Right. We're very, very excited about our next section. And it's been led by Doctor Manan Thakrar, whose name was utterly butchered by our AI voice over. And we've got Maram Al-Fozan, Doctor. Holly Hart, Natalie Jones, all from Medinet Minds. And we are extremely pleased to have them here and as one of the big providers for ADHD services for the NHS. Like many people will have had an assessment with them, also had support with them. And they are very important. They're answering an extremely critical question, which is when you finally get an ADHD or autism diagnosis, what happens next?

And so much of the systems entry goes into the assessment and far less into life after diagnosis. So this panel brings together four different professions from Medinet Minds to talk about exactly that. Processing the news, talking to the work, talking to work, talking to family and friends, getting the right support and with or without medication. Leading it is Doctor Manan Thakrar. He is medical director at Medinet Minds. He's a consultant psychiatrist. He's a member of the Royal College of Psychiatrists. And he has given four TEDx talks and hosts his own podcast. Maram Al-Fozan is a lead pharmacist. Her career spans inpatient forensic and community mental health, including child and adolescent perinatal and neurodevelopmental services.

And she also helps train the next generation of mental health pharmacists. Doctor Holly Hart is a lead psychologist. She's a counseling psychologist who's worked full time in neurodevelopmental practice since 2020 with a firmly neuro affirmative approach. And Natalie Jones is a lead nurse. She's a registered mental health nurse and a prescriber who's worked in crisis teams, led a community mental health team and helped develop home treatment services for children and young people. We're very lucky to have such a group of talented people here. And I'm excited to bring them on. If you have any questions, as you know, them in our Q and A. You can get them at globaladhd.com/live, which is the livestream page, or you can get them.

On the speaker page. So without further ado, please welcome the Medinet Minds panel led by Manan. I welcome Manan, Juan, Maram, and Natalie.

Morning, everyone. Thank you so much for the kind introduction, Henry, for our team. My name is Manan. I'm a consultant psychiatrist. I'm the medical director at Minds. The idea behind Minds was that we wanted to develop a service that we'd be happy for our families to use. We developed a a model of care and a service which focuses quite a lot on the idea of differential diagnosis, the the importance of a core, thorough psychiatric history, and that's what our model of care is based on. We wanted to create a service which clinicians would be happy to deliver, and our clinicians would feel safe with their PINs. Similarly, our patients would be happy.

A year and a half down the line, 20,000 or so patients... Service users down the line, We have a family of more than 800 clinicians. One in three of our clinicians are brought by other clinicians onboard. We usually score 4.3 or 4.4 on a friends and family score, telling you that about 90% of people would be happy for their families to be assessed or served by us. We aspire to work constantly on a service which does the right thing, supports end to end from the point of view of triage to post diagnostic support. And hence, today, team... My team and I, we will talk a little bit about how life is post diagnosis. Mindful that, Henry's kindly introduced, Maram, Nat, and Holly, all four of us, very kindly. So I won't repeat that.

We can get right into it. And today's session is focused more around an interactive session, really, a, amongst the four of us, but everyone in the audience as well. So please use the chat function. We have crafted some questions that we'll ask each other and try to get a dialogue going, but I'll keep an eye out on the chat box. If there's any questions that you'd like to ask any of us, not only from life post diagnosis, but also from the perspective of designing a service, building up a service which clinicians are happy to be a part of or or friends and family want to use, That... That's the idea. That's what we want to talk about except and outside of life post diagnosis as well.

In that spirit, I will start with my first question, and I'll ask my first question to Nat. Nat, once someone receives an ADHD diagnosis, how do you think they... How should they think about difficulties that might sit along with ADHD such as, say, anxiety, difficulties with past experiences, other mental health needs? How do we make sure that we're supporting the whole person rather than just treating the diagnosis?

Thank you, Manan. I often say that people... To people that when receiving a diagnosis, it isn't the end of the journey. In many ways, it's the beginning. Many people have lived with ADHD for years without knowing, and it really comes on its own. I see many people that also live with anxiety, low mood, burnout, poor sleep, and have also been through difficult experiences. When we think about it, it makes sense. If we've spent years being told that we're lazy, maybe disorganized, and you've had to work twice as hard as keeping up, it's understandable that anxiety and low self esteem can follow. In my career, with crisis teams and patient services, one thing that we've learned is that we can't separate ADHD from the person and their story.

If we focus on ADHD, we risk missing depression or other, like, trauma that sits maybe alongside. And if we only focus on anxiety, we may also miss that the ADHD that might have been driving the anxiety for years. So supporting the person as a whole means taking a broader view. It means asking about mood, sleep, relationships, maybe substances, physical health, not just focusing on attention and concentration. It also means thinking carefully about prioritizing. If someone is in crisis, that needs to come first. ADHD treatment tends to work best when other areas of people's lives are more settled. It means making space for people to how they feel about their diagnosis.

Letting them be able to talk about it. For some, it brings real relief, and then some others, it may bring some grief. And when they think about the child that they was when they were younger, it may have been misunderstood. And also, maybe missed opportunities throughout their life. And both responses are completely valid. But it also means professionals working together, though not one single service can meet every need. So collaborating with GPs, talking therapies, employers, schools is also essential to make sure that people don't fall through the gaps. And handing over to Holly.

