The Right to Choose for ADHD/Autism Diagnosis in Scotland and What You Can Do While Waiting: A CBT Therapist’s Perspective
Living with ADHD or autism often means facing various personal and societal challenges, but accessing a formal diagnosis can sometimes be one of the biggest hurdles. Across the UK, there’s a growing awareness and acceptance of neurodivergent conditions such as ADHD and autism. However, disparities exist in the diagnosis process. This is especially true regarding the “Right to Choose” policy, a right that people in Scotland currently do not enjoy.
In this blog, I want to explore the impact of not having the Right to Choose in Scotland for ADHD and autism diagnoses and how this can affect individuals from a cognitive-behavioural perspective. I will also outline practical steps individuals can take while waiting for a formal diagnosis.
What is the “Right to Choose” for ADHD/Autism Diagnosis?
In England, patients seeking an ADHD or autism diagnosis can exercise their “Right to Choose” under the NHS. This policy allows individuals to choose where they are referred for specialist services, including private providers that offer quicker diagnosis routes at no cost to the patient. This system has particularly benefited those experiencing long NHS waiting lists for assessments, sometimes taking years.
However, in Scotland, the situation is different. The Right to Choose does not apply, and many individuals are left on lengthy waiting lists for an NHS diagnosis. Private options are often expensive and inaccessible for many people, especially those from lower-income backgrounds.
The Impact of Diagnosis Delays
From my CBT therapist’s perspective, understanding one’s ADHD or autism diagnosis is critical for self-awareness, emotional regulation, and the development of coping strategies. Without an official diagnosis, people may experience increased anxiety, depression, and a feeling of “not fitting in.” As CBT is focused on helping individuals change unhelpful patterns of thinking and behaviour, a timely diagnosis allows us to work with clients more effectively, integrating their understanding of ADHD or autism into their therapeutic goals.
Research shows that the earlier ADHD or autism is identified, the better outcomes individuals have in terms of mental health, education, and relationships (National Institute for Health and Care Excellence, 2018). Delays in diagnosis can exacerbate feelings of frustration, low self-esteem, and hopelessness. Clients often report feeling “stuck” because they cannot access the support they need without a formal diagnosis. This gap can severely limit their ability to make meaningful life changes.
CBT and the Neurodivergent Brain
Cognitive Behavioural Therapy is a widely used therapeutic approach that connects thoughts, feelings, and behaviours. In the context of ADHD and autism, individuals often experience cognitive distortions such as “all-or-nothing thinking,” where they might view themselves as either completely capable or entirely incapable of achieving something. They may also face challenges in managing impulsivity, emotional regulation, and concentration—all of which are integral to ADHD and autism.
A diagnosis allows CBT therapists like myself to tailor interventions more effectively. For example, suppose I know a client is neurodivergent. In that case, I can help them develop strategies for managing overwhelm and sensory overload, encourage more flexible thinking patterns, and address specific social or emotional difficulties that might arise. With this knowledge, it’s much easier to target the areas of most concern to the client.
The Consequences of No Right to Choose in Scotland
In Scotland, the lack of Right to Choose perpetuates inequality in healthcare. Individuals who suspect they have ADHD or autism must often wait years for an assessment, especially in rural areas where specialist services are less accessible. During this time, their daily difficulties can worsen—at work, school or in relationships. Many clients describe the waiting period as “limbo,” where their mental health deteriorates while they await formal confirmation of their neurodivergence.
From a therapeutic perspective, this delay prevents individuals from accessing the accommodations and support they need. It also can erode trust in the healthcare system, leading to feelings of isolation and a sense of being “forgotten” by the system.
What Can You Do While Waiting for a Diagnosis?
While waiting for an ADHD or autism diagnosis can feel disheartening, there are several proactive steps you can take to manage your mental health and improve your well-being during this period.
Learn About ADHD and Autism
While a formal diagnosis is essential, understanding ADHD or autism through self-education can be empowering. Numerous reputable resources, such as books, podcasts, and online forums, can help you learn more about neurodivergence. These resources help you better understand the symptoms you are experiencing and offer tips for coping.
Books such as “Delivered from Distraction” (Hallowell & Ratey) for ADHD or “NeuroTribes” (Silberman) for autism provide insights into living with these conditions.
Online communities like the ADHD Foundation or Scottish Autism also provide resources and support groups where you can connect with others in similar situations.
2. Practice Self-Management Strategies
Even without a formal diagnosis, you can begin using strategies to address common challenges related to ADHD or autism. For instance:
Structure and Routine: A straightforward daily routine can help manage disorganisation and overwhelm, common in ADHD.
Mindfulness and Relaxation Techniques: Many individuals with autism or ADHD benefit from mindfulness, which helps with emotional regulation and reducing anxiety.
Time Management Tools: Using tools like timers, reminders, or apps designed for ADHD (e.g., Todoist, Focus Booster) can assist with time management and task completion.
3. Seek Therapy and Support
You don’t need a formal diagnosis to start working with a CBT therapist or another mental health professional. Therapists can provide support for managing anxiety, depression, or the stress that comes from feeling “different” or “stuck.”
CBT can help you develop coping mechanisms for managing unhelpful thoughts and emotions. For instance, we often work with clients to challenge negative self-beliefs and help them find adaptive ways to navigate everyday challenges, whether or not they have a formal diagnosis.
Advocate for Interim Support
Even while waiting for a diagnosis, accommodations in work or education settings are possible. Speak with your employer, school, or university about your challenges. In many cases, reasonable adjustments—like flexible working hours, extra time for assignments, or a quiet space to work—can be made without the need for a formal diagnosis.
Focus on Self-Care
Living with undiagnosed ADHD or autism can be exhausting. It’s important to prioritise self-care during this time. This may include:
Engaging in hobbies that bring you joy or relaxation, whether art, music, or physical exercise.
Setting boundaries: Learning to say no or limit commitments can help manage energy levels, especially if you struggle with overwhelm.
Sleep and Nutrition: Good sleep hygiene and a balanced diet can improve concentration and mood, which ADHD and autism often impact.
Keep a Symptom Diary
Maintaining a diary of your symptoms, emotions, and challenges can serve multiple purposes. Not only does it help you track patterns and triggers, but it can also provide valuable information to share with your healthcare provider once you get to the assessment stage. This will give them a fuller picture of how ADHD or autism affects your daily life.
For individuals in Scotland living with suspected ADHD or autism, the absence of the Right to Choose makes accessing timely and affordable diagnostic services a significant challenge. However, there are proactive steps you can take while waiting for a diagnosis, from learning about neurodivergence to implementing self-management strategies and seeking support from therapists or peer groups.
If you are feeling overwhelmed by the wait for a diagnosis or need guidance on managing ADHD or autism traits, I’m here to help. Get in touch today to see how we can work together.
Disclaimer: This blog is written by a Cognitive Behavioural Therapist (CBT) practising in the UK and is intended for informational purposes only. It should not be taken as medical advice. For personal support, please consult with a healthcare professional.
References:
National Institute for Health and Care Excellence (2018). Autism Spectrum Disorder in under 19s: recognition, referral and diagnosis
Scottish Government. (2020). The Scottish Strategy for Autism: Outcomes and Priorities
ADHD Foundation. (2023). ADHD Diagnosis in Scotland
For more information on ADHD and autism diagnosis in Scotland or to find out how CBT can support you, please get in touch with a licensed professional.
