1. Introduction: The ADHD Assessment Landscape in Waterford
The narrative of mental health provision in the South East of Ireland has historically been one of resilience in the face of structural scarcity. For residents of Waterford 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 Rice 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 in Waterford who are navigating this challenging terrain, aiming to dismantle the opacity surrounding assessment pathways and to establish a clear, authoritative roadmap toward diagnosis and support.
Waterford operates as a unique microcosm within the Irish healthcare framework. As the primary urban hub of the South East, the city services a dense and geographically dispersed catchment area that extends deep into South Kilkenny, Wexford, and South 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 South East has historically contended with slower resource allocation, recruitment difficulties, and a reliance on satellite services that are frequently overstretched.
The catalyst for the current surge in demand for assessments was undoubtedly the global disruption caused by the COVID 19 pandemic. During the extended periods of lockdown, many adults in Waterford found themselves stripped of the external scaffolding—such as the physical workplace, social regulation of office life, 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 5 was ill equipped to handle, creating a bottleneck that persists to this day.
The objective of this report is to provide an exhaustive and nuanced analysis of the current landscape. It contrasts the public pathway provided by the Health Service Executive (HSE) against the private sector options available to residents, analysing the efficacy, cost, and accessibility of each. It dissects the clinical methodologies used for diagnosis, specifically the DSM 5 framework and the DIVA 5 interview, explaining not just what they are, but why they constitute the gold standard for adult assessment.
Furthermore, it offers a granular breakdown of the financial implications, including tax relief mechanisms and insurance reimbursements specific to Irish providers like Laya and VHI. By exploring the intersection of clinical standards, regional logistics, and financial planning, this document empowers the reader with the data required to make informed decisions about their mental health journey.
2. The Public Pathway: HSE CHO 5 and Waterford Services
2.1 CHO 5 Coverage and Operational Reality
The provision of public mental health services in Waterford falls under the administrative jurisdiction of Community Healthcare Organisation Area 5, commonly referred to as CHO 5. This massive administrative division encompasses not only Waterford but also South Tipperary, Carlow, Kilkenny, and Wexford, creating a vast geographical remit that services a population exceeding half a million people.
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 across all CHO areas to standardise care, the implementation in CHO 5 has been marred by significant delays, funding disputes, and chronic staffing deficits.
As of the most recent operational updates in 2026, the service provision in Waterford and its neighbouring counties remains critically under resourced relative to the population demand. The target team composition for a fully functional, multidisciplinary Adult ADHD clinic includes:
- Consultant psychiatrist
- Senior psychologist
- Senior occupational therapist
- Clinical nurse specialist
- Dedicated administrative support
However, actual staffing levels in CHO 5 often fall short of this ideal. Reports and parliamentary questions indicate that key positions, such as the Clinical Nurse Specialist (CNS), have faced recruitment challenges, with vacancies in the region persisting for periods exceeding eighteen months in some instances. The absence of a CNS is particularly detrimental, as this role is often the linchpin for medication titration, patient education, and long term follow up. Without this crucial operational layer, the capacity of the consultant psychiatrist to see new patients is severely throttled by the need to manage the existing caseload.
CHO 5 Service Capacity (2026 Updates)
The table below outlines the current status of service nodes within the CHO 5 region which directly impacts Waterford residents:
| Catchment Area | Service Status | Operational Capacity | Estimated Wait Time |
| Waterford | Partially Operational | Limited by staffing gaps | 2.5 to 3 Years |
| Kilkenny | In Development | Staffing incomplete | Greater than 3 Years |
| Wexford | Satellite Service | Dependent on Waterford Hub | 2.5 to 3 Years |
This table suggests a grim reality for the public patient. The “Partially Operational” status indicates that while a team may exist on paper or in a limited capacity, it lacks the full complement of staff required to process referrals at a rate that matches demand. Consequently, wait times have ballooned, leaving many adults in a state of indefinite suspension.
2.2 National Clinical Programme Reality vs Regional Implementation
The disconnect between the National Clinical Programme’s strategic objectives and the tangible reality on the ground in Waterford 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. However, the rollout has been geographically uneven.