Holly, I mentioned the range of emotions a diagnosis can bring up, particularly when it comes later in life. How do you begin to process your diagnosis and make sense of what it meant for you?

Thank you, Natalie. From a therapeutic standpoint, to begin that process, just take a minute, Just of bask in the fact you've achieved something and going through the assessment process and allow yourself the time to honour that process. And then start to think about, how do I feel and how am I going to navigate these feelings? And what I'd say is that allow yourself to validate those feelings. I think we have a tendency with especially when we think about the word diagnosis, if we go from a medical point, we'll think about how do we fix, how do we sort it from here. But it's okay to.

Accept, to go beyond the word diagnosis and know that this is my identity. This is, you know, the stamp of who I am. And it's natural to go through a cycle, similar to grief. And I do a lot of this in my therapeutic work of, we're going to go on a journey here. We're going to feel really great, and we're going to feel really sad and angry, frustrated. And then we're going to start to bargain. And then we're going to eventually come to a place of acceptance. And what I'd say is that there's no timeframe on when to get to acceptance. It takes as long as it needs. But that can also be complicated by things maybe going on in your life. Maybe you've had.

Trouble with relationships or you've had difficulties at work, so it feels like I need the answer to why I am the way I am and I need to fix this. And there's other things on that periphery that you can do to help that immediate situation, but in terms of going really into the relational depth, just allow yourself to not suppress how you feel. Because we've probably spent a whole lifetime of feeling oppressed in some environments. Let's not do that within the environment of our minds. And express yourself in a way that feels good. You know, be reflective, be expressive with art, writing, music, go into nature, and just allow yourself to work out how do I colour in my pages?

What is right for me? Everyone's way of expressing those emotions and thoughts of their identity is different, and that's okay. If you work in therapies, with a therapist rather, or you work with a coach, There's no one prescriptive way to get to the place of acceptance. We are allowed to be different in our approach. And what I'd say is that where possible, use those resources. There's a lot of work online, really great fantastic resources that you can learn. And it's okay if you don't agree, if it doesn't work with you. Right? But it's knowledge. And then you can build on that knowledge to understand what it is that works for you. And learn who you are.

What are your values? What's important to you in life? One of the first questions I ask in therapies is, well, why are you here today to see me? But also, what's important to you in life? What makes you, you? Because at the end of the day, the greatest change can happen when we're rooted within our values. That comes from sort of acceptance and commitment therapies and compassion focused therapies. So when we have those pillars as a person, that's when we can elevate you in order to celebrate you. And when you have a diagnosis, what can be helpful in processing is, I always describe it as finally getting your prescription.

Right for your glasses or your vision. You know, you were always able to see, but maybe things were just a bit fuzzy or you couldn't quite see into the distance. But now we've found the right prescription and you've put on that pair of glasses for the first time and everything is so sharp and colourful. And with that in mind, you know, can only be part of it after a diagnosis diagnosis. And medication can be useful for some people. So going on the theme of prescriptions, that was a nice little segue for Maram. So there's obviously several different medications available for ADHD, Maram. How do you work out what medication's the right one?

Thanks Holly, that was a very good segue. So there are a few medications, two different types generally, so stimulants and non stimulants. So I think when you start sort of a titration journey or when you're exploring medication, the first time you meet a prescriber, you should have sort of a baseline assessment. So during that assessment, it's normally a slightly longer appointment. And what what we want to explore are treatment goals, impact on sort of day to day, where we want the benefits to be. Also, quite a thorough history on, mental health background, any sort of substance use, disorder or, history, also physical health. So there's quite a comprehensive cardiovascular assessment as well.

As well as what what current medication someone might already be taking. And sometimes if we needed additional tests just to get a better understanding of what what the safest option might be. So I would say that's where we start, and then there's a discussion around how the medications work, what the common side effects are. And then from there, it's it's really a shared decision. So it's discussion with the individual. It's these medicines come in different formulations. So some of the things that we think about is, do we just need it for the work day? If it's a child or a young person, perhaps we just need it for the school day. Do they have swallowing difficulties? So do we need to think about a capsule, for example?

What sort of... You know, how does their sort of day to day look like? Does taking medicine once a day or work better? Or if they are worried about side effects, is it better that they take them multiple times a day so they don't last as long? You know? Do they have sleep difficulties? And so it's start exploring all of those things about the individual's lifestyle, physical health, and then coming to sort of an agreement. Generally, we try to stick with the stimulant initially because they... They've got the best evidence and it's recommended as first line. But it is really a a shared decision. So... Yeah. So from that, I've got a question for you, Holly. Once you've received a diagnosis.

How do you talk about it with your partner, with your family, your friends, and your workplace or education provider? And also, how do you ask for support or reasonable adjustments to be made?

It's a great question. And, you know, it can be tricky to have the conversations. And, it's okay that it's tricky. And what I have found over the years is that people say to me, I don't know how to explain, know, for instance, to my partner who I've been with for ten years, that actually, this is why I am the way I am. But you've been with me for ten years, now it feels like I'm about to change, but I'm still the same person. So many questions can come about. And then do you explain something to someone that you cannot explain yourself yet? And I'd say that's the key, is being able to say, I'm not really sure what this is gonna look like, but are you coming along for the ride as well? You know, invite them along with the journey.

