Deciding to get assessed is a bigger step than it sounds, and most of what makes it hard is not knowing what you are walking into. So here is the shape of it.

Who can diagnose ADHD

Not a website. Not a questionnaire. Not a social media video, however accurate.

NICE, which writes the clinical guidelines used across the UK NHS, is specific: ADHD "should only be diagnosed by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in diagnosing ADHD". The diagnosis has to rest on a full clinical and psychosocial assessment, a full developmental and psychiatric history, and observer reports plus an assessment of the person's mental state.

The same guideline says a diagnosis "should not be made solely on the basis of rating scale or observational data" — though rating scales are useful as added tools.

In Nigeria and much of the region, the practical route is usually a psychiatrist, a developmental or general paediatrician for children, or a clinical psychologist working with a medical colleague. Federal neuropsychiatric hospitals, teaching hospitals and university medical centres are the usual starting points. Access is uneven: researchers studying ADHD in rural south-eastern Nigeria noted directly that care is concentrated in the cities. If you are outside a major city, expect to travel, and expect a wait.

What they are actually looking for

Three things, all of which have to be true together.

A pattern that fits the criteria. Symptoms of inattention, hyperactivity or impulsivity meeting the criteria in DSM-5 or ICD-11.

Real impairment. NICE requires "at least moderate psychological, social, or educational or occupational impairment". Difficulty you have absorbed and worked around still counts — but difficulty that costs you nothing does not meet the bar.

More than one setting. The symptoms must be "happening often, occurring in 2 or more important settings including social, familial, educational or occupational settings". This is the criterion most self-assessments ignore, and it is the reason "I can't focus at work" on its own is not enough.

They will also assess what else is going on. NICE asks clinicians to include an assessment of coexisting conditions, social, family and occupational circumstances, and physical health — because anxiety, depression, sleep disorders, hearing problems, thyroid problems and the effects of chronic stress can all produce overlapping pictures, and because they frequently occur alongside ADHD as well.

Adults: the childhood-history question

ADHD is a neurodevelopmental condition, so clinicians look for evidence that the pattern was present in childhood, even if nobody named it. NICE says to consider ADHD in all age groups, with symptom criteria adjusted for age-appropriate changes in behaviour, and it specifically advises that adults presenting with symptoms who do not have a childhood diagnosis should be referred for assessment.

In practice this is where many Nigerian adults get stuck, because the childhood evidence that clinics expect — school reports, a parent who remembers specifics — may not exist or may not be reachable. It is still worth going. Bring what you have, and say plainly what you cannot get. A good clinician works with incomplete histories all the time.

What to take with you

  • A written timeline. Roughly when each difficulty started, and what was happening in your life then.
  • Concrete examples, not labels. "I've been written up twice for missed deadlines" is worth more than "I'm disorganised."
  • Evidence from more than one setting — work, home, studies, money, relationships.
  • Old school reports if they exist, and anything a parent or older sibling remembers.
  • Someone who knew you as a child, if that is possible and comfortable. Observer reports are part of the formal process.
  • A list of everything else going on: sleep, mood, alcohol, other health conditions, medications.
  • Your questions, written down. You will forget them. That is rather the point.

What the appointment feels like

Expect a long conversation rather than a test. Most of it is history: childhood, school, work, relationships, money, sleep, mood, substances. Some clinicians use rating scales; some ask to speak to a family member; some use computer-based tasks as one input among several. For children and young people, NICE also asks that the parents' or carers' mental health be considered as part of the process.

You may need more than one appointment. That is normal and is not a sign anything has gone wrong.

About treatment

If a diagnosis is made, NIMH describes standard treatment as medication and psychosocial interventions — with examples including cognitive behavioural therapy, parent training and school-based support. NICE also expects a holistic shared treatment plan covering psychological, behavioural and occupational or educational needs, with treatment discussed before anything is started.

This site does not recommend medications and does not give doses. That conversation belongs with the clinician who assessed you, who knows your history, your heart and blood pressure, and what else you are taking. Be wary of anyone online who is prepared to be more specific than that.

If the answer is no

Many people who go for assessment are told that something else fits better, or that the threshold is not met. That is not a wasted trip and it is not a verdict on whether your difficulty is real.

The difficulty was real before the appointment and it is real after. You now know something about what is driving it, and the practical strategies on this site are useful either way — they were never conditional on a diagnosis.