Welcome back to second day of the Global ADHD Conference. We've started with the extraordinary Paul of Sussex, CB Ombudsman, he's put forward a report on ADHD. And one of the big things feeding into the report and one of the biggest pieces of work that's happened is the ADHD Taskforce run by Anita Thapar, who's coming forward now. This section's on ADHD services, challenges, and recommendations for the way forward lessons for the NHS Taskforce. She's absolutely... She shaped NHS thinking and shaping forward thinking on ADHD. Professor Anita Thapar, CB, she chaired NHS England's independent ADHD Taskforce whose report came out last November with recommendations for change, not just in the NHS, but across governments and societies.

Anita is a clinical academic child and adolescent psychiatrist. She's an honorary professor at Cardiff University. And back in 1999, she became Wales' first ever Professor of Child and Adolescent Psychiatry. Her research on genetics of ADHD broke new ground, particularly at a time when genetic explanations for ADHD were seen as controversial. The list of honours is extraordinary, a CBE for services to child and adolescent psychiatry, fellow of the Academy of Medical Sciences, fellow of the Learned Society of Wales, the Royal College of Psychiatrists President's Medal.

The Ryan Prize, the Frances Hogan Medal, a lifetime achievement award from the International Society of Psychiatric Genetics, and last year the World Federation of ADHD's Heinrich Hoffmann Medal for a lifetime of outstanding contributions to people with ADHD. And she's lead editor of the Rutgers Child and Adolescent Psychiatry and Psychology, which is the field bible. Sent in questions. If you've got more questions, put them in the Q and A. Just go to forward slash live on globaladhd.com. Today she's sharing the Taskforce lessons, what needs to change, much which is enormously relevant to the country and to people watching. So without my further ado, Professor Anita Thapar, wonderful, wonderful to see you.

Thank you Henry for your kind words and for inviting me this morning. I'm, very excited to speak and, it would be really great if perhaps one of your colleagues could share my slides. Lovely. Thank you. Handing over to you. Thank you. So just just to give a bit of background, Henry gave a very kind introduction. My own background is I've been I've been a child and adolescent psychiatrist, and I, first became one in 1986. So I've seen a lot of changes over the years. And I got interested in research in ADHD in around 1991. So again, a lot lot of changes that I've witnessed. Next slide, please. So these are my disclosures. So the roles I've played in terms of policy in Wales and England are unpaid.

And, that's my research funding. Next slide, please. So, basically, I'm going to structure my talk around three topics because I think the journey of the task force was was an interesting one and certainly eye opening for me. So I want to just highlight the impacts of a shifting political landscape and how that really is highly relevant to ADHD. I'm going to discuss the task force recommendations, which are, of course, published. So for those who wanting to want to know more details, can you you can also look at the NHS England website. And I'm going to finish then with some... Discussing some challenges and also some hope. So next slide, please. So let's start with the impacts for shifting political landscape. Next slide.

So at the start in 2024, and and and for those of you who are based in The UK, there was huge excitement, because the NHS England was going to launch a cross sector ADHD Taskforce. And this was quite significant because although, you know, ADHD has been around for decades and the research has matured incredibly, really, you know, the NHS had not really looked at ADHD in in in a close in a close fashion. So this was exciting. The next next slide. So this is all at the start of 2024. This was partly driven really by concerns that wait times were going up for children, and they were ranging across England five weeks to five years, twelve weeks to ten years for adults. And it... Similar situation across The UK.

And in England, some areas is a choice of of a private provider, the right to choose paid by the NHS, but not in all areas and and and not in in in all UK nations. And and this is, of course, outdated now, but the the NHS England data from March twenty four to twenty five estimated that referrals had increased 13.5. So this this put a a lot of impetus behind this task force, report and why they wanted it. Next next step, please. Next slide. Of course, in the meantime, there was also this media, description about the alarm, about the rise in ADHD prescriptions, which also then raised the question amongst some sectors. Oh, is it, you know, are we over diagnosing? And and people will be familiar with that.

Sort of rhetoric in in in the media and in other places. So next slide. So this is our starting point. Next slide. So what we were asked to do back in 2024, to look at why has that the ref... Why have the referrals and the demand increased and how should we manage it? NHS England wanted to to get some answers there. To identify ways to improve care for people living with ADHD and not just across health, but across different sectors. So education, criminal justice, and employment. Provide NHS England with initial recommendations in five months. So that was really quite rapid and final recommendations in ten months. So that was the ask in twin... At the, sort of late spring, early summer twenty twenty four. Next slide.