And I'd say that it's... You don't have to be the expert yet. You know yourself best. As much as, you know, we all pride ourselves on our experience of working in ADHD, when we work with a client, the person sitting opposite us is actually the expert in the room because they know how it feels within their body. So I think that trying to find a bit of the superhero pose within that. You know, when they ask you to sort of stand with your hands on your hips that I did do 10 before we started this, just to feel I can do this. You know, be ready to be worried about talking, but then be ready to also go, we're just going to figure this out. And I would say don't put too much pressure on the right wording.

Because we'll just get jumbled up, we'll get lost. I always say to people, when they don't know how to say something, imagine that you are going to the cupboard under the stairs where we just constantly chuck stuff in and go, a deal with that next week'. Rip out the cupboard and allow everything to fall down and then we go, right, here's what we're dealing with. How do we put the cupboard back together in a systematic way? So there's no real way to do it. But I would say that trust your relationships around you, especially for friends and families and partners, is that they will be with you no matter what. They might not understand and that's okay. Allow them to know that you can.

Can go your own journey with this as well. There's some really great resources out there. There's a fantastic book, ADHD and Us. I always recommend that to individuals where it... It's it's a great book on how it then explains ADHD as a partner, but also what the partner's going through. So just learn to kind of do that dance with each other of communicating, well, this is how it is for me, and how is that for you? Another really great theory to work on for communication styles is non violent communication by Marshall Rosenberg, where we say, when you do X, I feel Y. So I would really like if you or we could do Z. And learning how to be messy in life, but as long as we're communicating clearly.

That's when you can get through any difficulties. So I would say that there's not really a straight answer for it, as you can probably tell. But that's okay. And that's kind of the beauty of neurodivergence for me, is that there isn't really one line. It's a variation of the human experience. When it comes to educations and work providers, this is where people start to feel probably more anxious. So what I would say is that access the support where you can, occupational health, you know, go through EAPs, use the support that is there in order to, you know, protect it and support it within your place of education and work. I think that, I'd say now more than ever, people feel more apprehensive about explaining their ADHD diagnosis.

Within universities or or the workplace, because we worry about, you know, am I am I gonna be misunderstood? Are they gonna think I'm a fraud in some ways? You know, there's all these real things about identity, but there is support out there and there is protection. So thinking about your quality act, support from ACAS, just don't be afraid to ask for help is always my bottom line. But that sort of leads me into what can be difficult about asking for help is because of the emotional turbulence that we can experience. So Natalie, it brings me to my question for you about, you know many people with ADHD struggle with emotional regulation and rejection sensitivity.

So, what can someone do to understand and manage those emotions to improve their quality and experience of life?

Thank you, Holly. When people tell me what affects their lives the most, it's normally not about attention, it's about their emotions. And with ADHD emotions, they can rise very, very quickly, feel very intense, and take longer to settle. And people often describe going for like zero to 100, which then can lead to sometimes embarrassment and shame. Many people also recognise rejection sensitivity. It isn't a formal diagnosis, but it can describe a very real experience an intense emotional response to maybe feeling criticised, excluded or feeling like you've let somebody down. It can also be triggered by something quite small. So maybe someone's sending a brief message, not replying on time.

And the most important thing to understand is that this is part of how the ADHD brain can work. It isn't a flaw in someone's character, but recognizing that can reduce sometimes shame. I'm trained in dialectical behavioral therapy, and there's some really good practical skills in DBT that I find particularly helpful that can help you with ADHD. First is simply to notice and name the emotion, saying to yourself, I am feeling rejected right now. This can reduce this intensity. Second, checking the facts. Is my reaction based on exactly what has happened, or is it the rejection sensitivity that's shaping how I'm interpreting it? Is there another explanation?

And the third is about common body first. So when emotions are high, it can be difficult to think clearly. So things like cold water, just simple things, scratching on the face, brief physical activity, and steady breathing can then help slow the body before responding. Also thinking about basics, so sleep, regular meals, exercise, limiting alcohol, these can all have a significant impact on emotional resilience. It's also helpful to understand our own patterns, including our triggers and what our early warning signs are, and to share these with people close to you so that they can support you rather than it leading to conflict.

Many people find their emotions become more manageable once their ADHD is treated, and therapy and support can build on that progress. Which then leads me to you, Manan. How much of the conversation around ADHD focuses on getting a diagnosis, but what should happen afterwards? What does a really good post diagnostic ADHD service look like to you?

For me, a good ADHD service or any good mental health service really should be able to answer one very simple question. What happens to the... To this person after we give them a diagnosis? Because we we put such an awful lot of time, energy, and effort into getting people assessed, But the diagnosis should actually be the beginning of their care, not the end of it. Being being a medical professional by background, imagine the amount of resources that we invest in able... To be able to diagnose someone as having a fracture or having a stroke or having a heart attack versus the amount of time, energy, and resources that we invest to be able to actually manage and help with that?

Shouldn't majority of the resources be invested in helping folks with ADHD, helping folks with autism, helping folks get the right support? And I don't just mean meds. I I mean the right psychoeducation, the right therapeutic support, the right meds, the right life, the right occupational support. And and that for me is a is a decent service, which focuses not only on a comprehensive assessment model, but a comprehensive post diagnostic model as well. Because let's start from the point of view of.