While areas like CHO 1 (Sligo/Donegal) and CHO 6 (Dublin South East) established teams relatively early, CHO 5 has lagged behind significantly. This disparity translates into years of lost time, stalled careers, and strained relationships for patients in the South East.
The “Model of Care” documents explicitly highlight that adults with moderate to severe ADHD symptoms and functional impairment should have access to specialist assessment and multimodal treatment. Yet, the capacity to process referrals is severely restricted by the legacy of the “recruitment pause” that affected the HSE in 2024 and 2025.
Although recruitment processes have technically recommenced, the lag in onboarding specialist staff—complicated by the global shortage of mental health professionals—means that the backlog of referrals continues to grow. The operational capacity of existing teams was reported to be functioning between 16 percent and 80 percent in 2024, highlighting the fragility of the service.
2.3 Referral Protocol and Critical Bottlenecks
For a resident in Waterford to successfully access the public pathway, they must navigate a rigid and often exclusionary referral protocol. This involves a five step process starting at the General Practitioner (GP) level:
- GP Consultation: The process initiates when the patient presents to their GP with symptoms. The GP must rule out organic causes and deem the referral appropriate. General awareness of adult ADHD presentation among GPs varies, leading to inconsistent referral rates.
- Referral to AMHT: In many cases, the referral is sent initially to the local Adult Mental Health Team (AMHT) rather than directly to an ADHD specialist clinic. This places the referral in a general pool where it must compete with acute psychiatric crises.
- Comorbidity Stabilisation: This is the most critical bottleneck. 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.
- The Catch 22 of Stabilisation: For many neurodivergent adults, anxiety or depression is a symptom of untreated ADHD. The requirement to treat the anxiety first creates a paradox: the patient cannot access ADHD treatment because of their anxiety, yet their anxiety will not resolve without ADHD treatment.
- Screening and Waitlist: If accepted by the AMHT and deemed stable, the patient undergoes preliminary screening using tools like the ASRS or WURS. Only after passing these hurdles is the patient placed on the specialist assessment waitlist.
2.4 Why Waterford Waits Longer
The extended wait times in Waterford, often reaching up to three years, are driven by a confluence of factors:
- Dublin-centric Rollout: Pilot sites in the capital established clinical governance and recruitment pipelines earlier than the provinces.
- Recruitment Challenges: Attracting consultant psychiatrists and specialist psychologists to regional posts in the South East is historically more difficult than filling posts in major teaching hospitals in Dublin or Cork.
- Funding Gaps: Political pressure and funding allocations often follow population density, leaving the South East fighting for a proportionate share of the mental health budget.
- Lack of Local Training Schemes: The absence of a dedicated university hospital with a psychiatry training scheme focused on Adult ADHD in the region forces reliance on slower external recruitment.
3. Private Assessment Market in Waterford
3.1 Market Categories and Dynamics
Given the prohibitive wait times of the public system, many Waterford residents turn to the private sector. The private market is categorised into three distinct tiers:
- Traditional In Person Clinics: Consultant psychiatrists or clinical psychologists operating from physical brick and mortar clinics in Waterford City or commuting from Cork or Dublin.
- Regional Providers: Established private mental health clinics based in urban hubs like Cork or Kilkenny serving the Waterford population.
- National Telehealth Platforms: Remote services utilizing secure video conferencing to conduct assessments, generally offering the shortest wait times.
3.2 Waterford Provider Profiles
Landscape private provision within Waterford and its immediate environs is varied. A critical distinction regarding the scope of practice must be noted:
- Clinical Psychologists: Qualified to diagnose ADHD but cannot prescribe medication.
- Medical Referral: If a patient is diagnosed by a psychologist and seeks pharmaceutical intervention, they must then be referred to a consultant psychiatrist.
- Fragmentation: This creates a two stage process, doubling costs and requiring a second waiting list.
3.3 National Telehealth Providers
Telehealth has revolutionised access for Waterford residents, particularly in rural areas like West Waterford. The ADHD Now model represents an integrated telehealth approach. Unlike fragmented services, it houses both psychologists and psychiatrists within a single ecosystem. This allows for a seamless transition from assessment to medical treatment, contrasting with generalist platforms that may lack robust aftercare or titration services.
