Quality statement 1: Confirmation of diagnosis

Quality statement

Children and young people with symptoms of attention deficit hyperactivity disorder (ADHD) are referred to an ADHD specialist for assessment.

Rationale

Symptoms suggestive of ADHD are often identified in children and young people by their GP or teachers. In order to ensure an accurate diagnosis of ADHD it is important that a full assessment is carried out within secondary care by a healthcare professional with specialist training and expertise in ADHD.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people with symptoms of ADHD are referred to an ADHD specialist for assessment.

Data source: Local data collection.

Process

Proportion of children and young people with symptoms of ADHD who are referred to an ADHD specialist for assessment.

Numerator – the number of children and young people in the denominator referred to an ADHD specialist for assessment.

Denominator – the number of children and young people aged 3 to 18 years with symptoms of ADHD.

Data source: Local data collection. NICE clinical guideline 72 audit support tool, services for adults (criteria for diagnosis), criteria 5 and 6, and NICE clinical guideline 72 audit support tool, services for children and young people, criteria 1 and 2.

Data are collected through the child and adolescent mental health services (CAMHS) secondary uses dataset on referral request received date (global number 17300670), source of referral for mental health (global number 17300760), appointment date (global number 17300800), care professional group type (global number 17300990), CAMH care team type (global number 17301210), provisional diagnosis date (global number 17303190), provisional diagnosis (global number 17303180), diagnosis date (global number 1730210), primary diagnosis (global number 17303670), diagnosis date (global number 17303210).

Outcome

Rates of new diagnosis of ADHD in children and young people.

Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place for children and young people with symptoms of ADHD to be referred to an ADHD specialist for assessment.

Health and social care practitioners ensure that systems are in place for children and young people with symptoms of ADHD to be referred to an ADHD specialist for assessment.

Commissioners ensure that they commission specialist ADHD services for the assessment of children and young people with symptoms of ADHD.

What the quality statement means for patients, service users and carers

Children and young people with symptoms of ADHD are referred to an ADHD specialist for an assessment.

Source guidance

Definitions of terms used in this quality statement

ADHD specialist A psychiatrist, paediatrician or mental health specialist with training and expertise in the diagnosis and treatment of ADHD. For the assessment and diagnosis of ADHD in children and young people this will be a child psychiatrist, paediatrician or specialist ADHD nurse.

Diagnosis of ADHD

NICE clinical guideline 72 recommendation 1.3.1.1 states that a diagnosis of ADHD must be made on the basis of:

  • a full clinical and psychosocial assessment of the person; this should include discussion about behaviour and symptoms in the different domains and settings of the person's everyday life, and

  • a full developmental and psychiatric history, and

  • observer reports and assessment of the person's mental state.

Symptoms of ADHD

NICE clinical guideline 72 recommendation 1.3.1.3 states that for a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or inattention should:

  • meet the diagnostic criteria for ADHD in DSM-IV [the 'Diagnostic and Statistical Manual of Mental Disorders 4th edition'] or for hyperkinetic disorder in ICD-10 [the 'International Classification of Mental and Behavioural Disorders 10th revision'] and

  • be associated with at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation in multiple settings, and

  • be pervasive, occurring in 2 or more important settings including social, familial, educational and/or occupational settings.

As part of the diagnostic process, include an assessment of the person's needs, coexisting conditions, social, familial and educational or occupational circumstances and physical health. For children and young people, there should also be an assessment of their parents' or carers' mental health.

Note: The ICD-10 exclusion on the basis of a pervasive developmental disorder being present, or the time of onset being uncertain, is not recommended.

Equality and diversity considerations

Services should take into account the needs of children and young people with symptoms of ADHD who may present to health and education services within the youth justice system.