Quality standard

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

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

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.

Outcome

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

Data source: Local data collection.

What the quality statement means for different audiences

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.

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

Source guidance

Attention deficit hyperactivity disorder: diagnosis and management. NICE guideline NG87 (2018, updated 2019), recommendation 1.2.8

Definitions of terms used in this quality statement

ADHD specialist

A psychiatrist, 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]

Diagnosis of ADHD

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.

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

Symptoms of ADHD

For a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or inattention should:

  • meet the diagnostic criteria in DSM‑5 or ICD‑10 (hyperkinetic disorder; note that the ICD-10 exclusion on the basis of a pervasive developmental disorder being present, or the time of onset being uncertain, is not recommended) and

  • cause 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.

[NICE's guideline on attention deficit hyperactivity disorder, recommendation 1.3.3]

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.