Voices in Health and Wellness

From Trend To Truth: What Rising ADHD Diagnoses Really Mean with Dr Antonietta Pirillo

• Dr Andrew Greenland • Season 1 • Episode 62

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The headlines say ADHD is “everywhere.” We ask why it took so long to see it. Dr Antonietta Pirello, consultant clinical psychologist and founder of the Spectrum Clinic, joins us to map the real forces behind rising diagnoses: updated DSM‑5 criteria, long‑ignored inattentive presentations, and a culture that is only now recognising how masking hides girls and women in plain sight.

Across a candid, story‑rich conversation, we contrast media noise with what rigorous assessment looks like. Antonietta describes a neuroaffirming approach that centres lived experience alongside evidence: gathering examples from daily life, triangulating with family or teachers, and weighing function and strengths—not just ticking behaviours in a quiet room. We dig into clinician scepticism, the shift from a purely medical model toward the neurodiversity paradigm, and why subtle signs matter as much as overt hyperactivity. If you’ve ever been told “you don’t look ADHD,” this is the deep dive you’ve been waiting for.

Access is where ideals meet reality. We unpack NHS backlogs, the promise and pitfalls of Right to Choose, and the shared‑care prescribing breakdowns that leave people ping‑ponging between providers. Antonietta shares how her multidisciplinary team designs inclusive assessments, from staggered forms to phone‑supported questionnaires, and why personalised recommendations beat copy‑paste reports. We also explore practical reforms: consistent acceptance of independent assessments, clearer GP protocols, and community‑based hubs that offer adjustments and coaching before a formal label—because support shouldn’t start at the end of a queue.

If you care about ADHD, women’s health, evidence‑based assessment, or fixing care pathways, this conversation will give you language, data, and hope. Follow the show, share with someone who’s seeking clarity, and leave a review to help more listeners find thoughtful, stigma‑free content on neurodiversity. What myth would you retire today?

🎧 Guest Biography

Dr Antonietta Pirillo is a Consultant Clinical Psychologist and the founder of The Spectrum Clinic, a UK-based private service specialising in adult ADHD and autism assessments. With over a decade of experience across Italy and the UK, she brings a unique perspective to the intersection of neurodevelopment, clinical practice, and system reform. Antonietta is also the creator of ADHD Match, a training platform for clinicians seeking to deliver gold-standard, neuroaffirmative ADHD assessments. Through her work, she’s actively redefining how neurodivergence is understood and supported — in clinics, in education, and i

About Dr Andrew Greenland

Dr Andrew Greenland is a UK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. Drawing on dual training in conventional and root-cause medicine, he helps individuals optimise their health, performance, and longevity — with a particular interest in cognitive resilience and healthy ageing.

Voices in Health and Wellness explores meaningful conversations at the intersection of medicine, lifestyle, and human potential — featuring clinicians, scientists, and thinkers shaping the future of healthcare.

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Dr Andrew Greenland:

Welcome to Voices in Health and Wellness. This is the podcast where we sit down with the practitioners, founders, and changemakers redefining care in today's ever-evolving landscape. I'm your host, Dr. Andrew Greenland. Today's guest is someone who is truly making waves in neurodevelopmental space, Dr. Antonietta Pirello, a consultant, clinical psychologist, and founder of the Spectrum Clinic. Based in the UK, Antonietta specialises in adult HD ADHD assessments that put people first. She's passionate about delivering gold standard diagnostic work, breaking down stereotypes, and helping healthcare professionals better understand ADHD. Antonietta, welcome to the show. Thank you so much for joining us today.

Dr Antonietta Pirillo:

Hi Andrew, thank you for inviting me.

Dr Andrew Greenland:

So perhaps you could start at the top, perhaps give us a little bit of background as to how you got into this space and what your work is all about.