Getting a diagnosis. So someone can maybe leave an assessment feeling relieved. Like, we've all been there. As clinicians, we've had such a spectrum of reactions when we finally break the news to this... To the person to say that, you know what? Like, I do feel that you do meet the threshold based on this, this, and this. These are these are the points that I wanna discuss. That we've seen relief. We've seen overwhelm. We've seen sometimes anger. We've sometimes seen disappointment. We've sometimes seen happiness. But life life makes sense. Once once someone's had the chance to process a diagnosis, then sometimes it's a mixture of all of these emotions.

But life starts to make sense, especially when one gets a diagnosis as an adult when they've been through so much in childhood, felt misunderstood, felt like I'm I'm not fitting into that that mold that the society wants me to fit into. That needs to be supported. It's not just about medicine, not just about the biological side of it. So we need to make space for that. As a service, as people, as clinicians who who care for us, we need to make space to be able to process them, help them understand what this diagnosis means, and how this changes their life in a good way to be able to, a, make sense, but also then support in in the journey afterwards. So.

I'd suggest that, say, a good post diagnostic service or a good post diagnostic care should offer three things. First one being understanding. And by understanding, I mean proper psychoeducation that connects ADHD or autism to an everyday experience. Why someone struggles to start tasks? How does one manage time? How does one maintain relationships? How does one keep on top of responsibilities? And hence, in our in our CPD course, usually, the first session... And I know you guys sometimes.

Get bored because you've done the same thing over and over again. But we start off by drawing the brain, and we start off by drawing the lobes of the brain and what parts of the brain are responsible for, say, working memory, for for emotions, for learning, for... And understanding the core concepts of what is working memory versus short term memory versus long term memory. How does one process emotions? What does the amygdala do? What does the thalamus do? I think that information.

Should not just be available and and known to clinicians, but should also be available and known to folks who want to understand themselves better, their biology better. Folks do usually understand diabetes reasonably well. They do understand their blood pressure reasonably well and how salt impacts their blood pressure or how sweet food impacts their diabetes.

But I think there should be more awareness and more psychoeducation around the impact of all of these things, being able to make sense of those things. And and then with their consent then involving people around them as well, having that support readily available to their family members, their carers, their loved ones, because that understanding can make such a whole world of difference at home, at work. That essentially brings me to that second point, which should be that you should have a personalized plan. And we talk about this as mental health professionals who work at secondary or tertiary care. We talk about a care plan, don't we? We talk about how a care plan should start off in that first person language.

On what I'd want my diagnosis and what support I'd want, what are the things that work for me, what are the things that don't. A particular type of therapy doesn't work. And we were discussing Holly the other day, won't we, that a good therapist would take into account all of those things. We don't need to design a special module for a and special module for b, special module for c because a good clinician and a good therapist would take into account all of those needs when formulating that care plan. And that, I don't think, should be just expert opinion driven. And, you know, as as people of science, we should be aware about what the levels of evidence are. The first level of evidence being systematic reviews and meta analysis.

So when someone's either designing a service or judging a service, we should judge based on what could die... Post diagnostic care looks like, not in my opinion, not in your opinion, but in the opinion of meta analytical studies. Expert opinion and lab research is the level five of scientific evidence. It's the lowest level of evidence. The level four being case studies, case reports, level three being cohorts and case control studies, level two being randomized control trials, the highest level, the level one of scientific study being meta analytical research, which is done over various countries for hundreds of thousands of people, and it's been tried and tested over and over again.

And the beauty of today's day and age is... And the challenge, when you search AI, most AI search engines will not differentiate between the levels of evidence, which is why we as a service have taken some decisions where we will always go by scientific research. Our decisions will not be driven about what Manan thinks or what Maram thinks or what Matt thinks or what Holly thinks. They will be driven by core research and hence fostering that atmosphere as well where we can be challenged. We can look at, the right studies. We can look at the right evidence and then create services or create post diagnostic support, which is personalized but evidence driven, which is empathic.

But driven by science. And I don't think you can choose one. I think the right way to go about it is choosing both. Finally, having that continuity of care. People need to know who's responsible for their care, when they will be reviewed, who they can contact if something isn't working. If that medication is prescribed, then there should be careful titration and monitoring. There should... You should see the same clinician more often than not unless, you know, something's happened. If a GP cannot take on shared care, then that service needs a clear plan on how how does one provide that service post post discharge. And.

That's what I'd I'd judge a decent service by, whether your folks feel supported, whether the clinicians feel that they're getting that work satisfaction. Do you remember when when that nurse posted in in our group chat that after years of working in different services, I go home and I actually feel that warm fuzzy feeling in my tummy when I work because I do feel like I'm genuinely helping people. And that, for me, is the biggest validation for for how we deliver the care and the services that we want to. I think a really good service does give someone both an explanation of their difficulties and a clear way forward. In short, a service that we'd be happy for our families to use. Which brings me to my question to you, Maram. What.

Should people with ADHD know about alcohol, cannabis, caffeine, other substances, particularly when they're taking ADHD meds?

Thanks, Manan. So a few things. I mean, this this kind of goes back to the baseline assessment, which is a really important sort of opportunity to explore things like alcohol, caffeine, diet exercise, and also sort of cannabis, for example. So there's there's a few things to think about. Cannabis in the long term, I mean, sort of intermittent use, there's not a huge amount of evidence on the on the long term impact of of of cannabis. Whereas kind of daily regular use in the long term can have impacts on things like learning, decision making, attention, memory, impulse inhibition, emotional processing, and motivation as we know. And.

