The Hidden Cost of Waiting: Limerick Families and the ADHD Assessment Journey

1. Introduction: The ADHD Assessment Landscape in Limerick

The narrative of mental health provision in the Mid West of Ireland has historically been one of resilience in the face of structural scarcity. For residents of Limerick City and County, the pursuit of a diagnosis for Attention Deficit Hyperactivity Disorder (ADHD) frequently mirrors the broader struggle for equitable healthcare resources that defines the region. The journey toward understanding one’s own cognitive processes is fraught with systemic complexity, often resembling the slow moving congestion on Shannon Bridge during peak hours; the destination is visible, yet progress feels halting and impeded by infrastructure that struggles to cope with demand. This comprehensive report serves as a definitive resource for adults and parents in Limerick who are navigating this challenging terrain, aiming to dismantle the opacity surrounding assessment pathways and to establish a clear roadmap toward diagnosis and support.

Limerick operates as a unique microcosm within the Irish healthcare framework. As the primary urban hub of the Mid West, the city services a dense and geographically dispersed catchment area that extends deep into Clare and North Tipperary. The population here faces distinct challenges compared to the capital. While Dublin has witnessed a relatively faster proliferation of specialist services and clinical teams, the Mid West has historically contended with slower resource allocation, recruitment difficulties, and a reliance on services that are frequently overstretched.

The catalyst for the current surge in demand for assessments was the global disruption caused by the pandemic. During extended periods of lockdown, many adults in Limerick found themselves stripped of the external scaffolding, such as the physical workplace or the routine of the commute, that had previously masked their neurodivergent traits. Without these external structures, symptoms of inattention, executive dysfunction, and emotional dysregulation became impossible to ignore. This led to an unprecedented rise in referrals that the existing public infrastructure in Community Healthcare Organisation Area 3 was ill equipped to handle, creating a bottleneck that persists to this day.

2. The Public Pathway: HSE CHO 3 and Limerick Services

2.1 CHO 3 Coverage and Operational Reality

The provision of public mental health services in Limerick falls under the administrative jurisdiction of Community Healthcare Organisation Area 3, commonly referred to as CHO 3. This administrative division encompasses Limerick, Clare, and North Tipperary, creating a vast geographical remit servicing a significant population. The operational status of Adult ADHD services within this region is a matter of significant public interest and clinical concern. While the National Clinical Programme for ADHD in Adults was launched with the ambition of establishing specialist teams to standardise care, implementation in CHO 3 has been marred by delays and staffing deficits.

As of the most recent operational updates, service provision in Limerick remains critically under resourced relative to population demand. The target team composition for a fully functional multidisciplinary Adult ADHD clinic includes a consultant psychiatrist, senior psychologist, senior occupational therapist, and a clinical nurse specialist. However, actual staffing levels often fall short of this ideal, with vacancies in the region persisting for extended periods. The absence of key staff is particularly detrimental, as these roles are the linchpin for medication titration and long term follow up. Without this crucial operational layer, the capacity of the consultant psychiatrist to see new patients is severely restricted by the need to manage existing caseloads.

CHO 3 Service Capacity

The table below outlines the current status of service nodes within the CHO 3 region:

This table suggests a challenging reality for the public patient. The Partially Operational status indicates that while a team may exist, it lacks the full complement of staff required to process referrals at a rate that matches demand. Consequently, wait times have ballooned.

2.2 National Clinical Programme Reality versus Regional Implementation

The disconnect between the strategic objectives of the National Clinical Programme and the tangible reality on the ground in Limerick is palpable. The HSE Model of Care for Adults with ADHD was designed to provide a standardised, equitable pathway for assessment and treatment across the republic, yet the rollout has been geographically uneven. This disparity translates into years of lost time and stalled careers for patients in the Mid West. Although recruitment processes have technically recommenced, the lag in onboarding specialist staff means that the backlog of referrals continues to grow.

2.3 Referral Protocol and Critical Bottlenecks

For a resident in Limerick to successfully access the public pathway, they must navigate a rigid referral protocol starting at the General Practitioner level. The GP must rule out organic causes and deem the referral appropriate. Awareness of adult ADHD presentation among GPs varies, leading to inconsistent referral rates. In many cases, the referral is sent initially to the local Adult Mental Health Team rather than directly to an ADHD specialist clinic, placing it in a general pool where it must compete with acute psychiatric crises.

