The National Institute for Health and Care Excellence (NICE) has issued standards to improve the quality of care and support for children, young people and adults with attention deficit hyperactivity disorder (ADHD).

ADHD is a behavioural condition characterised by hyperactivity, impulsiveness and inattentiveness. Common symptoms of ADHD include:

• a short attention span,
• restlessness or constant fidgeting, and
• being easily distracted.

ADHD is the most common behavioural disorder in the UK, and is estimated to affect 2-5% of school-aged children and young people. By the age of 25, an estimated 15% of people diagnosed with childhood ADHD still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives [i].

The NICE quality standard is designed to improve the care and management of ADHD in children aged three years and older, younger people and adults.

In summary:

• Symptoms suggestive of ADHD are often identified in children and young people by their GP or teachers. In order to ensure an accurate diagnosis of ADHD, children and young people with such symptoms are referred to a specialist in the condition for assessment.
• Adults with symptoms of ADHD who have not had a childhood diagnosis should also be referred to a specialist in the condition for assessment. This diagnosis requires a full clinical and psychosocial assessment of multiple aspects of a person's life.
• Parents or carers of children with symptoms of ADHD who meet the NICE eligibility criteria are offered a referral to a parent training programme. This provides parents or carers with coping strategies and techniques for managing the behaviour of their children with ADHD. These programmes can help improve the relationship between parents or carers and their children and improve the child's behaviour
• People with ADHD who are taking drug treatment have a specialist review at least annually to assess their need for continued treatment. There are a number of potential side effects associated with drug treatment for ADHD; therefore people taking drugs for ADHD need to be monitored regularly. Side effects from drugs to treat ADHD can reduce adherence to treatment.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “ADHD can affect learning, behaviour and development in children, and for adults with the disorder it can be associated with forgetfulness, mood swings, and extreme impatience. This quality standard outlines how to deliver the very best care and support for both adults and children with the condition.”

Professor Chris Hollis, Chair of Child and Adolescent Psychiatry at the University of Nottingham Child and member of the specialist committee which developed the standard said: “ADHD is increasingly recognised as a lifelong neurodevelopmental condition characterised by difficulties with organisation, distractibility, restlessness and impulsivity, which can have a major impact on education, work, and relationships. Although highly effective treatments exist that can change lives, ADHD, can go unrecognised and untreated, and provision of specialist services, particularly for adults, remains very patchy. The NICE quality standard for ADHD represents a real advance by setting a benchmark for improved recognition, diagnosis and delivery of evidence-based treatments across the lifespan of a person with this condition.”

Anthony Reynolds, Director of My ADDventure and patient member of the committee which developed the standard said: “As an advocate of, and someone personally affected by ADHD, being part of the committee which developed this quality standard has been a life changing experience; not only for myself but for the ADHD community as a whole. Much careful thought and consideration has gone into this standard and I feel that each statement is crucial in improving the care and experience of those with this condition.”

Professor Philip Asherson, President of the UK Adult ADHD Network which endorsed the quality standard said: "ADHD is a common neurodevelopmental disorder that gives rise to significant impairment in 3-4% of the adult population. These include education and occupational underachievement, increased rates of drug abuse and criminal convictions and the development of mental health problems such as anxiety, depression and sleep problems. Despite effective treatments, clinical services are only just being developed in many parts of the UK. This quality standard is critical to service development by outlining how best to deliver diagnostic and treatment services and the importance of a multimodal approach."

Dr Matt Hoghton, Medical Director of the Clinical Innovation and Research Centre of the Royal College of GPs which endorsed the quality standard said: "The NICE quality standard is important to help children, young people and adults with ADHD get a diagnosis quickly so that they and their families can be helped as soon as possible. Mental health comorbidities, transition issues and long delays in diagnosis, particularly in adults, are recurrent problems for people with ADHD. The emphasis on a specialist annual review will help ensure that any drug treatment should be part of an ongoing comprehensive psychological, behavioural, education and occupation plan. This standard needs to be considered by all of us in health care and should be part of each area's annual Joint Strategic Needs Assessment to ensure this vulnerable group receive the support they need."

Ends

Notes to Editors

References

[i]. NHS Choices

About the quality standard

1. The NICE quality standard for ADHD.

2. The NICE quality standard for ADHD is based on the following NICE accredited guidelines:

• National Institute for Health and Clinical Excellence (2013) Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management. NICE clinical guideline 158.
• National Institute for Health and Clinical Excellence (2009) Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. NICE clinical guideline 72.
• National Institute for Health and Clinical Excellence (2006) Attention deficit hyperactivity disorder (ADHD) - methylphenidate, atomoxetine and dexamfetamine (review). NICE technology appraisal 98.

3. The NICE Evidence Update for ADHD is also published today.

4. NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. They are derived either from NICE guidance or guidance from other sources that have been accredited by NICE, and apply right across the NHS in England.

Related NICE guidelines and quality standards

Published

5. Patient experience in adult NHS services. NICE quality standard 15 (2012).

6. Service user experience in adult mental health. NICE quality standard 14 (2011).

In development

7. Autism (children, young people and adults). NICE quality standard. Publication expected March 2014.

8. Conduct disorders (children and young people). NICE quality standard. Publication expected May 2014.

Future quality standards

9. Managing the transition from children´s to adult services.

10. Personality disorders (borderline and antisocial).

About NICE quality standards

NICE quality standards aim to help commissioners, health care professionals, social care and public health practitioners and service providers improve the quality of care that they deliver.

NICE quality standards are prioritised statements designed to drive measurable quality improvements within a particular area of health or care. There is an average of 6-8 statements in each quality standard.

Quality standards are derived from high quality evidence-based guidance, such as NICE guidance or guidance from NICE accredited sources, and are produced collaboratively with health care professionals, social care and public health practitioners, along with their partner organisations, patients, carers and service users.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health care professionals and social care and public health practitioners can use quality standards to help deliver high quality care and treatment.

NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

Quality standard topics are formally referred to NICE by NHS England (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for areas such as social care and public health.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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