However, in June 2024, The UK held a general election, which meant that everything paused, and it was extremely important and relevant for the ADHD Taskforce and policy because nobody really knew whether the taskforce was going to go forward. Next slide, please. So it's just to illustrate for those of you living in The UK, you'll have witnessed this a rapid... Been a rapidly changing world since 2024 and how this really impacted on the journey of the Taskforce report behind the scenes. Next slide, please. So as I said, the task force initiation had started, and it was really uncertain whether it will go ahead, but it actually reasonably.

Quickly landed on the health sec... Secretary of state for health desk. And by August 20 '20 '4, it was given the go ahead by the new government. Next slide, please. So just for those of you who are not in The UK, and who are watching, so the government Department of Health and Social Care, at that time when the task force started, the the the secretary of state, the person in charge for health was, West Reading. And the... And and and he... One of his deputies was minister Stephen Kinak, who is the lead for neurodivergent social care and primary care. So, again, for those of you who are not in The UK.

Government is... They were in the Department of Health and Social Care. And in England, the NHS is managed by a body called NHS England. And at that time, the amount... Amanda Pritchard was the chief executive. And they they they worked fairly independently, but when the new government came in, they wanted a much closer working relationship. And and health in England is delivered across health boards. They're at 42, and these are then linked with NHS England. So that was the system, and it started changing with a new government with a closer relationship. I'm actually based in Wales where health is is is, devolved. So health has its own government. We have our own government for health and education.

And so I was already quite used to the government and the NHS working being really close. So next slide. So that was the starting point. So let's let's move on to twenty twenty five. Next stage. So we had already started the Taskforce report, and, actually, I had drafted totally on timetable with colleagues that that that... The first, report. But in March 2025, there was an announcement that the chief executive of NHS England and other senior staff had resigned. And then suddenly, we heard that NHS England would be abolished in March 2025. And so part... The part one report of the task force had just been submitted. So the new chief... NHS England chief executive.

Started the April 1 and was tasked with merging NHS England with the Department of Health so that it would sort of no longer be the separate entity. But through April, and if any of you who were on the task force are on this or or or were affiliated to the task force, well, remember, we have this phase in April where all the meetings paused and nobody knew what was going to happen, whether it would be pulled, because the task force was an independent task force commissioned by NHS England. So it was uncertain whether it was going to continue, and there was a quite a big... A reasonable sized team, not huge, but there was a support team, and that all changed. So everything was left in limbo, and I think that was really quite difficult for.

A large number of people, of course, those working in NHS England, but also all the people affiliated to the Taskforce. Next slide. But persistence paid off. It was submitted. It went through. The chief exec looked at it, the new chief executive, and it was also required... Yeah. It required approval, of course, by government, and it was published in June 2025. Next slide, please. Part two, the task force. We also produced then part two again to timetable by July. It was all done and submitted, but then we were told over the weekend, can you just look again at your report? Because it coincided with the ten year NHS England government plan being published. Luckily, we had known about it before, so we had framed it around.

The ideas of the new NHS England delivery. But it did mean just sort of rewording things, and it was resubmitted. So autumn twenty twenty five, the part two report finally did get published. But a new minister before that, it took a bit of time because we'd obviously developed relationships with minister Kinnock and prior to that, Chief Executive of NHS England. And we had a new minister appointed Minister Kinnock was moved into primary care and we had a new minister appointed for neurodivergent Minister Zavir Ahmed. Next slide, please. So just to give you the context of a rapidly shifting political landscape, and this is not a political talk. I'm merely a clinician and a scientist, but how it actually impacted.

On on on on what... On the task at hand, if you like. So these are the report recommendations. We go to the next slide, please. So this is the first part one that came out in the spring. So it was decided, before before I started, all all my research and quite a lot of my government policy work in Wales had been codeveloped, with people with lived experience of ADHD. So the membership of the task force, it was not decided generally by me. We went and got PPI done through, what was, at that time, Healthwatch England. And it was through that process, the structure and the main aims of the task force and the the the expertise needed for the task force membership with suggestions came up here.

We then had three groups because this is a very small group with with expertise in clinical education, criminal justice, and employment. And then we had three groups feeding into that experts and research evidence group. And whilst I'm a researcher, I wanted to be independent of that. The lived experience group, which so many people... Obviously, didn't include everyone in The UK, but we we included people who could then reach out to others. And then a clinicians group, from England. And and and there was just so much, obviously, verbal material from the meetings that were held until April, as well as 200 pages to to to, sort of work work through from these groups. Next. Next slide.

So these are the common perceptions I encountered at the beginning. So a d a... There's a really a belief in many quarters that ADHD is surely now being over diagnosed. It didn't used to be there before, and in this regard, was really quite helpful that I've been a psychiatrist for so long because I could sort of address from an, you know, from a clinical as well as research perspective these issues. There was a strong belief in many quarters about there being overtreatment and about the potential harms of getting a diagnosis.