Dr Antonietta Pirillo:

Right, so yeah, I'm I'm a clinical psychologist, founder of the Spectrum Clinic and ADHD Match. So we primarily, I primarily do autism and ADHD assessments. I offer training for clinicians, so I trained them to uh deliver ADHD assessments and support them with that journey of establishing their practice. Um but I didn't, you know, I didn't quite start straight away like that. So I um qualified in Italy as a clinical psychologist, so doctor of psychology in 2012, and my specialty has always been developmental uh psychologists and psychopathology. So um conditions, you know, neurodevelopment from neurodevelopmental conditions such as autism, ADHD, specific learning difficulties, and so on, have been part of my core study. But I started working with children to begin with. When I then moved to the UK, children and adolescents, when I moved to the UK, uh I started having a mixed bag of experience also with adults, and especially you know, on the more severe end of the spectrum or neurodevelopmental conditions, and something changed inside me that made me think, okay, something is not quite right, because often these people sit in between services, you know, there are a lot of gaps and um, you know, working through camps for a number of years, then leading another service um for transforming care pathways, um, it became apparent that there was a different way, that surely there must be a different way for us to support neurodivergent people, not just with assessments. So I think the shift, the big shift for me has been from a purely medical model to embracing um a list, key elements of the neurodiversity paradigm. So it's um it's been a journey and a fascinating journey. I have developed more and more a passion for ADHD, and um yeah, I that's what I've specialized, especially in the last few years, in private practice.

Dr Andrew Greenland:

Thank you. Always good to hear about the background and inspiration to do what you do. But there's a lot of noise in the media about um neurodivergence, the diagnoses, the number of diagnoses going up. What's your take on this, and how do you kind of explain what we're hearing in the media to people that you see?

Dr Antonietta Pirillo:

Oh, it's a constant battle. It's something I discussed straight away in my training as well, because everybody has experience of, especially in regard to ADHD. So, with autism, we saw this happening about 10, 15 years ago, when you know, um autism seemed to be in fashion, seemed to be a trend of the moment, and there was an increase in referrals, an increase in the people that we were and children that we were assessing. Um, and the same movement is happening with ADHD, and social media is playing even more of a crucial role. Um, there are a lot of the younger generations, you know, they jump on TikTok or Instagram, and there is a lot of video content and more awareness around these conditions. Um, so I think part of it is people becoming more aware about their own experience and uh and therefore showing up to their GP for assessment, right? Requesting an assessment and eventually to services. Another side of it is there is a bit of misinformation, quite a bit of misinformation around. And actually, the data tells us that we're not overdiagnosing, although it still remains a concern, you know, it's still something that we need to monitor because we need to be accurate, right? So we need to uh to follow the guidelines, we need to uh follow the standard procedures for these assessments, uh, ethically. Um, but actually what we know is the opposite, that uh in regards to ADHD, because that's that's where the clue is at the moment, is uh is underdiagnosed, especially in women, or the inattentive presentation. We're coming to understand it better, to recognize it better, and uh and therefore there will be an increase in generally speaking rates of diagnosis. But these are people who have been missed, you know, 20 years ago, 30 years ago, when also the DSM 5 DSM criteria, right? So three and fourth edition of the DSM were different and less inclusive than what they are now in the DSM V. So it's a combination of factors. On one hand, you have more awareness through media, social media, even when the media is negative about ADHD. And on the other hand, you have um you know diagnostic criteria that are permitting the overlap with what is inspection disorder, for example, which wasn't possible uh before 2013. Um the the age of onset, you know, has changed, so it's been raised. There are things that have changed that allow us to diagnose. So up till you know 2013, um, we couldn't diagnose someone with ADHD if they had already a diagnosis of autism. And considering that the overlapping, so the comorbidity is the norm rather than the uh the occasional occurrence, then we missed a large part of the population. So that in itself explains a lot of the why the rates, the diagnostic rates will go up. Uh, they are going up. That's what we see anyway. That's what we know is happening. Although the numbers and figures uh will be um, you know, revealed at the end, we will see uh what they actually are.

Dr Andrew Greenland:

Thank you. So you talked about this sort of raising awareness um over recent years and how your clients are approaching this or viewing this, but what about other clinicians, both in and outside of your space? How are they approaching all of this? Is there an ignorance outside of you know your particular niche about this condition as well?

