Quality statement 2: Identification and referral in adults

Quality statement

Adults who present with symptoms of attention deficit hyperactivity disorder (ADHD) who do not have a childhood diagnosis of ADHD are referred to an ADHD specialist for assessment.

Rationale

A diagnosis of ADHD requires a full clinical and psychosocial assessment of multiple aspects of a person's life, and should be undertaken by a healthcare professional with specialist training, knowledge and experience of ADHD diagnosis and treatment.

A number of adults being treated for coexisting mental health problems within general psychiatric services or who present directly to their GP have been found to have undiagnosed ADHD.

Quality measures

Structure

Evidence of local arrangements to ensure that adults who present with symptoms of ADHD who do not have a childhood diagnosis of ADHD are referred to an ADHD specialist for assessment.

Data source: Local data collection.

Process

Proportion of adults who present with symptoms of ADHD without a childhood diagnosis of ADHD who are referred to an ADHD specialist for assessment.

Numerator – the number of people in the denominator who are referred to an ADHD specialist for assessment.

Denominator – the number of adults aged 18 years and over who present with symptoms of ADHD without a childhood diagnosis of ADHD.

Data source: Local data collection.

Outcome

Rates of new diagnosis of ADHD in adults.

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 adults who present with symptoms of ADHD without a childhood diagnosis of ADHD to be referred to an ADHD specialist for assessment.

Health and social care practitioners ensure that adults who present with symptoms of ADHD without a childhood diagnosis of ADHD are referred to an ADHD specialist for assessment.

Commissioners ensure that they commission specialist services for the assessment of adults who present with suspected ADHD.

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

Adults with symptoms of ADHD who have not had a diagnosis of ADHD in childhood are referred to an ADHD specialist for an assessment.

Source guidance

Attention deficit hyperactivity disorder: diagnosis and management (2018) NICE guideline NG87, recommendation 1.2.10

Definitions of terms used in this quality statement

ADHD specialist

A psychiatrist or paediatrician or other appropriately qualified healthcare professional with training and expertise in the diagnosis of ADHD.

[NICE's guideline on attention deficit hyperactivity disorder, recommendation 1.3.1]

Symptoms of ADHD for adult referral

Adults presenting with symptoms of ADHD in primary care or adult general 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, if 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 or educational or occupational impairment.

[NICE's guideline on attention deficit hyperactivity disorder, recommendation 1.2.10]

Adults

People aged 18 years and over.

Equality and diversity considerations

Consideration should be given to the provision of services for adults within the prison population who present with symptoms of ADHD.