And a really strong belief in many influential quarters, it's TikTok and social media that's driving demand. And actually, the... This increase in referrals and prescribing are a major concern. So these are these are some of the perceptions I encountered. Next slide, please. So the science was really actually very clear, and I just sometimes people are... I said... People say, why did you choose to do ADHD, amongst, you know, neurodivergent psychiatric disorders when you were when you were back there in '91 in terms of research? And the reason is it was really quite straightforward. It came out as very highly genetic, very effective treatments, and research evidence is, you know, quite clear cut compared to many other.

Conditions in in the NHS. So this is the research evidence of which there's huge amounts across across at least higher income countries studies. ADHD when it's unsupported, and this audience will know this is a really potent route into educational failure, unemployment, crime, substance misuse, suicide, mental and physical illness, and premature mortality. But also, we highlighted that people with ADHD can and do thrive. Economic costs are huge. This is an underestimate because this... We we calculated this based on data from Denmark, and it was from 2012. And the sitch... Obviously, in The UK, there are different types of support to Denmark, but they were at least 17,000,000,000.

And as I mentioned, the the the clear message is that there are lots of things you can do to support ADHD and people can and do thrive with that support at the right time. Next slide, please. There was a huge amount of research investigation by the evidence group. And the one thing we're really lucky in The UK is we have very... Maybe not good sort of NHS data, but our research data is very good. And it became really clear that actually in England and actually across all UK nations, ADHD, the ADHD that's recognized and treated is well below that sort of, if you like, the true population prevalence of ADHD. So in England, it's under recognized and undertreated. The increased referrals we highlighted, there are multiple potential reasons.

Including, of course, a maturation of science. When I first started out, ADHD was only thought to affect children. People thought they grew out of it, then the research showed that was not the case. The historic tradition, people thought, oh, this is something that affects boys, young boys who who fail in school. And again, showed that is not the case. So it was increased awareness, the address, you know, less stigma because when I first started, people said, this is due to, you know, adverse social circumstances or parenting. And lots of research showed no. Actually, it's not. And, actually, the the genetics is really quite... Is very important. So the stigma changed. And, actually, the... This increase.

Was not specific to The UK. There was... So it's unlikely there's something that's happening in The UK about our systems. It's pan European and actually pan across all high income countries. The other thing that we highlighted, if the research suggests that the prevalence is at least three to five percent, any other health condition that's this prevalent in The UK is actually managed in primary care. There are very few psychiatrists. So actually, it's unsurprising there's a wait time. It's just not designed for for this level so that there will be inadequate service and personnel capacity in secondary care to ever catch up. Next slide, please. So.

We highlighted that most people with ADHD in The UK have not been accessing services or obtaining medication. And for those who like the research evidence, it's all there in the task force report. And to stay detached from it, I did not get involved in this research paper, but the people who looked at all that data published this in the British Journal of Psychiatry. Next slide, please. We also highlighted that many many people, especially including in education and other sectors, wait for a diagnosis before they will get engaged in support. And we heard from many parents who are waiting for and chasing special educational needs and what the cost was in terms of human cost, as well as economic cost to multiple groups of people.

Next slide, please. We also highlighted that NICE guidance in many instances was really interpreted differently. So in the NHS, generally, most people think, oh, ADHD can only be managed by specialists. So secondary care... And within secondary care, even like maybe super specialists. So in adult psychiatry, only sort of specific ADHD people. So it was... But whereas in other providers, people were saying, well, no. With with with, you know, a little bit of training, you can assess and treat ADHD. So it's very subject to interpretation. And there were also issues raised about uneven quality across service providers. I mean, for me as a as a clinician, this really ran home as to how cumbersome our clinical practice.

Is. Most services are still pen and paper, lots of questionnaires, time consuming. It's very slow. It's a huge burden for people with ADHD. Have to keep repeating it. You move. You've to do it all over again. Although... And, we have to keep highlighting it. Although you have to take ADHD seriously, there are enormous impacts and risks. But just like, say, with blood... Higher blood pressure or higher lipids, actually, you support, you intervene, people can and do thrive. You can modify those outcomes. Next next slide. And we put in all the research evidence on that. Next slide. We highlighted that ADHD care is mostly delivered by the specialist sector and most publicly funded by the NHS, and there just wasn't capacity.