Dr Antonietta Pirillo:

Yeah, the uh the word that pops to mind is ignorance and skepticism. Uh, because if you think about it, even someone like me who started training in clinical psychology in 2000, right? It's been 25 years, if I remained stuck to that kind of training, I would have a completely different view of neurodevelopmental conditions, ADHD. Um, so it but it's not just a matter of age, it's a matter of how that the culture and the systems in the services that provide this kind of assessments. Um, so I think we're slowly reaching clinicians, but it's not unusual that um clinicians who come to my training, you know, they um they express their concern that perhaps people coming to the attention of services may do so because it's trendy, because there is a secondary gain of some sort. Um and they don't seem to, not everybody seems to grasp the idea of camouflaging, so that someone can be inattentive and you don't notice it. Uh, also for ADHD, you know, that someone can be struggling in their life, but in that one hour, two hours that you spend with them, you may not see it. So I think there is a cultural shift that needs to happen in service provisions, you know, and a retraining of stuff to um embrace what we know from research, you know. We don't have to embrace any philosophy without verifying it. But there are some key elements that we know from research and and we go with those ones.

Dr Andrew Greenland:

Thank you. So, what does your typical day look like at the moment? And I I presume there is no such thing as a typical day, but how does it kind of um fit together with the kind of clinical aspects, the administered administrative aspects, the aspects of running a business? How does it all look?

Dr Antonietta Pirillo:

Well, uh busy. It's um uh it takes a lot of uh organization and trying to keep boundaries, um, learning to delegate as much as possible, um, and uh asking for help. You know, I try to um practice what I preach. So I have a business coach now who keeps me on track with everything. So I will have clinic days when I typically do uh two assessments, one in the morning and one in the afternoon. Um, I may have other days when I do an assessment and perhaps I have a couple of patients. Um, and the rest is about um, I'm very passionate about delivering training and creating resources to help clinicians. So uh I will spend it in my ADHD match community, I will answer questions. I offer a lot of supervision, so um Mondays, Monday afternoons tend to be for uh supervising clinicians. Um, it's hard to keep you know that rhythm. Um, but so it's my my day is uh is varied. What I've learned to do is to start a bit later because it works well with childcare and other commitments and perhaps finish a bit later, um, so that uh it suits me best.

Dr Andrew Greenland:

Thank you. I don't know how um demand is at the moment. I'm guessing it's huge, and obviously with the increased awareness and self-diagnosis, how is demand being met for the assessments, not just in your practice, but more generally, is there a massive backlog and with all these people waiting to get some kind of clarity over where they have this diagnosis? Where do you see demand and supply at the moment?

Dr Antonietta Pirillo:

There is a lot of backlog, unfortunately. There's always been in the NHS. I mean, with the introduction of right to choose, um, which is a pathway, a very useful pathway, where um people who think they may have ADHD or their children may have ADHD can choose a private provider that has a contract, you know, with the NHS to do their assessment, and they would not pay the fee so the NHS would cover. And this scheme has been introduced to um you know to try and reduce the waiting lists, and in some areas, you know, they can go up to seven, eight years. Um, we've seen clients privately who had been waiting for a very um minimum of four or five years. You know, people don't go into a private assessment because they have money to splurge generally because they're they're expensive assessments. They require a lot of time, both admin and organizational time skills. Um and uh yeah, so it's that's that's the very minimum. So they they usually go to a private clinic when they don't have an alternative. Uh, or they they have been through services and these were unhelpful or perceived to be unhelpful, such as a referral wasn't initiated, or they um didn't meet the screeners threshold, and and so on. But the right to choose is a um it is a very good scheme, and that's how the NHS is tackling the matter. The problem of right to choose is that only bigger companies get to go on the right to choose because they have the infrastructure, they have the money to invest, um they they have more the uh the financial power to um adhere to all the regulations, all the things that are necessary. It's not impossible for small practices, but um there are compromises to be made.

Dr Andrew Greenland:

Got it. So, with this massive demand-supply mismatch, is this changing the way that clinicians are engaging with the patients that they see or even how they're trained? Because obviously you have a foot in both camps, you're seeing the patients, but you're also helping to train others. How are you kind of taking on board this massive demand in supply and demand in the work that you do?