These are things that can be affected in ADHD. So it's it's something to kind of be mindful of with when it comes to diagnosis, but also discussing treatment options. In terms of the treatment and with medication, cannabis can add cardiac strain, it can have an effect on the heart and the blood vessels when taken in combination with therapeutic stimulants, which is something that would be a caution when it comes to prescribing. And also because of the action of certain neurotransmitters in the brain, it can also cause an additive effect or increase the risk of developing psychosis, which is something that's very, very real and something that we do... We have seen in practice. And so I... With...

Particularly with cannabis, just like actually with with all of the sort of caffeine, alcohol. It is a case by case. It's an opportunity for the health care professionals to sort of explore lifestyle in general in a nonjudgmental way and actually to identify other ways of support or or ways that we can support and sort of either get an individual to a place where we can trial medication or if we can look at other forms of support as well. Different providers will have different policies around cannabis use and prescribing, and so I can't really sort of comment in terms of what the definitive guidance is. And so it's just a matter of having a conversation around it, but there are considerations when it comes to prescribing.

And sort of cannabis use, for example. Similarly with alcohol, it's... Again, it's just one of those conversations that is really, really important to be open and have a discussion with your health care provider. You know, it's... It should be kind of a nonjudgmental space. You know, some people have spoken to me about self medicating with alcohol sometimes, sometimes if there's sleep difficulties, and it's it's sort of... It should be a safe space to to do that. There is a lot... You know, plenty of guidance around, you know, the the... What the alcohol... What your alcohol consumption should look like. So fourteen units a week having alcohol free days, and that is something that your health care professional should discuss.

Or should discuss with individuals. What we think about with alcohol when it comes to medication, there there is again some additive effects. So again, increases or or or increases in blood pressure and pulse or cardiovascular strain, and again, that's that's... That would be something that we would consider in terms as an additive effect, particularly during the initial phases where we're introducing a new medication. And so in a lot of cases, we would potentially ask individuals to abstain from alcohol during that period just to make sure that we're prescribing safely. I think in terms of that initial discussion around alcohol, it's it's it's really important to explore when.

Alcohol might be problematic or it might be an indication that an another service or other forms of support might be more helpful to sort of explore and manage alcohol. And then sort of other lifestyle factors, so caffeine. Again, caffeine is a a low potency stimulant and it can have that additive effect. When it comes to medication, actually, you might find that some people with ADHD consume higher levels of caffeine because it's actually they find it really helpful. Whereas in other circumstances, you can find that people just don't tolerate caffeine at all. But it's again, it's just kind of having a conversation, giving sort of the warning signs of what... Because what what might happen is that you could.

Confuse the side effects of stimulant medication with caffeine or even just kind of if they were had in combination, it could look like anxiety, tremor, kind of just feeling generally quite unwell, and just being able to identify that. It's not an absolute contraindication. It's not that you can't have caffeine when you're taking ADHD medication, but it's definitely something to discuss in, you know, during... With your prescriber. And then just kind of some other important things to think about. So diet, really, really important when it comes to treatment, having regular meals because a lot of these medicines do suppress appetite.

And sometimes people just forget to eat and then feel a little bit unwell or dizzy. And, you know, it would... It's difficult to differentiate whether or not that's got to do with the medication or if it's actually got to do with the fact that, you know, you just haven't eaten throughout the day. So just kind of having regular meals, a good balanced diet. And actually, that that has a really positive impact on ADHD overall as well. And exercise. So that can... Something vigorous and fun, something that, you know, people might kind of stick to, and that really does help with symptoms of hyperactivity or stress relief, but also things like yoga, and sort of mindfulness or walks can really help with attention or kind of managing impulses.

For example. So moving on from that, I've got a question for you, Manan.

So Or you ask me the question because I think we've got a chat question. I will be... I'm keeping an eye out on the general chat box, guys. So if anyone's got any questions that you wanna ask any one of us, please pop it in the chat box. We've got it. We've kept an eye out. We will, of course... We've got questions that we wanna ask each other from FAQs that we usually get. But if there's any questions that anyone in the audience wants to ask, please do pop it in the chat box. Richard's asking the question, Maram, that he's heard that alcohol and stimulant meds can give a risk of stroke. Would you have any sort of comments or suggestions on that?

I mean, in terms of specifically risk of stroke, that would be sort of something I'd have to look into, but there is definitely an additional cardiac strain. And so that's overall. Specifically for stroke, I'm not a 100% sure, but it is... The combination is is associated with an increases in... An increase in cardiovascular strain, which could then increase the risk of of stroke. Is that okay? Are there any other questions?

Yeah. It seems like there's about 25 questions on the q and a section, but I'm not able to see that section unfortunately. I don't know, Henry, if that is something that you can give us sight of and more than happy to answer those questions. Or if someone from the team can just pop them on the on the private chat as well, more than happy to. In the meantime, while we get those questions, Maram, if you wanna ask yours.

Yeah. Fine. So if we get an ADHD diagnosis, treatment, and ongoing support right, what difference can it make to someone's life in the longer term?

