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'Referral advice' recommendation details

Attention deficit hyperactivity disorder (ADHD)

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG72 Children and young people with behavioural problems suggestive of attention deficit hyperactivity disorder (ADHD) can be referred by their school or primary care practitioner for parent training/ education programmes without a formal diagnosis of ADHD. The diagnosis should take place in secondary care. If the child or young person's behavioural and/or attention problems suggestive of ADHD are having an adverse impact on their development or family life, healthcare professionals should consider: a period of watchful waiting of up to 10 weeks, offering parents or carers a referral to a parent training/education programme (this should not wait for a formal diagnosis of ADHD). If the behavioural and/or attention problems persist with at least moderate impairment, the child or young person should be referred to secondary care (that is, a child psychiatrist, paediatrician, or specialist ADHD child and adolescent mental health services (CAMHS)) for assessment. A child or young person who is currently treated in primary care with methylphenidate, atomoxetine, dexamfetamine, or any other psychotropic drug for a presumptive diagnosis of ADHD, but has not yet been assessed by a specialist in ADHD in secondary care, should be referred for assessment to a child psychiatrist, paediatrician, or specialist ADHD CAMHS as a matter of clinical priority. Time frame not specified
CG72 Identification and referral in adults with attention deficit hyperactivity disorder (ADHD) involves: - Adults presenting with symptoms of ADHD in primary care or general adult psychiatric services, who do not have a childhood diagnosis of ADHD, should be referred for assessment by a mental health specialist trained in the diagnosis and treatment of ADHD. - Where there is evidence of typical manifestations of ADHD (hyperactivity/impulsivity and/or inattention) that began during childhood and have persisted throughout life are not explained by other psychiatric diagnoses (although there may be other coexisting psychiatric conditions) have resulted in or are associated with moderate or severe psychological, social and/or educational or occupational impairment, referrals should be made. - Adults who have previously been treated for ADHD as children or young people and present with symptoms suggestive of continuing ADHD should be referred to general adult psychiatric services for assessment. The symptoms should be associated with at least moderate or severe psychological and/or social or educational or occupational impairment. Time frame not specified
CG72 Parent-training/education programmes are the first-line treatment for parents or carers of pre-school children with attention deficit hyperactivity disorder (ADHD). These programmes are the same as those recommended for the parents or carers of other children with conduct disorder. If more help is needed the child can be referred to a tertiary service. Healthcare professionals should offer parents or carers of preschool children with attention deficit hyperactivity disorder (ADHD) a referral to a parent-training/education programme as the first-line treatment if the parents or carers have not already attended such a programme or the programme has had a limited effect. Time frame not specified
CG72 Treatment for school-age children and young people with attention deficit hyperactivity disorder (ADHD) and moderate impairment: If the child or young person with ADHD has moderate levels of impairment, the parents or carers should be offered referral to a group parent-training/education programme, either on its own or together with a group treatment programme (CBT and/or social skills training) for the child or young person. For children and young people (including older age groups) with ADHD and a learning disability, a parent-training/education programme should be offered on either a group or individual basis, whichever is preferred following discussion with the parents or carers and the child or young person. Time frame not specified
CG72 For people taking methylphenidate, dexamfetamine or atomoxetine who have sustained resting tachycardia, arrhythmia or systolic blood pressure greater than the 95th percentile (or a clinically significant increase) measured on two occasions should have their dose reduced and be referred to a paediatrician or adult physician. Time frame not specified
CG72 Drug treatment for adults with with attention deficit hyperactivity disorder (ADHD) who also misuse substances should only be prescribed by an appropriately qualified healthcare professional with expertise in managing both ADHD and substance misuse. For adults with ADHD and drug or alcohol addiction disorders there should be close liaison between the professional treating the person's ADHD and an addiction specialist. Time frame not specified

This page was last updated: 22 August 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.