Dr Antonietta Pirillo:

Um well, I think that there are a lot of more independent practitioners who are offering uh ADHD assessments at the moment. So um I think the demand is spread across a lot of providers. Um, clinicians are starting to shift their mindset and the way they see neurodivergence or neurodevelopmental conditions to uh to support people not just with uh not just as a problem, you know, not just as something that creates distress in some areas or uh impairment in other areas, but it's something that also brings strengths. So the shift is around supporting people and meeting people where they are, supporting them with what they like, uh, with the with the things that you know, with their ambitions, their aspirations, um, again, you know, trying to accommodate or find solutions for their weaknesses and um put more value and emphasis on the strengths. Um a lot of clinicians started adopting, you know, a neuroaffirmative way of dealing with their patients, which is exactly that, you know, not just looking at neurodivergence as a disorder, but as something to be valued, and more as a it goes back to identity, so from a medical condition to something that is part of a person, it's a different way of seeing the world, it's a different way of interacting with the world, and it is as valid as the rest of people, the rest of the people out there. So there is definitely a shift towards that perspective.

Dr Andrew Greenland:

Thank you. I'm gonna talk a little bit about stereotypes because you must see an awful lot of stereotypes around ADHD. What do you think are the most damaging or persistent myths that you're still seeing in 2025?

Dr Antonietta Pirillo:

Unfortunately, is the um is towards girls, ADHD girls, that you know the girl who is uh complying and doing well in school or apparently you know not causing any problems cannot possibly have ADHD or B ADHD. That is the main problem that we have. Um and understandably, you know, from a teacher's perspective, if you have a large classroom and you're trying to um manage you know the lesson but also different types of uh learning styles and children and behavior and so on, the girl who is uh also boys can be inattentive, but predominantly girls tend to be um at a young age, then the girl doesn't cause problems, you may be daydreaming for the whole lesson gets missed. Wow that is that is a big one still now, still now.

Dr Andrew Greenland:

Interesting that there's a kind of a gender stereotype here with this, um, that's really fascinating. What about um health other health professionals? Are there any um stereotypes or misconceptions amongst health professionals who might you would expect to know a little bit better?

Dr Antonietta Pirillo:

The same, pretty much the same, but also I think the misconception is that um they expect to to be able to see you know ADHD. Uh and especially with the inattentive presentation, it might not be so uh they are they they expect to be able to record behaviors and um and fill in checklists, and what it truly matters actually is the experience of that person. So if you talk to them and you ask them to describe their day, a typical day as you just did with me, what does it look like? Perhaps starting you know from the morning and getting up and how they manage school, how they manage when they've they're dreaming, how what do they do? Is there anyone supporting them and so on that until you know the day ends and how often that occurs? Right? Is it just a day off, or is it um a one-off, or is it a daily occurrence? Um, then you get to really grasp the um uh not just their experiences, but that you find the things you're looking for, which we're thinking about symptoms and criteria, right? But it they cannot be separated from the stories. And if we go in and ask direct questions, I I don't know, do you make careless mistakes on a daily basis? People may not be aware that they're doing that. Uh, actually, we know that um adolescent boys especially tend to underreport. We know that teachers may not be able to pick up on subtle cues. And as clinicians, if you are not trained in doing some behavioral analysis, for example, uh, you may miss microexpressions, you may misinterpret what's happening in the session, but um, it is possible to observe it, not in the typical way. You don't always see um a woman or a girl, you know, standing up and having to fidget and having to move or being verbally hyperactive, so talking a lot, um, which you know the hyperactivity symptoms are the um uh make clinicians feel safe because they have something that they have observed. While around in attention, they need to become subtler and subtler. So um that's what they tend to bring in supervision. Um, to say, can I trust this patient when they tell me that? Like, well, if you gather enough examples, if you gather enough it that's the evidence, isn't it? Is the stories that's what they tell you, okay. Um examples for each symptom, then then yes, you're more likely to be able to trust what they say. And why should you not? Is there a reason not to trust them? So that that's that's the other question that I ask. Is that is there a reason not to trust what they're telling you? What is it about? Is it a lack of confidence in your skills? Is it something about that client or patient that is um that feels a bit off or feels a bit inconsistent or incoherent, and and so on.

Dr Andrew Greenland:

Thank you. So, what's working really well for you in the clinic right now, and what are you most proud of in terms of how you've structured your practice?