I think the biggest difference is that someone can begin a life that feels much more manageable, much more on their own. I think being able to see that... You know, how many times do adults come to us and say that they've spent their years incredibly hard trying to fit into the mold, trying to become a part of something that they don't naturally feel a part of and and feeling that they're constantly falling short. They may they may have been described as lazy, unreliable, not reaching their potential. And over time, those descriptions do become heavy, because they they start influencing the way we see ourselves.

So getting the diagnosis right is helpful. It's really good. But then getting the post diagnostic support right is also equally helpful. Getting the diagnosis right can help someone make sense, but really good post diagnostic support helps folks get the ongoing support that helps them move forward. And changes to to begin with can sound quite ordinary. Do know what I mean? Like, getting to work on time, finishing something that they just started, remembering an appointment, being able to listen to their partner without constantly losing the thread of the conversation.

But when those difficulties have been compounding over years and years and years, that... Those improvements can be so meaningful, can can impact the quality of life so much. And over the longer term, I'd hope to see that translate more into a sustainable employment, a better experience in education, stronger relationships, greater confidence. Most importantly, when you look at yourself in the mirror, you feel like you're doing a good job at being yourself and being the best version of you. You go to sleep happier. You go to sleep much more content that you're being the best version of you. And we should also pay attention to the amount of effort that's being involved in doing that. So some folks might already be performing well.

But only through a lot of preparation and a lot of support. We... I say this quite often that good therapeutic support or good post diagnostic support isn't getting you to sit on your desk and then teaching you how to go about life. No. It's about amplifying and validating all the right things that you've already done. Like Holly said in her answer that, you know, the person who we're sitting in front of.

Is is the expert in what ADHD is to them. They've lived a life with ADHD or lived a life with autism. They've developed a lot of coping mechanisms, a lot of tools, a lot of things that work for them. It's about identifying those trends, building up on those trends, validating them as the right things, and then maybe learning a couple of new skills along the way to to get the right support there.

That impact in the long run extends beyond the individual because when daily life becomes more manageable, lives become more impactful, makes a difference in their partner's life, a difference in their children's life, a difference in their work life, and and you see a person who's contributing to society so much more than what we were... What they were before. So, of course, treatment or meds don't remove every difficulty. Outcomes will vary, but that's why ongoing support matters because ongoing support is dynamic. It listens to what works. It listens to what doesn't work and then adapts. Isn't that the very definition of intelligence? We keep changing.

Our approach. We keep learning, and we keep improving, which is why that should not be just what Manan's learnings are over, say, fifteen years of his career or Manan's learnings over twenty years of her career. It should be about what science is teaching us constantly. And for me, the long term goal is essentially to have... People have more choice over how they live, more confidence in how they go about their lives, and can follow through on the things that matter to them. And that's where the whole conversation... I don't wanna get into the politics of it, but go back to the levels of evidence, and Henry and I have spoken about this at the back end, that if the right diagnosis and the right support is given at the right time.

Meta analytical studies show that people are less likely to go on employ... On unemployment, less likely to go on benefits, less likely to go out of education. The right diagnosis and the right support makes lives more productive, not less, And there's ample evidence to show that. So it does get disheartening when such clear as day things sometimes need to be told to society, to decision making individuals. But I think that's the crusade and which is why we we respect the work that ADHD UK have done, which is the work that Henry has done, which is they've been such strong advocates of this crusade. And and, you know, like, hats off to them. So, yeah, I I think that's what that's what a change a good diagnostic... Good post diagnostic.

Process can make. It can make society much more productive. It can make individuals much more happier. It can make lives much more meaningful. I know that we've got some questions from the audience. I'll start off by the first one to you, Holly. What's what's the importance of using neuro affirmative language in in folks' day to day life but also in in diagnostic reports?

It's a really wonderful question. So I'd say that when we talk about neuro affirmative language, it's about honouring the neurodivergent experience. You know, we've certainly came from an era of deficit based language, you know, sort of pathologising, whereas this is and it like Doctor Jessica had said just before we came on was about we're on this frontier and this new paradigm shift of moving into an era where we really understand more and can identify ADHD and autism within people and making space for everybody. I always say there is room for everyone. We just maybe have to do a bit of a shimmy and a bit of adjustments here. Why neuro affirmative language is important, particularly within reports.

Is that I always see your report should be like an autobiography of yourself. We should be able to read this from anyone who's written it and get to know you. If you think about a celebrity's biography that you got given at Christmas time and you've read it, you'd actually feel like you've gotten a better understanding of this person that you will have no interaction with for the rest of your life. And that's why the language we use within the report should respect the difficulties a person's been through, the differences that they have been made to feel, maybe intentionally or unintentionally. And also, neurofirmative language gives us hope. It allows us to change the course of how we speak to one another about the difficulties.

That ADHD and the challenges that ADHD or an autistic person will face. You know, like Natalie had said, being perceived as, oh, you're lazy or you don't keep up. It's not that at all. It's just that my brain processes differently. It's neuro affirmative language for me starts to give people the permission to respect and operate with dignity and integrity. I hope that answers your question, Manan.

Yeah, it does. Nat, are you keeping an eye out on the questions? Do you want to take the next one?