We highlighted this really limited GP involvement and that had even been dropping off in a lot of areas because of concerns about shared care prescribing, the work at Intel GPs we heard from the previous speaker not feeling equipped to deal with it, concerns about the quality of diagnosis. Both in the independent sector, surprising because there's not enough capacity in the NHS. But then the problem, particularly for the person who has ADHD, then it wouldn't be recognized by the GP or by the NHS. So summer twenty twenty five, as I said, the report was submitted and published in the autumn. Next slide, please. And we aligned these with the NHS England ten year plan, of the minister, which was to focus on three priorities, prevention.

Shift to primary care, and digitization, which we thought was actually actually perfect for ADHD, actually, because if you manage ADHD, that is actually a prevention route into so many adverse outcomes. The shift to primary care, we'd already highlighted. There's not enough capacity in secondary care, and we already highlighted about the the sort of antiquated systems in in in in in many of our clinics. Next slide. So we highlighted that, actually, ADHD isn't just the business of health. It's it's across sectors. And, actually, what came... And and and, again, we heard this from the previous state, speaker and and and Henry, the data quality is really poor. That became really clear. Nobody knows where where people with ADHD are.

And we thought that was really important to get the data because how can you support map, outcomes, see how well you're doing if you don't have those data. So we recommended that, actually, you can't split it in this way. You need holistic spending plans across sectors and integration right from government level right down to locality. And as a clinic... Job and clinician, I've often seen that, you know, there'd be this batting, oh, this is education. No. This is health. This is social care. So actually around ADHD, you really need it integrated, the care and and the funding. Next slide, please.

We also highlighted, and again, this has come up, that people really felt ill equipped to cross sectors, the first port of call for people with ADHD. It's really important to get the training across all these different sectors where people may encounter ADHD for the first time to help recognize and support ADHD and have all these mechanisms in place for, accelerating more intensive intervention. And we are recommended that the Department of Health and Social Care fund training programs, including for primary care. Next slide, please. We said... Yeah, we said that it's not... It can't be just super specialists.

It's actually got to be across for everyone. All these people have to say... They can't say, I don't know about ADHD. They have to know it. And as I said, the data joined up. Next slide, please. Prevention. We highlighted that often by the time people appear, and we know that late diagnosis of ADHD is associated with with poorer outcomes and much more cost to not just the NHS but multiple sector. You can you've got to start early and you actually don't need to wait for a diagnosis. So we highlighted the evidence that outside of health, that support doesn't have to wait for a diagnosis or wait till your child is old enough to have a diagnosis. Those supports need to be uncoupled from a diagnosis. I need a diagnosis to.

In my clinical practice if I'm going to help people in clinical, but but for other other other places they don't. So we highlighted the evidence on early years. Of course, Sure Start had been discontinued many years ago, and actually the long term follow-up was shown quite good impacts on mental health, special educational needs, employment, etcetera. So we highlighted the preschool support and parenting being really important, but we thought it needs to be more mature to take into account the new findings on genetics, and actually they needed to be... The delivery needed to be neurodivergent friendly and also consider the possibility of ADHD in parents.

And that the... Any parenting support and programs that were evidence based needed to be around ADHD. Next slide. For school aged children, school mental health support was already being started to be rolled out in England when we started. And we were very concerned about the silos that people don't come in neat diagnostic packages. We thought it was very important that the school mental health support teams did not say, oh, well, that's ADHD. I can't... I don't do that or neurodivergence. It had to be inclusive and not be sort of based on presumed diagnosis. And that actually schools need to have a physical link with the clinical services, in some sort of way so that, I think, you know, higher risk.

In children could be seen much more quickly, and there would be consultation, sort of along the way. Next slide, please. We we did not mince our words because if... Appropriate support, we'd know and delay diagnosis ADHD can lead to adverse outcomes. We were not shy about making a recommendation that governments got to act quickly to address this backlog across children's and adult ADHD services. You cannot just leave people on a waiting list. You have to improve support for those on the wait list. We don't know how to triage best. So that actually... That's got to be evaluated, but it has to be addressed. Next slide, please. For the eleven to twenty five year old group, because the minister had asked for research evidence.

Things that were supported models of service. Now this is a high risk age group. It's not that other ages aren't, but it's just because you've got a lot of social transition everyone will recognize. You've got the, transition maybe out of home into employment. It's the highest onset of mental health problem, substance misuse. And of course, that coincides with service the service transition gap at age 18. And many countries have now got integrated youth services, which bridges that gap, which brings together health education, employment, peer support, substance misuse. The one that's been best evaluated and actually about a third of the the people coming forward had ADHD. I talked to the Canadian colleagues who'd who'd developed.