Dr Antonietta Pirillo:

Um my team, you know, we are a small team and um like-minded practitioners, we have a couple of clinical psychologists, uh, one of them is clinical and educational psychologist, um, a speech and language therapist, we have a pharmacist prescriber, uh, just about to get another one and uh working on improving the practice always. Uh, but those are you know, these people really uh share some deep values. So if they have to spend more time with a with a client or a patient, they wouldn't say, oh no, that two hours is gone, or this is my fee, or uh, they would always go the extra mile to follow up to find additional information, even if it means you know reaching out to external sources of information, a parent, a teacher, a partner, and so on. Um, they always want the best outcome for uh for the clients, and with that in mind, that really um we work in an MDT, so a multidisciplinary team. So when when we meet after an assessment, uh the aim is how can we help this person and we give it some proper thought. So it's not just you know copy and paste recommendations because we're in a rush and the next person is waiting. No, it doesn't work like that. Another thing I'm really proud of is how the clinic has evolved because we try to be as inclusive as possible. So we take the feedback from our clients at heart after each session, after each assessment. We always ask, what could we do better? So we're really open to suggestions and we modified, modified our practice to be that inclusive. Examples may be you know staggering the um the forms that we send so people are not overwhelmed, asking if they need someone to be on the phone and help them complete a questionnaire because perhaps they're dyslexic. And as I as I've already mentioned, you know, neurodivergence and neurodivergence goes together, so we see high comorbidity rates. Um but not just that, you know, all of those things I think they make us feel more like um I wouldn't say a family, but a very caring team. Very caring.

Dr Andrew Greenland:

Amazing. And on the contrast, is there anything that's frustrating, more difficult than expected, or bottlenecks or challenges that you are overcoming, had to overcome in your work?

Dr Antonietta Pirillo:

Quite a few challenges. Uh the main challenges that we face are after ADHD assessments and is with uh liaising with all the services, especially NHS services, to get some support. Um well, that there is no support, barely any support out there. So whoever comes for an assessment then will have to typically um either go privately for therapy, coaching, medication, or rely on charities, support groups. Uh some of them, you know, I think that they're popping up more and more around the country, and they do an amazing job really, very often without getting paid because they have lived experience of ADHD or they have a family member, a child with ADHD, so they volunteer their time to help others. Um, and uh well the the biggest frustration is with medication, ADHD medication, because um services are pulling away from shared care agreements and from not not everybody, not every GP practice or service would recognize um an independent assessment, right? A private assessment. Um do. So when we started, when I started, um we would typically refer back to the GP with a thorough report, and by thorough I mean at least 20-25 pages of evidencing how they meet the criteria and excluding all the things that could potentially explain the symptoms or the presentation. Um and uh what we were seeing was uh GPs very keen to review, you know, we received a very positive feedback, and they would then refer on to um community mental health services, right, for a psychiatrist review. The problem is that the waiting list is as long as an assessments waiting list, and that's the best case scenario for someone who doesn't have the money to pay for their medication. Uh then another alternative is to start the uh the medication privately, so pay the cost of the reviews and the cost of the medication itself. Um, and when the optimal dose has been established, there aren't significant uh side effects, we would go back to the GPE and say, could we agree to share care here? Where we say, you know, this is what happened, and I can guarantee we are very thorough with our records. This is what happened, that this patient has come through for a diagnosis, we established an optimal dose. Can you prescribe on the NHS? We will be responsible to review. Um, that's the quickest route to accessing ADHD medication, but not all GPs would agree to that shared care. Um, I must say that the majority, especially the ones who perhaps they're used to our reports and to working with us, they're okay. But then if a decision not to go for shared care agreements is made at an ICB level or a practice level, the GP will have no choice than pulling away, leaving a lot of patients without support. Another thing that then that happens as well with the right to choose. So it's not just with clinic like us, but it you may have patients who go for an assessment through the right to choose. Usually the waiting times are much shorter than the NHS, so it would be between six and twelve months. Um, and then you know, they are referred back to their GP for medication, at which point the GP says we don't do that, we have nowhere to refer you. Or we would this service, you know, the service we could refer you on does not accept this assessment that you've just done. So that feels incredibly frustrating for people. Um sometimes the private care, you know, the um right to choose provider will start titration and then go back to the GP and say, can you please prescribe on the NHS? And even then, there may be cases where these pathways are not integrated, um, which means again a lot of trouble for the patients. Where we can, we advocate, we mediate, I personally get on the on the phone with GP practices and try to understand if there is anything that we can do. to uh to make the situation better. Um and but it it is so um diverse around the country so it's not like what one area in the same county is funded in a certain way another area in the same county may be funded in a different way and they therefore you not act in a different way.