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). This framework lists 18 symptoms divided into two categories:
Inattention Criteria (9 Symptoms):
- Careless mistakes in work
- Difficulty sustaining attention
- Does not seem to listen
- Fails to finish duties
- Difficulty organising tasks
- Avoids tasks requiring sustained mental effort
- Loses things necessary for tasks
- Easily distracted by extraneous stimuli
- Forgetful in daily activities
Hyperactivity and Impulsivity Criteria (9 Symptoms):
- Fidgets, taps, or squirms
- Leaves seat unexpectedly
- Extreme restlessness (in adults)
- Unable to engage in leisure quietly
- “On the go,” driven by a motor
- Talks excessively
- Blurts out answers
- Difficulty waiting turn
- Interrupts or intrudes
To meet criteria in adulthood, an individual must exhibit 5 or more symptoms in either category (or both for Combined Type). 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 in Ireland is the DIVA 5 (Diagnostic Interview for ADHD in Adults).
- Structure: Semi-structured interview covering symptoms in adulthood (last six months) and retrospectively in childhood (ages 5 to 12).
- Duration: Typically lasts between 60 to 90 minutes.
- Collateral Information: Clinicians often request a partner, parent, or friend contribute to provide an objective perspective and corroborate childhood symptoms.
4.3 Management Frameworks
Following diagnosis, a multimodal approach is established:
- Psychoeducation: Teaching the patient about their brain.
- Lifestyle Modification: Sleep hygiene, diet, and exercise.
- Workplace Accommodations: Adjusting environment to support functioning.
- Pharmacological Intervention: Medication prescribed by a medical doctor.
4.4 CAARS and QbTest
- CAARS (Conners’ Adult ADHD Rating Scales): Standardised questionnaires to quantify symptom severity across domains.
- QbTest: A computerised test measuring attention and impulse control objectively by tracking movement while responding to shapes on a screen.
- Availability: While CAARS is standard, the QbTest is less universally available in Waterford and more commonly found in specialised private clinics.
5. Recognising ADHD: When to Seek Assessment
5.1 Three Warning Signs
- Inconsistent Performance: A capable employee delivering a brilliant project one week but failing basic tasks the next. This gap between potential and performance is a hallmark of ADHD.
- Emotional Dysregulation: Intense, rapid mood shifts triggered by situations, such as disproportionate shame or rejection sensitivity.
- Chronic Overwhelm: Daily tasks like grocery shopping or the school run feel insurmountable due to struggles with prioritisation.
5.2 Life Transitions Triggering Recognition
- Entering SETU Waterford: The shift to self-directed learning exposes executive function deficits.
- First Professional Job: Joining Waterford’s medical or tech sectors requires skills (time management/prioritisation) that may be impaired.
- Parenthood: Managing family schedules causes previous compensatory strategies to collapse.
- Pandemic Aftermath: Removal of external office structures highlighted internal struggles with self-motivation.
5.3 Conditions That Mimic ADHD
It is vital to differentiate ADHD from mimics such as sleep disorders, thyroid dysfunction, anxiety, depression, vitamin deficiencies, or menopause. The key differentiator is the neurodevelopmental onset; ADHD symptoms must have been present in childhood.
5.4 Value of Diagnosis
A diagnosis provides access to critical rights and treatments:
- Educational Supports: Students at SETU can access the DARE and RACE schemes.
- Workplace Accommodations: affording protections under employment law.
- Treatment Access: Gateway to stimulant and non-stimulant medications.
- Self-Understanding: Reframing a lifetime of struggle as a neurological difference.
6. Professional Qualifications: PSI vs IMC
6.1 Two Regulatory Bodies
- PSI (Psychological Society of Ireland): Regulates Psychologists. A Chartered Psychologist can diagnose ADHD but cannot prescribe medication.
- IMC (Irish Medical Council): Regulates Doctors, including Psychiatrists. An IMC-registered Psychiatrist can both diagnose and prescribe medication.
ADHD Now Team Credentials: The team consist of clinicians registered with both the IMC and the PSI, ensuring a multidisciplinary pathway.
6.2 Medication Pathway Options
- Psychiatrist-Led: Diagnosis and prescription happen within the same clinical relationship.
- Psychologist then Psychiatrist: Patient pays for a psychologist assessment then must pay again for a psychiatrist review to initiate medication.