This. It was a one stop shop with immediate access for young people, codesigned by young people. I mean, it was faster than... It was, you know, CAMS and neurodivergent was... Clinics was still had good outcomes, but it was faster. And, actually, less specialist time was needed. So we said that this could be this could be a model that could be evaluated in in in The UK. Next slide. We thought it was we've got to move away from diagnostic and service silos. We're seeing all sorts of carving up and actually making it very difficult for people with ADHD and also for clinicians and also expand service capacity because that had to be done because it's historic, our capacity.

But a lot of things could be task shifted. You don't need super specialists, psychiatrists for everything. It has to include multiple disciplines, primary care, and voluntary sector education, social work to to to to help. And and that would probably vary by locality and locality, so not everything is done just by one person and a single front door because co occurrence is so typical. Next slide, please. We thought it was really important to expand the role of primary care and that has happened in many countries for GPs who are interested. And we asked the Department of Health and Social Care to incentivise GP practices to take on.

With... First of all, highlighted which all GPs need to know about ADHD because they need to be able to recognize and manage things. So they could take on general aspects of ADHD and greater leadership, but then also people with more specific ADHD management diagnostic and treatment, would... Could could train a specialist GPs, but all primary care to have timely embedded support from psychiatry. And there are plenty of models in physical health where this is happening, for example, in diabetes. And as I said, other countries are shifting. They're all... Every every high income country is dealing with increased referrals and actually that that primary care involvement is important and also in line with the ten year plan, which was to shift.

Next slide, please. We we highlighted that it's common. We need to move to a generalist model. Not everyone needs a super specialist psychiatrist. We thought it was very important. NICE has already did suggest this, but it doesn't often happen. Is stepped care start with all the environmental adjustments in school, in work... In the workplace. People immediately get tools for self management, psychoeducation, parenting if it's children, around neurodivergent and post diagnostic support, but rapid, rapid access to to clinicians where where it's necessary. We we suggested that the the biggest body for evaluating, health health service models is NIHR.

And to to evaluate co developed stepped care models where you could rapidly go up and rapidly go down and and and move between these steps. Next stage. We thought regulation was really important. It was it was impacting on people with ADHD, creating uncertainty amongst professionals. And we asked NHS England Department of Health to work with NICE and its professional groups to review its definition of specialist. I'm not sure that was... Has been taken on board. We also asked the Department of Health and NHS England to produce the quality standards framework for ADHD to comply with published standards to have some sort of uniform standards, quality standards across all providers so people would be confident.

And we said that please ensure equity for wait times, for people with ADHD. And if you're concerned about, you know, the potential in the future, it's not happening now about ADHD overprescribing, etcetera, Just monitor it with data. Look look at rates of diagnosis prescribing as well as wait times of data again. Next next line. We highlighted the need for harnessing digital technologies and evaluating where we could. There's some areas that you can do it safely, like the administrative data, like our health records, our questionnaires, the data collection and capture, and the only evaluated ones that QB test for children used in conjunction, not as a substitute for clinical assessment.

But nothing else has been evaluated, so have to be very careful. So we asked NICE to scope an early value assessment digital projects for ADHD for streamlining, services. Next slide, please. So challenges and hope. Next next slide. Through... When when I first started, and as I said, the the main relationship at that time was with minister Kinick, He highlighted very quickly the severe constraints on funding health care in UK and in England and the geopolitical situation which impacted on the funding. In 2025, you could see the shift even even before any formal declaration of government increasingly focused on over diagnosis of ADHD.

And it did feel very much I was having the same conversations with the same research papers and because I'm a scientist to bring all the evidence and graphs and, you know, look at actually how the rate of prescribing in UK is from the lowest in Europe. But that was the focus. Next next slide. These were challenges. The challenges were that a lot of the ADHD community put huge amounts of effort and hope about this task force report. And many of us, including myself, just spent all our time... Well, I spent all my time doing it between '24 and '25. And so it was disappointing. There was no formal government response to the task force report or its recommendations.

When it was published, NHS England did. I mean, time... I mean, this figure will have changed around seven hundred thousand people waiting for an assessment for ADHD in England alone. Whilst we still have wait times, but the views around neurodivergent site have encountered... Had encountered until the task force had been really different. I mean, the political situation changed in Wales, but the minister at that time in Wales said to me, she said, I really think everyone in waiting list likely has ADHD. How are we going to best? How are we going to really change things? So it was quite a different rhetoric.

Despite it at that time being the same political party. So it was a different experience. So that's... That was interesting, but it was a challenge in England. Next slide, please. So we published the task force report, and, of course, it coincided with the health secretary ordering a review into what was called over diagnosis when we'd tackled that in the part one and part two, and that there was going to be a new review into looking not just at ADHD, but things that we haven't covered, mental health and autism. Next slide, please. So as Henry alluded, it carries on. I feel that, there's always no time really to do research anymore because you're always dealing with the politics and the education around ADHD.

