This guidance updates and replaces NICE technology appraisal 13 (published in October 2000).

If a child or adolescent needs treatment with medication for ADHD, methylphenidate, atomoxetine and dexamfetamine are all recommended as possible choices. When deciding which to use, doctors should consider the following:

  • whether the child or adolescent has other conditions such as epilepsy
  • the side effects of each medicine
  • factors that might make it difficult for the person to take the medicine at the right time (for example, if it is difficult to take a dose during school hours)
  •  the possibility that the medicine might be misused, or passed on to another person for misuse
  • the individual preference of the child or adolescent and/or their family or carer.

Where more than one of the medicines is considered to be appropriate for a child or adolescent, their doctor should choose the cheapest one.

Treatment with methylphenidate, atomoxetine or dexamfetamine should only be started after a specialist who is an expert in ADHD has thoroughly assessed the child or adolescent and confirmed the diagnosis. Once treatment has been started it can be continued and monitored by a GP.

Your responsibility

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.