Yeah. So just to warn... Just a bit of a warning that this does involve somebody's partner committing suicide, and it says I have recently been diagnosed as I suffered a psychotic episode over fifteen years ago. I've been told I have to wait to see if medication is suitable for me. During that awful period in my life, was self medicating due to domestic abuse and then my husband committing suicide. Should I be penalized for being honest in my assessment? Have I been... I have been clean ever since, and I don't drink or smoke anymore.

No. Absolutely, you shouldn't shouldn't be penalized in in any assessment or that shouldn't. We say this over and over again that the more honest and open you are, the best... The most accurate diagnostic tool. When we look at diagnostic tools as to what gives the right diagnosis. The the four scientific elements... Yeah. Pritchard, I'll have a look at that question after this. The the four scientific metrics that decide whether a diagnostic tool is accurate or not is sensitivity, specificity, positive predictive value, and negative predictive value. Sensitivity is the number of true positives. Specificity is the number of true negatives. Positive predictive value is the total number of positive results divided by...

True positive results by the total positive, and negative predictive value is total true negative versus total negative. Now the most accurate diagnostic tool for ADHD and autism is actually a thorough proper psychiatric history because any screening tool would not take into account a thorough number of differential diagnosis. And that's why the the... Well, the service model that we've designed, but also the the importance and the focus that NICE guidelines or any national NICE guidelines have placed on a thorough history on differential diagnosis, on making sure that these diagnostic decisions are not a a flowchart or an algorithm, that they take into account the service user or the person's overall story, the overall history.

So, no, you should absolutely not penal... Be penalized or go through anything for for any past experiences you've had. Rather, that should help formulate a thorough diagnostic picture. And like we said towards the beginning of this session that folks who have ADHD, folks who have autism often have been through trauma. Evidence suggests that they're much more likely to go through trauma than folks who haven't. Because the world is designed in such a way. The awareness around those sort of things, you know, like back in the day of nineteen seventies and nineteen eighties, ADHD was the naughty male child in school. But science's understanding of of ADHD, science's understanding of autism has evolved so much over the past few decades.

And one of the main reasons why I got into psychiatry was because we know much little about the brain as compared to much we know about the liver, how much we know about the heart. We have figured out the the heart, the liver, the intestines much more than we figured out the brain. But that's what makes the life of a mental health professional fascinating as well because there's so much new scientific material coming out day in and day out. You've got to keep yourself updated. You've got to keep reading. And more than anything, there's there's a story. Any mental health professional... I I say this over and over again, don't I, that empathy is not conditional if you wanna be a decent mental health professional.

Most decent mental health professionals have either been through something themselves or seen something up close and personal, and hence, a good history or a good diagnostic evaluation should consider all of that, should encourage you talking about that, should treat all of that with empathy. And at the end of a thorough diagnostic evaluation, you should actually feel like you've had a cathartic experience because you've been able to tell your life story, and that makes sense. So absolutely not. We shouldn't be penalized for that is is the is the short answer. What's the next question? Rick, we've got another question. When we say that ADHD people can become productive.

You mean productive in the sense of being able to contribute within a capitalistic system? I suppose being productive in the in in the sense of being happier, having more meaning to their lives, doing what works for them. Productive for someone can be being more artistic, productive for someone can be spending more time with their families meaningfully, productive for someone can be... Meaning that contributing more in the life of their parents as a son, contributing more in the life of their children as a father or a mother, contributing more in the life of their friends as a friend, contributing more in their company, their their life. Essentially.

When I say being more productive, I mean living more fulfilling lives with that support, having known what their strengths are, what their challenges are. I hope hope that helps clarify. Okay. What's the next question? Maram, have you kept an eye on... Next question. There's.

There's one someone diagnosed autistic at 57 and with ADHD at 62. I spent decades adapting and masking in environments not built for neurodivergent minds at a high personal cost. How can post diagnostic care support late diagnosed adults through unmasking, processing past burnout and navigating systems without treating decades of coping strategies as no support needed.

Do you want to give that one a go, Holly, when I can add bits to it? I'll certainly give it a go. What.

I would say is that... And it's similar to what Doctor Jessica was saying, is that we need more support for later years of life. We should be looking at support for across the lifespan. Just unfortunately, where we're at in the paradigm shift, it's just not there yet, is really difficult to sit with, I know. But what I would say is that it's never too late, you know? And you're worth the time and investment of understanding yourself. From a therapist point of view, I would be thinking about, well, let's look at the resources you have now to think about unmasking. There's some really great books on unmasking, for both genders actually. Thinking And about how you go into tomorrow with with peeling back a layer at a time, it sounds like.

Taking... If if available to you, taking time to understand that through therapies would be really useful. And it's not necessarily thinking about structured therapies like adapting CBT or anything like that, but maybe kind of a more person centred approach to really explore yourself and your experiences, and then thinking about what can I do next? Manan, I'll pass back to you.

Yeah, I think, like like we discussed, tailoring that approach towards... I'm a general adult psychiatrist, so majority of the people that I diagnose are are adults. And, being able to see a diagnosis that wasn't commonly given when I started my career versus a diagnosis that is much more commonly given these days and how science is understanding has evolved over the past few years and decades. I'm a bit of a nerd, so I've gone through... Read all of Signal Point's books when I was in training, read through all the editions of the DSM, the DSM one, two, three, four, five. And it's fascinating to see how science's understanding of ADHD has evolved over years and years. And shout out to all.