But, of course, every... Everyone in The UK will know this channel four, ADHD 2026, the deluge of complaints immediately got contacted by BMJ. Can you write something about this? I mean, yeah, it has been such a hot topic this year for for not really the right reasons. Next slide. Helpful reasons. Next slide. So as I said, it was published. We're disappointed that there was no real firm commitment, and, you know, people said, ah, the government didn't like your report, so we're going to do another one. And so, actually, we published a perspective piece in the BMJ. But, you know, just on the positive side, you know, in the background, whilst this was all happening.

Due to certain colleagues in NHS England, we're trying to execute change at the same time as the report was evolving. Quite a few ICBs were really innovative, wanted to do things and taken on board. I mean, I've got loads of feedback during the time we're doing the report and also afterwards that, oh, yeah, we're looking at this. And actually, what's pleasing is many nation people from other countries at least have looked at it and are instituting elements of it. Next slide, please. So as as I said, this is just to highlight the evolution. This is the August 30, so not long ago. This reporter, had heard about the difficulties.

With the Taskforce report and the, announcement of the prevalence review and focused on on on a family who had a bereavement because their child had killed themselves and and the ADHD hadn't been recognized. And, you know, I mentioned again that the task force recommendation. So it it is always in the news. Next next slide, please. So I think for those of you in The UK, you know, this... It hasn't been easy, but it is actually a political issue in many countries. But a lot of countries have shifted and moved very quickly to deal with the demand, and I feel that we should do... Be doing this in The UK. And I think it's really interesting because some... A colleague in NHS England said by this because I'm a researcher, scientist. For.

Me, it's the research evidence. But, actually, political decisions aren't always evidence driven, and that that was quite a learning exercise. The two are not the same. For the... For those of us who are researchers, you think you're doing the research. Well, this is this is the evidence. It's really good. Why would you not change that? Next slide, please. So I like to end with some sort of optimism. As fate would have it, as I was wandering around one sunny afternoon shopping for our holiday, I met Andy Burnham outside the public library in Cardiff, and nobody recognized him. It was a few days before he became prime minister, and.

He would take questions. So, of course, I I I went up to him and said, are going to do about the Taskforce report? What are gonna do about ADHD? Please, can you have a sort of compassionate stance and look at some of these things and change things? And he he, you know, he came across as very compassionate, but we will see. And j j j Platts, who I've worked with a few year... For a few years, she herself has lived experience of ADHD and was chair of your party parliamentary group, but then had to resign as that because she was then became parliamentary private secretary to the prime minister. So I'm hoping at least awareness and recognition about ADHD.

Will be there at the highest levels, but but let let... You know, I always think you've got to remain hopeful, but also persistent. Next slide, please. Just to bring it up to date, there's a lot of news... Have been a lot of news coverage. I don't know what's in it. And I did meet with the the the the people who were chairing it, but, yeah, as I said, I I haven't been part of it, and I don't know. I only know them as scientific colleagues. They're very good scientists, but let let... Let's wait and see. I really don't know what's what's in it. I mean... Yeah. Next slide. I just want to acknowledge there's just so many people who worked so hard on this that that, of course, the task force. All the evidence synthesis people behind.

The research evidence who did a lot of the work behind the scenes. It's also important to know there was a Department of Education for Education Neurodivergent Task and Finish Group at the same time. My colleague, Karen, who chaired it, she sat on our task force and I sat on hers. And independently, I mean, they were total different constitution, the DFE. We we all pretty well came to the same sorts of conclusions. Of course, different emphasis because this was education and ours was cross sector, but it was remarkable how we came to pretty similar conclusions. Next slide, please. The lived experience group, and this is not the... All the people contributed their names are are not on the slide. So.

The ADHD community across The UK really pulled together here. It was really helpful. The clinical reference with all the clinicians who so... Felt so passionate about it and contributed. And I contacted scientists not just across The UK, but from all over the globe across Australia, Canada, social scientists, clinicians, psychologists, and the chairs and advisers of government groups in education and the department for work and pensions. Next slide, please. I want to end here, and some of you may know she was the director of ADHD and NHS England, Catherine Hinwood. Of course, all the changes affected people working in NHS England the most, not not me. I'm not... Wasn't employed by NHS England. It was unpaid independent role.

But I don't think we could have got this report over the line, and I could not have gone through all those political issues without without Catherine really supporting and helping. So thank you to everyone, and thank you, Henry and colleagues, for inviting me and for the audience for listening today. We don't need slides now. Thank you.

