Quality standard
Quality statement 2: Identification and referral in adults
Quality statement 2: Identification and referral in adults
Quality statement
Adults who present with symptoms of attention deficit hyperactivity disorder (ADHD) who do not have a childhood diagnosis of ADHD are referred to an ADHD specialist for assessment.
Rationale
A diagnosis of ADHD requires a full clinical and psychosocial assessment of multiple aspects of a person's life, and should be undertaken by a healthcare professional with specialist training, knowledge and experience of ADHD diagnosis and treatment.
A number of adults being treated for coexisting mental health problems within general psychiatric services or who present directly to their GP have been found to have undiagnosed 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 adults who present with symptoms of ADHD who do not have a childhood diagnosis of ADHD are referred to an ADHD specialist for assessment.
Data source: Local data collection.
Process
Proportion of adults who present with symptoms of ADHD without a childhood diagnosis of ADHD who are referred to an ADHD specialist for assessment.
Numerator – the number of people in the denominator who are referred to an ADHD specialist for assessment.
Denominator – the number of adults aged 18 years and over who present with symptoms of ADHD without a childhood diagnosis of ADHD.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers ensure that systems are in place for adults who present with symptoms of ADHD without a childhood diagnosis of ADHD to be referred to an ADHD specialist for assessment.
Health and social care practitioners ensure that adults who present with symptoms of ADHD without a childhood diagnosis of ADHD are referred to an ADHD specialist for assessment.
Commissioners ensure that they commission specialist services for the assessment of adults who present with suspected ADHD.
Adults with symptoms of ADHD who have not had a diagnosis of ADHD in childhood 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 1.2.10
Definitions of terms used in this quality statement
ADHD specialist
A psychiatrist or 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]
Symptoms of ADHD for adult referral
Adults presenting with symptoms of ADHD in primary care or adult general psychiatric services who do not have a childhood diagnosis of ADHD should be referred for assessment by a mental health specialist trained in the diagnosis and treatment of ADHD, if there is evidence of typical manifestations of ADHD (hyperactivity/impulsivity and/or inattention) that:
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began during childhood and have persisted throughout life
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are not explained by other psychiatric diagnoses (although there may be other coexisting psychiatric conditions)
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have resulted in or are associated with moderate or severe psychological, social or educational or occupational impairment.
[NICE's guideline on attention deficit hyperactivity disorder, recommendation 1.2.10]