One of the most critical bottlenecks is comorbidity stabilisation. The HSE protocol dictates that co occurring mental health conditions, such as depression or anxiety, must be treated and stabilised before a formal ADHD assessment can occur. For many neurodivergent adults, anxiety is a symptom of untreated ADHD. This requirement creates a paradox where the patient cannot access ADHD treatment because of their anxiety, yet their anxiety will not resolve without ADHD treatment.

2.4 Why Limerick Waits Longer

The extended wait times in Limerick, often reaching up to three years, are driven by several factors. Pilot sites in the capital established clinical governance and recruitment pipelines earlier than the provinces. Attracting consultant psychiatrists and specialist psychologists to regional posts in the Mid West is historically more difficult than filling posts in teaching hospitals in Dublin or Cork. Furthermore, funding allocations often follow population density, leaving the Mid West fighting for a proportionate share of the mental health budget.

3. Private Assessment Market in Limerick

3.1 Market Categories and Dynamics

Given the prohibitive wait times of the public system, many Limerick residents turn to the private sector. The private market is categorised into traditional in person clinics, regional providers in urban hubs like Cork or Galway, and national telehealth platforms. Telehealth services conduct assessments via secure video conferencing and generally offer the shortest wait times.

3.2 Limerick Provider Profiles

A critical distinction regarding the scope of practice must be noted. Clinical psychologists are qualified to diagnose ADHD but cannot prescribe medication. If a patient is diagnosed by a psychologist and seeks pharmaceutical intervention, they must then be referred to a consultant psychiatrist. This creates a fragmented two stage process, doubling costs and requiring a second waiting list.

3.3 National Telehealth Providers

Telehealth has revolutionised access for Limerick residents, particularly in rural areas like West Limerick. The ADHD Now model represents an integrated telehealth approach. Unlike fragmented services, it houses both psychologists and psychiatrists within a single ecosystem, allowing for a seamless transition from assessment to medical treatment.

4. Clinical Assessment Methodology

4.1 DSM 5 Framework

The diagnostic standard used in Ireland is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). To meet criteria in adulthood, an individual must exhibit 5 or more symptoms of inattention or hyperactivity and impulsivity. Symptoms must have persisted for at least 6 months and several must have been present prior to age 12.

4.2 DIVA 5 Interview

The gold standard tool used for adult assessment is the DIVA 5, a semi structured interview covering symptoms in adulthood and retrospectively in childhood. Clinicians often request a partner or parent to contribute to provide an objective perspective and corroborate childhood symptoms.

4.3 Management Frameworks

Following diagnosis, a multidisciplinary approach is established. This includes psychoeducation to help patients understand their brains, lifestyle modifications, workplace accommodations, and pharmacological intervention prescribed by a medical doctor.

4.4 CAARS and QbTest

Assessments often include standardised questionnaires like the Conners Adult ADHD Rating Scales (CAARS) to quantify symptom severity. The QbTest is a computerised test measuring attention and impulse control objectively by tracking movement while responding to shapes on a screen, though it is less universally available in Limerick.

5. Recognising ADHD: When to Seek Assessment

5.1 Three Warning Signs

Inconsistent performance is a hallmark of ADHD, where a capable employee delivers a brilliant project one week but fails basic tasks the next. Emotional dysregulation involving intense, rapid mood shifts or rejection sensitivity is also common. Finally, chronic overwhelm can make daily tasks like grocery shopping or managing a family schedule feel insurmountable.

5.2 Life Transitions Triggering Recognition

Entering the University of Limerick (UL) or Technological University of the Shannon (TUS) often exposes executive function deficits due to the shift toward self directed learning. Joining Limerick’s medical or tech sectors requires high level time management skills that may be impaired. Parenthood and the pandemic aftermath have also highlighted internal struggles with self motivation and organisation.

5.3 Value of Diagnosis

A diagnosis provides access to critical rights and treatments. Students at UL or TUS can access resource supports and exam accommodations. It also affords protections under employment law and acts as a gateway to medication. Most importantly, it allows for self understanding, reframing a lifetime of struggle as a neurological difference.

6. Professional Qualifications: PSI versus IMC

6.1 Two Regulatory Bodies

The Psychological Society of Ireland (PSI) regulates psychologists. A Chartered Psychologist can diagnose ADHD but cannot prescribe medication. The Irish Medical Council (IMC) regulates doctors, including psychiatrists, who can both diagnose and prescribe medication. The ADHD Now team consists of clinicians registered with both bodies, ensuring a multidisciplinary pathway.

