Attention Deficit Hyperactivity Disorder, The Nice Guideline: On Diagnosis And Management Of ADHD In Children, Young People And Adults

The guideline on Attention Deficit Hyperactivity Disorder endorsed by the UK's National Institute for Health and Clinical Excellence (NICE) sets out clear, evidence-based recommendations for healthcare and educational staff on how to diagnose and manage ADHD in children, young people and adults to significantly improve their treatment and care.

ADHD is a common disorder. It is associated with serious impairments in childhood and those with a sustained diagnosis often develop significant difficulties in adulthood, including personality disorder and substance misuse. The NICE guideline is an important tool in helping professionals to make appropriate decisions about treating and caring for people with ADHD and improving their long-term outcomes.

The guideline includes the evidence for the validity of the diagnosis, psychological interventions and parent training, pharmacological treatment, interventions for children in educational settings, dietary interventions, and combining and comparing psychological and pharmacological treatment.

It also contains a useful overview of ADHD, and chapters on the organisation of care and on service user experience of treatment and care for ADHD, including a study of children and young people's views of stimulant medication, which was commissioned especially for this guideline.

These guidelines from NICE set out clear recommendations, based on the best available evidence, for health care professionals on how to work with and implement physical, psychological and service-level interventions for people with various mental health conditions.

The book contains the full guidelines that cannot be obtained in print anywhere else. It brings together all of the evidence that led to the recommendations made, detailed explanations of the methodology behind their preparation, plus an overview of the condition covering detection, diagnosis and assessment, and the full range of treatment and care approaches.

The accompanying free CD-ROM contains all the data used as evidence, including:

• Included and excluded studies.
• Profile tables that summarise both the quality of the evidence and the results of the evidence synthesis.
• All meta-analytical data, presented as forest plots.
• Detailed information about how to use and interpret forest plots.

Table of Contents

Guideline development group members

1. Preface
• National guidelines
• The national ADHD guideline
2. Attention deficit hyperactivity disorder
• The disorder
• Diagnosis and assessment
• Epidemiology
• Aetiology
• Current care and treatment of ADHD for children in the NHS
• ADHD from an educational perspective
• Adults with ADHD
• The economic cost of ADHD
3. Methods used to develop this guideline
• Overview
• The scope
• The Guideline Development Group
• Clinical questions
• Systematic clinical literature review
• Health economics methods
• Focus group methodology
• Stakeholder contributions
• Validation of this guideline
4. The experience of treatment and care for ADHD
• Introduction
• The experience of ADHD
• Living with ADHD
• The experiences of children and young people of stimulant medication for ADHD
• Issues for adults diagnosed with ADHD and their partners
• Recommendations
5. Diagnosis
• Introduction
• Definitions of terms
• The validity of ADHD as a diagnostic category
• Methodology
• Reviewing the validity of the diagnosis: A summary of the evidence
• Is the cluster of symptoms that defines ADHD associated with significant clinical and psychosocial impairments?
• Is there evidence for a characteristic pattern of developmental changes, or outcomes associated with the symptoms, that define ADHD?
• Is there consistent evidence of genetic, environmental or neurobiological risk factors associated with ADHD?
• Limitations
• Summary of validation of the diagnosis of ADHD
• Defining significant impairment
• Position statement on the validity of ADHD
• Consensus conference
• Summary from review of the diagnosis
• Implications for practice
• Differentiating ADHD in adults from other co-occurring >disorders
• Recommendations
• Research recommendation
6. The organisation of care for ADHD
• Introduction
• Stepped care model for ADHD - school-aged children and young people
• Stepped care model for ADHD - pre-school children
• Services for adults with ADHD
• Models of care for adults in established services
• Competencies for evaluation of ADHD in children and young people
• Assessment framework and competencies for evaluation of ADHD in adults
• Recommendations
7. Psychological interventions and parent training
• Introduction
• Psychological interventions for children with ADHD
• Psychological interventions for adults with ADHD
• Other non-pharmacological approaches
• Recommendations
• Research recommendations
8. Interventions for children with ADHD in educational settings
• Introduction
• Databases searched and inclusion criteria
• Studies considered
• Clinical evidence for screening for ADHD in educational settings
• Clinical evidence for advice to teachers about ADHD, effective classroom interventions, and teacher training
• From evidence to recommendations
• Recommendations
• Research recommendations
9. Dietary interventions
• Introduction
• Elimination diets
• Supplementation diets
• Recommendations
10. Pharmacological treatment
• Introduction
• Prescribing for children, young people and adults
• The regulatory framework
• Databases searched and inclusion/exclusion criteria for clinical evidence
• Studies considered in the systematic review of clinical evidence
• Methylphenidate (stimulant)
• Dexamfetamine (stimulant)
• Atomoxetine
• Clonidine
• Bupropion
• Modafinil
• Antidepressants
• Atypical antipsychotics
• Efficacy/ harms in special circumstances
• Conclusion from clinical evidence
• Health economics evidence
• From evidence to recommendations
• Recommendations
11. Combining and comparing psychological and pharmacological interventions
• Introduction
• Combined interventions for children with ADHD
• Comparing psychological and pharmacological interventions for children with ADHD
• The MTA study: implications for treatment decisions
• Health economics evidence
• From evidence to recommendations: Treatment decisions and combined treatment for children with ADHD
• Recommendations