Dr Andrew Greenland:

So you talked a little bit about um paying attention to feedback.

Dr Antonietta Pirillo:

Are there any other metrics that you focus on in terms of um the business caseloads client experience that you're particularly interested in as a business owner um yes well um I I am personally interested in clients' experiences so they their personal so I try to follow up with them to see if the if the diagnosis actually has changed or the outcome I should say of the assessment has changed um anything in their life if there is anything else that we can do uh in terms of metrics you know we are at that point we we have this I personally have this little privilege of training clinicians so if there is a bit more demand um I can always pull from from these clinicians and say that the ones that I supervise perhaps uh and I would say would you would you like to join as an associate or would you would you help us out because in this moment we have more assessments so that we keep those waiting times really really short and usually we are able to see someone within four weeks from when they first come to us. We don't have the same demands that the NHS faces let me say loud and clear so we don't see thousands of patients um so we see a handful of patients um during you know a quieter month and then a more a busier month it might be it might be a dozen but it's it's still very you know very manageable compared to to the volumes that uh the public healthcare system faces. So what's next for you in the Spectrum Clinic perhaps over the next year are you looking to go in any particular direction with your work well we are exploring um some partnerships with other clinics just to try and offer uh a 360 service around that patient so uh expand on um the coaching offer for example the medication offer um the um we we yeah we we are going as as we speak through um we're working on the CQC registration and we uh we will be considering right to choose but it very very reluctantly very reluctantly it it depends on a if we feel that the quality of our work is is we can sustain that basically if we cannot sustain that um it will not be my my choice um so I presume that's going down that line is really to kind of help with the supply-demand mismatch but have you got any other ideas about how this can be solved more nationally in terms of the the the demand for the assessments versus the number of people that can deliver them uh yes I do uh I don't know if my view is very realistic or many people will want to invest in that but I see healthcare as community care you know I I imagine centers where you can you can walk in and you get helped um there needs to be training you know the staff needs to be retrained uh and a revision of what they the NHS has been doing um in the last few years because you know I I tell you in five years in camps we had restructuring every year and those who leave are the most senior people in the service um then end up you know in private practice where where there is all the the offer is um so yeah definitely training understanding is um is the cultural shift that needs to happen from you need to imagine that in services like cancer especially the pressure is very high the demands are really high and staff is always one step away from burning out so it that is the situation they are in a crisis crisis and then you have on the other side these patients who perhaps are also in a crisis and they cannot be seen. So when they eventually see you for the first time it's it is not necessarily a pleasant meeting because the focus will be on what you did wrong why you didn't see me why was the referral rejected and so on. All those conversations that could be held somewhere else very early on and also do people need a diagnosis to be supported to be offered the therapy I'm not thinking specifically about medication because you know they are licensed for specific conditions but to make environmental adjustments or to have someone like me going into school and say okay what can we do to help this 15 year old this 14 year old or meeting with parents what's not working you know that can happen early on and unfortunately people want or seek out a diagnosis because they cannot access it's not just to have a label um many times it's to understand themselves because it brings um uh some some kind of relief that they they've not been making it up basically that that is a genuine experience and they want that kind of validation um but also is that the majority of them is because they need to access support and they're told well we can only accept that we can only offer this if you have a diagnosis we can only do this if you have a disability and so on.

Dr Andrew Greenland:

So let's try and reverse the thing let's offer the support first let's train clinicians to be more compassionate ideally more people working because it goes down to funding and to the number of people working in any given service so yeah does it sound um utopic as a as a vision perhaps a bit on that note Antonietta thank you so much for your time this afternoon and for the very insightful honest conversation not just that but also for the work you're doing in challenging assumptions and improving how neurodevelopmental conditions are understood. It's been a real pleasure having you on the show thank you so much.

Dr Antonietta Pirillo:

Thank you Andrew