6.2 Medication Pathway Options

Patients may choose a psychiatrist led pathway where diagnosis and prescription happen within the same clinical relationship. Alternatively, a psychologist then psychiatrist pathway requires the patient to pay for a psychologist assessment and then again for a psychiatrist review to initiate medication. Shared care involves transferring care to a GP for monthly prescriptions after specialist stabilisation, though this is at the GP’s discretion.

7. Limerick Logistics and Telehealth

7.1 Geographic Spread and Access

Residents in Limerick City have the best access to transport, but those in rural West Limerick face significant travel times to specialist clinics, which are rarely located outside city hubs. Telehealth eliminates these geographic barriers, allowing assessments to occur in the comfort of the home with only a stable internet connection and a camera required.

8. Financial Planning

8.1 Insurance Coverage

Laya Healthcare often offers refund benefits for neurodevelopmental assessments through schemes like Simply Connect. VHI and Irish Life Health also contribute toward consultant visits or mental health assessments on specific plans.

8.2 Tax Relief

Every Irish taxpayer is entitled to 20 percent tax relief on qualifying medical expenses, including assessments and prescriptions. This relief applies to non reimbursed portions of medical costs.

8.3 Medication Costs and the DPS

The Drug Payment Scheme (DPS) caps the maximum a family pays for prescribed approved medication at 80 Euro per month. Major Limerick pharmacies such as Hogan’s, O’Sullivan’s, and Boots are well versed in this scheme.

9. Living with ADHD in Limerick

9.1 Lifestyle Practices and Exercise

The Limerick Greenway is a world class off road trail ideal for rhythmic exercise like cycling or walking, which boosts dopamine. Curraghchase Forest Park offers over 300 hectares of rolling parkland and mixed woodland trails for sensory connection with nature. Lough Gur provides a tranquil environment rich in folklore, perfect for family relaxation. The University of Limerick campus also offers extensive river walks for quiet reflection.

10. Post Diagnosis Support in Limerick

10.1 Educational Accommodations at UL and TUS

Students with a diagnosis can register for supports through Disability Access Offices. TUS has been officially designated as Ireland’s first ADHD friendly university, offering quiet spaces and staff trained to support neurodiverse students. Supports include extra time in exams, assistive technology, and access to lecture slides in advance.

10.2 Workplace Accommodations

Employers in Limerick’s tech and manufacturing sectors, such as Boston Scientific and Johnson and Johnson, must provide reasonable accommodations. These may include noise cancelling headphones, flexible working hours, and structured written instructions. The Work and Access scheme provides grants for workplace needs assessments and assistive equipment.

11. ADHD Now Limerick Service Model

Limerick residents often choose the ADHD Now model for its integrated care. Diagnosis is typically achieved in approximately 7 days, and the service is accessible from anywhere in the county without travel. The team is led by Clinical Director Dr. Vishnu Pradeep, a Consultant Psychiatrist with extensive experience in the Irish healthcare system and academic lecturing. Reports provided are recognised by universities and major employers for accommodations.

12. Frequently Asked Questions

Q: Are telehealth assessments recognised by schools for DARE? A: Yes, providing the report is from a consultant psychiatrist or chartered psychologist.

Q: Can I use my ADHD Now report to get medication from my Limerick GP? A: Typically after a stabilisation period, a Shared Care Agreement is sent to the GP, though acceptance is at the GP’s discretion.

Q: Is the assessment covered by the Medical Card? A: No, private assessments are not covered, but the Medical Card covers prescribed medication.

Q: Do I need a GP referral to book with ADHD Now? A: No, self referral is possible directly through the website.

Works Cited

• Limerick Post. Children with disabilities waiting 32 months for assessment of needs. 2025.
• HSE. CHO 3 Population and Health Network Statistics. 2025.
• Technological University of the Shannon. TUS designated first ADHD friendly university. 2024.
• University of Limerick. Disability Support Services for Students. 2026.
• ADHD Now. Virtual ADHD Assessments Limerick. 2026.
• Revenue Commissioners. Tax Relief on Health Expenses. 2026.
• Citizens Information Board. Drugs Payment Scheme. 2025.
• Department of Social Protection. Work and Access scheme guidelines. 2025.
• Irish Medical Council. Search the Register. 2026.
• Laya Healthcare. Simply Connect Benefit Table. 2025.