- GP Shared Care: Care transferred to a GP for monthly prescriptions after specialist stabilisation (usually 6 months). Verification with individual Waterford practices is required.
7. Waterford Logistics and Telehealth
7.1 Geographic Spread and Access
Residents in Waterford City have the best access to transport. However, those in Tramore, Dungarvan, or rural West Waterford face significant travel times to specialist clinics, which are rarely located outside city hubs.
7.2 Telehealth Advantages
Telehealth eliminates the geographic barriers of the South East:
- Benefits: No travel required; assessment occurs in the comfort of the home.
- Tech Requirements: Stable internet connection, device with a camera, and a private room.
- Coverage: Most of Waterford has sufficient connectivity for high-quality video calls.
8. Financial Planning
8.1 Insurance Coverage
- Laya Healthcare: Schemes like ‘Simply Connect’ often offer a refund benefit for neurodevelopmental assessments (e.g., up to €500 or €600).
- VHI: Typically contributes toward consultant visits or mental health assessments.
- Irish Life Health: Coverage often includes contributions to consultant psychiatrist fees.
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 per month. Major Waterford pharmacies such as Mulligans, Phelan’s, Delany’s, and Boots are well-versed in the scheme.
9. Living with ADHD in Waterford
9.1 Lifestyle Practices and Exercise
- Waterford Greenway: A world class 46km off road trail ideal for rhythmic exercise like cycling or walking, which boosts dopamine.
- Morning Light: Walking on Tramore beach or the Quays helps reset circadian rhythms.
- Nature: Mount Congreve Gardens offers “green time” to reduce cortisol levels.
- Waterford Nature Park (Kilbarry): Offers quiet trails for sensory regulation.
- Newtown Cove: Open sea swimming for deep pressure and temperature regulation.
10. Post-Diagnosis Support in Waterford
10.1 Educational Accommodations at SETU
Students with a diagnosis can register for supports through the Disability Access Office:
- DARE: Reduced points entry for school leavers.
- Exam Supports: Extra time, separate exam centres, and recording devices.
10.2 Workplace Accommodations
Employers in Waterford’s tech and pharma sectors (e.g., Sanofi, Teva, Bausch + Lomb) must make “reasonable accommodations”:
- Noise cancelling headphones or quiet zones.
- Flexible working hours.
- Structured mentoring or written instructions.
11. ADHD Now’s Waterford Service Model
Waterford residents often choose the ADHD Now model for its integrated care:
- Speed: Diagnosis achieved in approximately 7 days.
- Accessibility: Accessible from anywhere in the county without travel.
- Multidisciplinary Team: Led by IMC-registered Consultant Psychiatrists and PSI-registered Senior Psychologists.
- Recognition: Reports are recognised by SETU and employers for accommodations.
12. Frequently Asked Questions
Q: Is the diagnosis recognised by SETU 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 Waterford GP?
A: Typically after a stabilisation period (usually 6 months), a “Shared Care Agreement” is sent to the GP. Acceptance is at the GP’s discretion.
Q: Is the assessment covered by the Medical Card?
A: No, private assessments are not covered. The Medical Card covers prescribed medication (subject to government levy).
Q: Do I need a GP referral to book with ADHD Now?
A: No, self-referral is possible directly through the website.
Works Cited
- ADHD Now. “Virtual ADHD Assessments Ireland – Waterford.” ADHD Now, 2025.
- HSE. “ADHD in Adults – National Clinical Programme.” HSE.ie, 2025.
- Medical Independent. “HSE admits to ongoing gaps in ADHD services for adults.” Medical Independent, Jan 2026.
- Sinn Féin. “ADHD waiting lists leave thousands without support.” Sinn Féin News, Nov 2025.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 2013.
- DIVA Foundation. “Instructions for DIVA-5.” DIVA Center, 2025.
- Laya Healthcare. “Simply Connect Benefit Table.” Laya Healthcare, 2025.
- Revenue. “Health Expenses.” Revenue.ie, 2025.
- Citizens Information. “Drugs Payment Scheme.” Citizens Information Board, 2025.
- SETU. “DARE – Disability Access Route to Education.” South East Technological University, 2025.