Well, thank you. That was absolutely... Well, I think I think that was absolutely fascinating and very, very important and extremely grateful for what you've done and what you continue to do because you continue to fight very, very, very strongly. And you talked about the enormous political flux as you were doing it. One of our most live issues right now is the report that was very clearly told with the independent review on mental health, ADHD and autism. Yeah, which was due to be published last week I think, or I think it's been delayed. We're now expecting it next week. One of the things that's been sort of teased like a terrible movie is that they want to change the recommendation for who gets an ADHD assessment.

And they want to move it to needs based, which I struggle to understand what we're basing it on right now. There isn't needs based. But essentially to say that not everyone should get an ADHD assessment and support. And so I want to be very curious, like, what's your view on that? Sure.

So I guess what I want to start with first is it hasn't been published. I haven't looked at it, and I don't know yet. All all I know is, I guess, what what you know, which is what's being reported in the media. And so I do not know that. So I'll start with that by saying we need to be cautious because we haven't seen it and it isn't yet being published. So I think until it's published, I... I'm careful to reserve judgment. Peter Farneghi, I know as a colleague, you know, as a scientific colleague. He's he's a great, you know, colleague. He's done a lot of amazing work. So, you know, I I I... Yeah. I definitely... So not... So just just to qualify that. So let's... Let's...

If you look at everything we've done, we've always been very... Yeah. So.

So let us suppose... Like, we don't know. But let's just speculate for a minute that that is what it says because we don't know. We don't... No. We don't. It's it's absolutely... We've.

We've had to put out a statement based on the times report that... Yeah. We don't we don't know.

We don't know. I I think what's really... You know, because we put needs in our in our report as well. But the thing is, it isn't just one answer. It's got to be a whole host of things. I think needs based... I mean, somebody asked me about this a few days ago, and I said, well, if if I'm a teacher, I think it's really important to have a needs based, you know, Having a diagnosis is really important if I'm making a decision, if I'm going to prescribe, if I'm going to... And it's very helpful, you know, for many people with ADHD. But actually, what you're going to do in school and of course, as you know well, Henry, and everyone on this in this meeting will know, there's a huge variability in ADHD. So actually.

You do need a need space system, same in work... In the workplace. But it's not an alternative to clinical. Actually, I think it's really difficult. Well, I think it's impossible to say. People who meet ADHD diagnostic criteria, evidence that they don't need a diagnosis or would benefit from treatment simply isn't there. Our randomized control trials of interventions are based on DSM and now ICD definitions. So I would... We just don't have evidence, research evidence behind subcategorizing ADHD, if that makes sense. In fact, out of curiosity, it's only a research paper. It's not been published yet. It's in press.

So just a letter. I asked one that... Well, actually, he happens to be married to me, but he likes the analysis. He's an ex GP. I said, look at the dataset people born in 1958 because we've shown before that before treatment and before ADHD was diagnosed, people died early. It's all modifiable, by the way, because I never like saying that. It's all modifiable. You can see the pathways and modifiable to premature mortality. So said, does it... Can we divide by severity? And of course, it's not. It's continuum. So certainly, as a clinician and scientist, I would not... I I... There's no means of subdividing people with ADHD. And given we've got underdiagnosis, I think I would not want to subdivide ADHD, assuming that's what's what's.

What's in it. For those who fall below the threshold and sometimes I have people like that, you know, but they've still got symptoms and say, look, you're not me quite meeting the threshold and I'll draw a little graph in my clinic. At least I used used to draw a graph in my clinic and say, it's a bit like blood pressure. If you're if you're sort of just below the threshold, you could like exercise more, you know, look what you're eating, etcetera. And I'd say, you might still find it helpful reading about self management of ADHD, look at your context. So because it's a kind of continuum, yes, of course, there's other things and other context. But I think for people.

Who meet, you know... And as I said, we have... We don't have that five percent prevalence or three percent prevalence. I would feel very... I mean, if it was my waiting list, I would feel very nervous about suggesting that they don't have ADHD and actually it's quite a different stance from the politician I... The minister I talked to in Wales at the time a couple of years ago and she said, I really think everyone on that adult ADHD rating has got it. So it's your premise really and and your interpretation of evidence. But as I said, I reserve judgment until I until I've seen it. The other thing we did say in our task force report which is relevant is that.

We all we, you know, we all triage. Naturally, but the thing is by the time somebody comes to clinic, they've already generally been triaged by GPs. So we're... We would have to be sort of saying GPs don't know how to triage. Also, patients tend to do quite a lot before as people with ADHD will know before you come to clinic. So people do get triaged, and we highlighted in our Taskforce report there isn't a way of stratifying. There's no good way. You actually have to talk to people. And, actually, the guide... You know, evidence suggests that you can't just use things like questionnaires or something to automatically screen people at...