The all the folks who've done such good work in creating awareness around it, studying it, picking that up as a as a topic of interest, and doing research around it. But late life diagnosis, especially amongst women, is a fascinating area of research because that isn't massively studied or massively understood. But a good therapist, a good clinician, a good post diagnostic support would consider the challenges that someone has. I I had I had a hairdresser who had her own shop and was diagnosed at the age of 62 and to see how she had coped with life before the diagnosis and realizing that all of that makes sense now and and how then looking at amplifying the strengths that she'd already developed through the years.

Understanding that there was a core understanding that that she had about what works for her and what doesn't. She couldn't put a point pin on it and and say that, yes. This is this is RSD, or this is hyperactivity, or this is inattention. She didn't have the articulation to use the exact same words, but there was... It was there in actions. The the the the solutions were put in actions in the staff that she appointed, the way she maneuvered her staff. She's she's a supremely successful individual because there was a lot of masking there. But at the same time, there was a lot of exhaustion. There was a lot of burnout. There was times when she had to completely decide of this or the moment that, you know what, I can't make it to work today.

And just being able to allow herself to understand what her diagnosis means, what her strengths are, what her weaknesses are, the fact that she could navigate this operating. I I often say this, that by and large on, say, 80% of your days or 80% of your workdays, you should be operating at 80% of your capacity. Because those 20% of your workdays, when you need that extra 20%, that shouldn't be a 120%. That should be close to a 100. That's what makes it sustainable. So being able to budget the the energy, the stress, the cortisol levels is just so very important and and makes a lot of difference. So I think taking into consideration late life diagnosis, taking into consideration masking and the things that we've developed.

Where we are masking is quite different for different individuals even if they might belong to the same social sector or they might belong to the same age or gender bracket. It might be very different for for folks. And hence, being able to tailor a good care plan which understands their story and formulates a process which helps them validate the right things, I think is is is really, really important. Maram, do you want me to... Or are we are we out of time, Henry? I think we are out of time. We probably got time for one more if you're quick. Well, we've got... Or we can we can pass it on to you, Henry, and there's any closing remarks that you've got. Because Maram's really happy because Maram was going to get that question. Yeah.

Well, we're all intrigued now. That that you could... I can... Last question, and you've been amazing. We sadly have to say goodbye. I can't Alright. Okay. So the last question is that.

Maram, what does a pharmacist do after diagnosis? I didn't even know that that was an option.

So I am conscious that this is a global conference. So every... In every country, the role of the pharmacist could be different. So in The UK, you can have prescribing pharmacists who are trained to prescribe in their scope of practice. So, our our pharmacists are prescribers. They run, prescribing clinics where they titrate individuals, and also, monitor individuals and and and the long term management of their medication. I guess, there's also supporting other prescribers, so advising on side effects, any interactions, any contraindications, you know, as sort of medicine specialists. That would be part of our role where where we would support other prescribers and other staff.

And, also, I I I do know a few pharmacists who are trained in ADHD coaching and also who have got a lot of experience in secondary mental health and so are trained in kind of the the therapies where they can sort of use that alongside their prescribing clinic. But most of our focus is around kind of medication management.

But if you do have a good pharmacist, then they understand the importance of psychoeducation. They understand the importance of mental state examination, serial mental state examination. So, yeah, sort of closing remarks, if if you've got a good team around you, which I do, it it... It's an honor and privilege because you always keep learning from them. And I think that's the importance of lateral intelligence, isn't it? Holly knows quite a lot about meds. Maram knows quite a lot about therapy and psychoeducation, and having that lateral intelligence, especially when you're designing a service, is extremely, extremely important.

Thank you so much for for spending this last hour with us. It's an honor and a privilege. Thank you, Henry, and the team at ADHD UK for being excellent hosts. Well, really, it's it's thank you from us for for you doing this. I found it extraordinarily.

Interesting and it's wonderful that you brought so many people, your broad skill base. I'm actually talking directly to that question of that people with ADHD are people. We're all... One of the things we talk about is we're all unique individuals plus ADHD. And with that uniqueness brings complexity. And you've talked very eloquently to the different challenges people face and how to help them with that. So I think that, you know, absolutely wonderful. So thank you. Thank you. Yeah. And thank you. We've got our little celebration, as you may have seen already.

I think this should be the norm with every candidate. Absolutely, this should be.

We we coded this specially, like, and so it's unique for for for for this. Because we wanted to celebrate you. Because it's genuine. I know how challenging it is. You're often talking and... But it's without an audience and it is a challenge. I can't tell you enough how grateful I am for taking on a difficult topic and a very, very important one The post diagnostic is not talked about enough and you've been very eloquent on it and all the work you've done. So I'm grateful for you, for Medinet Minds, putting you up and for doing all you do. We've had public sector involvement and Medinet Minds does work for the NHS in substantial volumes. It's important and wouldn't be.

.. People wouldn't be getting the help they would without your work. And so we are genuinely grateful, so thank you. Thank you. Thank you for all the hard work. And, Henry, we all are admirers of your work and and the and the advocacy that ADHD UK do, the research, the participation. We're we're all awestruck by your passion, so we're inspired by it.

Back to you, sir. Thank you. I have to say goodbye though. It's... So goodbye. Thank you, Manan, Holly, Maram, Natalie. Thank you so so much. Thank you. Thank you. And that was...