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NICE guidelines: attention deficit hyperactivity disorder (ADHD) in children, young people & adults

Last month, NICE - the National Institute for Health and Clinical Excellence in England & Wales - issued a guideline on Attention Deficit Hyperactivity Disorder (ADHD).  In the associated press release they commented "ADHD is a common behavioural disorder in children and young people estimated to affect up to 3% of school-age children and young people in the UK, and about 2% of adults worldwide. It usually starts in early childhood and some people will continue to have ADHD as adults. Severe ADHD is sometimes known as ‘hyperkinetic disorder'. The symptoms of ADHD include: being inattentive (unable to concentrate for very long or finish a task); hyperactivity (fidgety and unable to sit still); and impulsive (speaking without thinking about the consequences). It is an extremely distressing disorder, affecting the person as well as their families and carers."

The introduction to the 24 page Quick reference guide states "ADHD is a heterogeneous behavioural syndrome characterised by the core symptoms of inattention, hyperactivity and impulsivity. Not every person with ADHD has all of these symptoms - some people are predominantly hyperactive and impulsive; others are mainly inattentive. Symptoms of ADHD are distributed throughout the population and vary in severity; only those people with at least a moderate degree of psychological, social and/or educational or occupational impairment in multiple settings should be diagnosed with ADHD. Determining the severity of ADHD is a matter for clinical judgement, taking into account severity of impairment, pervasiveness, individual factors and familial and social context.  Symptoms of ADHD can overlap with those of other disorders, and ADHD cannot be considered a categorical diagnosis.  Therefore care in differential diagnosis is needed. ADHD is also persistent and many young people with ADHD will go on to have significant difficulties in adult life." 

It goes on to comment that "Trusts should ensure that specialist ADHD teams for children, young people and adults jointly develop age-appropriate training programmes for the diagnosis and management of ADHD for mental health, paediatric, social care, education, forensic and primary care providers and other professionals who have contact with people with ADHD."  I would welcome the wider availability of such training.  I work mainly with adults and I regularly come across people who have undiagnosed ADHD symptoms.  Typically these symptoms co-exist with and complicate other problems like social anxiety disorder and depression.  For years, here in Scotland, it has been very difficult to find a specialist who can help in this situation.  I've put together a list of helpful websites that you can access by clicking here.  This guideline is good news.  There has been a real deficiency, for many years, in the provision of adequate facilities for the diagnosis and management of ADHD in children and, even more so, in adults. 

NICE guideline (2008)  "Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults" at http://www.nice.org.uk/CG72  Accessed on 23 October.

Associated NICE press release (2008) at http://www.nice.org.uk/media/8A3/63/2008056ADHD.pdf  Accessed 23 October.


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