Does that answer your question, Henry? Let's wait... Let's wait and see. I keep waiting for it so I can read it. So... But I reserve...... Both. I get the sort of drip feed.

But I think a very elegant and important answer, we we don't know what recommendations are. The idea around some new levels based on some new ideas of severity is challenging in terms of not having the data to do it, the systems to do it, and knowledge of the impact. Certainly, as I said in my opening question, the idea that we're not already needs based like in terms of how we go forward. And I actually thought your point on the interventions are based on that. And so we don't know what would happen with different lines. This is an assumption that the way we measure ADHD on a severity scale then equals impact. We don't have good correlated evidence yet. I'm trying to be very, try my best Anita to say.

That in the proper academic caveated way. You're amazing and I'd like, and I actually, you've been learning yourself for a little while now and both from different... Watching the different political changes. You've dealt with the flux of the political extraordinarily well and I can't imagine how difficult it must have been in your seat. Subsequent to the publication and something I think people should know is how vocal you've been in support of people with ADHD, both through the Taskforce report and then subsequently. And the Taskforce report, can have a very, very blank face, okay? Like when I say what I'm about to say, which is that my understanding is that when your report was submitted, it was the indication given.

Was that, don't respond to, was that the minister wasn't going to be particularly pleased. It didn't go in the way that they wanted it to do. And that is a testament to you. You were led by the science, by the understanding and you put a report together that I think you are rightly proud of and put forward. You're allowed to go be proud of your report. I still don't want to get in trouble with them. And I suppose I wanted people to know how strong and powerful you've been on this and shouting out. I can't, like, that is when your, the interim report was published and something I learned, and I imagine you've learned the hard way too, is that whilst the report might be independent, when it's published, it isn't.

And that gives government the opportunity to put it out on days when it's gonna get less coverage. And so the interim report went out on the day of the debate on assisted dying. Which I mean, you want a very healthy report, that's like, which I've realized is a terrible analogy that's there. Then that's the day that's gonna do it, and did. And then the second, the actual report was published. We were both on BBC Breakfast and talking about a different ADHD story that was taking the news. There'd been a decision to release the main report that day. But these reports gets issued with a... Which is standard.

With a time when you're allowed to talk about it. So it's embargoed until then. And the embargo time was 10AM that day when both of us were off the breakfast sofa. Both off, so we weren't allowed to talk about it. And so a big ADHD story had gone out and then there wasn't really that much coverage to cover the next one. And then as you said, your reports got overridden by a new report. The answer that would want it hadn't been got is a new report was looks looks like a new report then was made on that. And that was terrible. And And you've been... And you never got a formal response. I think it was sad. You covered that in this. I I really kinda just told a story then. There was absolutely no question to the end of it.

I I think I wanted to tell you, just say thank you, that you're amazing and what you've done is extraordinary. And you've worked so hard and you continue to be a loud voice for people with ADHD and I'm really grateful for it.

Thank you. I mean, I I I don't have ADHD, but I just think looking at the site... I mean, I went into psychiatry because I thought there was injustice, but I thought, like, ADHD is just huge injustice. Just the research evidence is there. So why, you know, this happens for physical health. Why isn't it happening for ADHD? So... Yeah. It's good. But I think people working together, I think, just keep pushing. I've never written so much in the last year. So... For ADHD, so there you go.

No. Thank you. I think we're out of... I said, well, we can have just some... We're out of time, can we... If we could just have some parting. What would you like... If you're talking to the minister right now, what would you say?

I will say this cost... Huge cost of doing nothing. I might not say it on this, but I think I said all all of Europe dealing now with this increased awareness, the maturation of science. And I think trying to avoid it is really going to end up costing so much more when there are... We we we know what could be done. And... Yeah. I I just kind of think that you can't keep doing reports. I would... Well, I hope they won't, and you actually need to deal with this. I was going to say, we can't be, you know, ostriches in the sand. You can't say it's not gonna go away. You you know, it's not gonna go away. It's just prolonging the the problem. Just think, just sort it. Yeah. It's not that difficult.

No. That's... I think there's a huge need. There's a moral and economic argument, which he made very very well. And on the basis of both of those, putting the resources in to to catch up and to deal with the overhang is what we want. Anita, you're wonderful. Thank you so so much. I have to say goodbye to you. I wish I didn't. And, as you know, we have a celebration of you. It's a complex fact that once you do these online things, you just walk away. So we have this little thing to say, thank you very much.

I love that. Thank you. That makes is it enormously.

Thank you very much for all you do. Thank you for what you have done. Thank you for coming to be part of the conference. And it's a big deal. I need to thank you very, very much. We're gonna have to say goodbye. Thank you. Bye.