Dr Blandine French So, it is really important to get a diagnosis as early as possible. The earlier you get help, the better the outcomes are in the long-term, whether it’s educational outcomes, social outcomes, or professional outcomes. By getting an – a diagnosis early you can put strategies in place, you can seek treatment, there will be better communications between the parents and the schools, for example, or the patients and work colleagues, or friends or families. It’s just a way of understanding the strengths and the difficulties that the children have, which will help shape their life and make decisions over the long-term. So, in terms of, you know, what you pursue for your educations, which, kind of, professional pathway to follow, yes. So, no diagnosis means no treatment and no accommodations in place, and we know that children and adults who have not received a diagnosis, but have ADHD, are at higher risk of difficult outcomes such as, you know, lower educational achievement, they’re more likely to self-medicate later on in life, because they’re not receiving the treatment that help them with their conditions. They’re more likely to have mental health diagnoses such as depression or anxiety. They’re more likely to struggle with work, with school, with relationships. So, the consequences of not receiving a diagnosis and not trying treatment can be really important in life for anyone with ADHD really. So, this is a very, very hard question to answer because the expected pathway is very different com – depending on where you live, so where you live in the world, but even in the same country it will be very different, you know, if you live in a city or if you live in a country. As we’ve seen, it involved a lot of different professionals and it’s a very complicated and long process usually. You know, some countries may have it down to a tee, but usually it takes a lot of time, it takes the involvement of a lot of different people, documentations from the parents, from the school, from the healthcare professionals, so it – there is no one expected pathway to get a diagnosis and an assessment of ADHD and to get treatment. And similarly, the treatment options are very different across countries, they’re very different within countries, depending on if they have the right services. So, for example, we know that the best treatment option is a mixture of medication and psychoeducation programmes, but a lot of places don’t offer a psychoeducation programme. But the one thing that there is available to everyone is there is a lot of help online for all these different steps. So, while this varies and it’s really hard to give a very straight answer about what pathway to care looks like, because it depends on so many different factors, there is a lot of online help on this. So, one of the websites that I like to use is called ADDitude, A-D-D-i-t-u-d-e, and while it’s an American-based website it has a lot of information on all these different steps. So, I do recommend parents just go online and look for, you know, what is the first step? What can I do in the meantime? How can I help? How does it work in my country? How does it work in my area? You know, parents forum where you can, you know, exchange information with parents, and these are really good, the online support and the online understanding is very, very good usually. It is very difficult for a GP to evaluate a child in a practice. GPs have got a very, very short window, you know, it’s usually a five to ten-minute appointment and it’s really hard to see ADHD there. So, we know, for example, a lot of GPs base – well, might base their decision on whether the child behaves while you’re sitting there for a ten-minute appointment or not. And, you know, if the child sits still it might bias their opinion and whether they’re likely to send a referral through or not. But that’s not so much because – you know, nothing wrong that the GPs are doing, it’s just they’re trying to see a behaviour that might not necessarily show during an appointment. They might miss comorbidities, or they might just focus on these without seeing ADHD. So, a lot of time, if a GP can identify ADHD in a patient, they might miss other things that happens, you know, maybe traits of autism, or maybe traits of dyspraxia, for example. But the same the other way round, especially in teenagers and adults, you know, the teenager might be seen for depression, and what the GP doesn’t see or they miss is that depression is, kind of, caused by the ADHD that they have. So, there are, kind of, complexities there, and to be fair, they’re really hard for the GP to unpick. But these are the, kind of, things to look out for, and especially if a child is high-functioning, it’s very hard for a GP to see any impact or any impairment if a child is high-functioning and gets good grades, and doesn’t get told off at school, and in general has an okay behaviour in family or in school, they can’t see the long-term impact that this will have on the families, on the child, and how difficult it might be to manage these high-functioning temperaments. So, the role of the school in a diagnosis pathway is a different level. Usually, the school will provide supportive information for a diagnosis. So, at some point within a pathway, whether it’s at the primary care level or at secondary care, the school will need to provide reports or statements about the child’s behaviour, because in order to receive a diagnosis of ADHD, we need to show that the inform – impairments are at different levels. So, in children, it will have to be at home and at school, in adults it might have to be, you know, at work and at home, or, you know, in childhood and in adulthood. So, they usually provide a lot of supportive information that will allow for a diagnosis. It helps healthcare professionals get a complete picture of the child’s struggles. It helps them understand how they behave in different situations. So having the school support is very important, but also, school will help with putting strategies in place when you’re waiting for a diagnosis and after having a diagnosis. So, communicating with the Teachers, with the special education needs professionals within the school about how you can support your child, usually you don’t need a diagnosis for that. When you have a diagnosis, you definitely need the support and there will be accommodations that they will put in place, such as extra time, or breaktimes, or ability for the children to go to a quiet room. But often, if you ask for these accommodations to be put in place before you get a diagnosis, if the school is supportive then this should happen as well.