects of ADHD, however adults with ADHD are not hyperactive in the same way an 8 year boy is. This misunderstanding is what has lead to so many adults remaining undiagnosed for so long.
The term “hyperactivity ” current evidence shows, has no diagnostic validity in adults, and should be replaced with Impulsivity. Impulsivity has the potential to lead to significant  negative consequences for adults in multiple areas of their life.

The most significant issue is that the current diagnostic criteria and terms used are wholly inadequate and discriminatory when considering how this disorder presents in Women and Adolescent girls.

Our diagnostic approach embraces ADHD as a broader Executive Functioning Self Regulation Deficit Disorder in Women which encompasses difficulty in emotional regulation and rejection sensitivity and cognitive and verbal and behavioural impulsivity.