Diva-5 form
14. Mr O complained the organisation did not accurately complete an ADHD assessment. He told us the Diva-5 section of the assessment form was incomplete and did not consider the self-report scale provided by the family. He said subsequently, the organisation decided Mr L did not have ADHD.
15. The organisation told us its decision was based on the completion of the assessment which spanned three appointments, self-report scales completed by Mr O and Mr L and the Diva-5 tool. It said the decision was a unanimous one made by a multidisciplinary team of professionals which included two specialist ADHD nurses, an assistant psychologist and a specialist ADHD practitioner.
16. We reviewed this issue with help from our psychiatrist adviser, using Mr L’s clinical records.
17. NICE ADHD assessment guidelines say a diagnosis of ADHD should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in the diagnosis of ADHD, on the basis of:
• a full clinical and psychosocial assessment of the person; this should include discussion about behaviour and symptoms in the different domains and settings of the person's everyday life and • a full developmental and psychiatric history and • observer reports and assessment of the person's mental state
18. We can see the ADHD assessment carried out by the organisation included a comprehensive psychosocial assessment, use of DIVA-5 assessment and a collateral history.
19. The DIVA-5 form completed on 11 October 2023 had all the sections ticked if the positive symptoms were present and the absent symptoms were left blank. We saw there were differences between the self-report scale provided by the family and the scoring by the clinician in the DIVA-5 assessment. For example, Mr L self-reported issues with forgetfulness in daily activities and the Diva-5 form has recorded no symptoms present for this area.
20. Our psychiatrist adviser explained DIVA-5 is a semi structured interview performed by the clinician who uses their clinical judgement in scoring the symptoms which can lead to differences from the self-reported symptoms. For a problem behaviour or symptom to be scored as present, the problem should occur more frequently or at a more severe level than is usual in an age and IQ matched peer group.
21. On 18 January 2024, the organisation sent an ADHD diagnosis outcome letter to Mr L to confirm he did not meet the criteria for ADHD. The letter explained the diagnosis was based on an initial assessment exploring Mr L’s history, completion of a Diva-5 assessment, completion and review of a self-report scale, gathering and review of collateral information from Mr O, discussion and review of assessment by a multidisciplinary team and a feedback appointment to share the outcome.
22. The diagnosis letter included a twelve-page document detailing the findings of the assessments. Although the document summarises each assessment in detail the reasons for the differences in the scores between DIVA-5 and the self-report scale were not adequately explained.
23. GMC Good Medical Practice says, ‘you must make sure the information you give patients is clear, accurate and up to date based on the best available evidence.’
24. We saw the organisation carried out the ADHD assessment in accordance with NICE guidance, but did not adequately explain the reasons for the differences between the self-report scale and the Diva-5 form in the ADHD diagnosis outcome letter.
25. The organisation has agreed to put a service improvement in place by ensuring in future its reasoning is more adequately explained in the diagnosis outcome letter. Mr O seeks service improvements as an outcome to his complaint and so we are satisfied this is an appropriate remedy to this part of his complaint.
Second opinion
26. During a local resolution meeting held in May 2024, Mr O asked the organisation for a second opinion. The organisation advised it was waiting to hear from the ICB (which commissioned the assessment) if it was authorised to offer a second opinion and had no timescale for when this would be decided by the ICB.
27. GMC guidelines state a doctor must recognise a patient’s right to choose whether to accept your advice and respect their right to seek a second opinion.
28. Mr O emailed the ICB directly on 26 July 2023 to ask if it was feasible to request a second opinion and the procedure for doing so.
29. The ICB responded advising Mr O he could ask the organisation if it would offer a second opinion or alternatively he could go directly to his GP to request a referral elsewhere and get a second opinion that way.
30. We asked Mr O why he did not return to his GP to request a second opinion when this was an option given to him by the ICB. He told us he did not want to go back to the GP as his experience of the NHS mental health service was such he had no confidence it would result in any positive outcome having just spent months working with the organisation.
31. Mr O told us another lengthy wait would not have been sustainable as Mr L was coping with symptoms of ADHD such as disorganisation, poor time management and struggling to care for himself. He said this was also a cause of anxiety for himself and his wife as they were providing care for Mr L while he completed his studies.
32. Despite the issues Mr O says they were dealing with, it wasn’t until six weeks later on 13 September he contacted a private clinic. Mr O could have made enquiries with his GP on or soon after 26 July when he was advised to do so by the ICB.
33. We understand Mr L and his family faced a difficult time and we are sorry to hear how Mr L struggled to cope with his symptoms. We consider there was an option to request a second opinion through the NHS and it was Mr O’s choice to seek a private assessment.
34. We have seen the ICB advised Mr O he could ask his GP for a second opinion in line with GMC guidance.