Attention deficit hyperactivity disorder

1. Attention deficit hyperactivity disorder Implementing NICE guidance 2008 NICE clinical guideline 72

2. Related guidance • This guideline incorporates recommendations from two technology appraisals: • Methylphenidate, atomoxetine and dexamfetamine for attention deficit hyperactivity disorder (ADHD) in children and adolescents. NICE technology appraisal guidance 98 • Parent-training/education programmes in the management of children with conduct disorders. NICE technology appraisal guidance 102

3. What this presentation covers • Background • Key priorities for implementation • Costs • Discussion • Find out more

4. Background: 1 • Definition of ADHD • - a heterogeneous behavioural syndrome with core symptoms of inattention, hyperactivity and impulsivity • Incidence of ADHD • Symptoms of ADHD

5. Background: 2 • Diagnosis • Assessing severity

6. Key priorities for implementation • Assessment and diagnosis of ADHD • Training and the role of specialist teams • Parent-training/education • Comprehensive treatment plans • Drug treatment

7. Assessment and diagnosis • ADHD symptoms should: - meet diagnostic criteria in DSM-IV or ICD-10, and - be associated with at least moderate impairment in multiple settings, and - be pervasive, occurring in two or more settings • Diagnosis should include assessment of: - the person’s needs - coexisting disorders - social, family, educational/occupational circumstances - physical health For children and young people, assess parent or carer mental health

8. Training and the role of specialist teams • Trusts should ensure that specialist ADHD teams develop age-appropriate training programmes • Teachers who have received training about ADHD should provide behavioural interventions in class

9. Parent-training/education • Offer parents or carers of pre-school children referral to a parent-training/education programme as first-line treatment • Offer parents or carers of school-age children with moderate impairment referral to a group parent-training/education programme • A group treatment programme for school-age children (CBT and/or social skills training) may also be offered

10. Comprehensive treatment plans: children and young people • Drug treatment for children and young people with ADHD should always form part of a comprehensive treatment plan that includes psychological, behavioural and educational advice and interventions • Develop transition service models according to best practice guidance

11. Comprehensive treatment plans: adults • Drug treatment for adults with ADHD should always form part of a comprehensive treatment programme that addresses psychological, behavioural and educational or occupational needs

12. Drug treatments: 1 • Pre-drug treatment assessment • Choice of drug treatment • Response to treatment • Licensing

13. Drug treatments: 2

14. Costs

15. For discussion • What training is available locally for healthcare professionals who come into contact with a young person or adult with ADHD? • How do we involve young people or adults with ADHD and their parents/carers in making decisions about their care? • To what extent is current provision of parent/carer training programmes or group training programmes meeting local needs? • What is our local care pathway (for all ages) and how does this integrate with other organisations? • How do young people transfer to adult services in our area?

16. Find out more • Visit www.nice.org.uk/cg072 for: • Other guideline formats • Costing report and template • Audit support • Implementation advice