7 Implementation and audit

7 Implementation and audit

7.1 When NICE recommends a treatment 'as an option', the NHS must make sure it is available within 3 months of this guidance being published. This means that, if a patient has attention deficit hyperactivity disorder and the doctor responsible for their care thinks that methylphenidate, atomoxetine or dexamfetamine is the right treatment, it should be available for use, in line with NICE's recommendations.

7.2 NHS organisations that offer treatment for children and adolescents with ADHD and general practitioners should review their current practice and policies to take account of the guidance set out in Section 1.

7.3 Local guidelines, protocols or care pathways that refer to the care of children and adolescents with ADHD should incorporate the guidance.

7.4 To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in Appendix C.

7.4.1 Drug treatment for a child or adolescent with ADHD is initiated only by an appropriately qualified healthcare professional with expertise in ADHD, and is based on a comprehensive assessment and diagnosis.

7.4.2 Where drug treatment is considered appropriate, methylphenidate, atomoxetine or dexamfetamine is offered, within licensed indications, as an option in the management of ADHD in a child or adolescent.

7.4.3 The decision regarding which product to use considers the following:

7.4.3.1 the presence of comorbid conditions

7.4.3.2 the different adverse effects of the drugs

7.4.3.3 specific issues regarding compliance identified for the individual child or adolescent

7.4.3.4 the potential for drug diversion and/or misuse

7.4.3.5 the preferences of the child or adolescent and/or his or her parent or guardian.

7.4.4 If there is a choice of more than one appropriate drug, the drug with the lowest cost is prescribed.

7.5 Local clinical audits on the management of ADHD in children or adolescents could also include the following: ensuring that children or adolescents and their parents are informed about ADHD, treatment options, and the importance of medication compliance; clinician follow-up on any effects of drug treatment; compliance with national or local guidelines on the management of ADHD or shared care arrangements with local GPs; and planning for the continuation of care for adolescents who are approaching the age for moving from child and adolescent care services to adult services.