What does an ADHD titration review actually need?
A titration review needs three things at every dose change: how symptoms have responded since the last change, which side effects have appeared and how troublesome they are, and a blood pressure and pulse reading. NICE NG87 is the guideline that frames it. Everything else in the appointment is judgement built on top of those three inputs.
Symptom response
How symptoms have moved since the last change, rather than how they look on the day of the appointment.
Side effects
Which have appeared, roughly when they started, and how troublesome the patient finds them now.
Blood pressure and pulse
A reading at the change, read against the readings that came before it rather than on its own.
None of that is complicated to collect. The difficulty is that all three are historic. They describe a stretch of weeks that has already happened, and the only record of those weeks usually sits in the patient's memory. So the appointment starts with reconstruction, and the quality of the decision at the end of it depends on the quality of a recollection made under time pressure by someone who has ADHD.
A patient who cannot remember whether the appetite loss was the first fortnight or the second is not being difficult. They are being asked to do the one thing their diagnosis makes hardest, in the room, on the spot.
Why do titration reviews overrun?
Reviews overrun because the record is built in the appointment rather than brought to it. Establishing what happened eats the time that was meant for deciding what to do next. When the history is thin, the safe move is to hold the dose and review again, which adds another appointment to a list that is already long.
The pattern is familiar to anyone running titration at volume, and it always splits the slot the same way.
Orientation. Where were we, what changed, and what are we deciding today.
Questions the patient half answers, plus a blood pressure reading taken in a clinic room after a journey, which is a poor place to read a cardiovascular trend from.
The discussion that actually needed a clinician, the one about whether this dose is the dose, gets whatever time is left.
Multiply that across a caseload. Titration is not one appointment, it is a sequence of them, and each dose change buys another. That sequence is where the capacity goes.
What can patients bring to a titration review?
More than most services ask for. A patient with a phone can log every dose as they take it, rate focus and sleep daily, tag side effects as they appear, and record blood pressure at home on a consumer monitor. Compiled and dated, that turns the historic part of the review into something the clinician can read rather than reconstruct.
The useful version of this is structured, not a diary of prose. What a review can use is:
Not "I take it in the morning" but the actual clock times, so timing questions have an answer.
Focus and sleep scored the same way every day, aggregated by week, so a trend exists rather than an impression.
Tagged when they happen, with intensity, and lined up against the dose change that preceded them.
Readings taken at home across the interval, grouped by dose period rather than pooled.
When the patient reports the effect fading, which is often the single most useful thing they know and the first thing they forget.
Where does the capacity pressure come from?
Upstream. Right to Choose gives NHS patients in England the legal right to choose who carries out their first outpatient appointment, and long local waits have made it the realistic NHS route for many people. Referrals that arrive and result in a prescription all become titration cases, in a system where prescribing has to start with a specialist.
NHS England management information published in February 2026, covering data to December 2025. Both figures are reproduced from our NHS ADHD waiting times guide, where the full table and its sources sit.
The scale is on the record, and providers taking Right to Choose referrals absorb a share of it, then carry the titration behind it.
A diary changes the review itself. Each one opens with the last few weeks already on the page, so the first ten minutes go to the decision rather than to archaeology.
Built for the weeks between appointments.
ADHDose is a consumer medication diary. Patients log doses, sleep, focus, side effects, blood pressure and heart rate on their own phone, and the app compiles the last stretch into a structured report they can bring to a review. Every entry is the patient's own record, logged as it happened rather than remembered in the room, and prescribing decisions stay with the clinician. Data stays on the device by default.
For the patient, it removes the memory test from the appointment and gives them something to point at. For the clinician, the historic half of the review is already answered when the conversation starts, and the report closes with notable patterns phrased as questions rather than conclusions. It runs entirely on the patient's side, so the only thing that reaches your service is the report.
What services ask us first
ADHDose is a consumer medication diary, not a regulated medical device. It does not diagnose, dose or advise, and its output is not clinically validated. All inputs are self reported. Waiting list figures quoted here are NHS England management information published in February 2026, covering data to December 2025, and are reproduced from our NHS ADHD waiting times guide. Report figures shown are from a demonstration report built on demo data. This page is general information about how the pathway runs, not clinical or commissioning advice. Written by ADHDOSE LTD, a UK company registered in England and Wales.