Excerpt

This guideline has been developed to advise on the treatment and management of attention deficit hyperactivity disorder (ADHD). The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, service users and carers, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for people with ADHD while also emphasising the importance of the experience of care for them and their carers (see Appendix 1 for more details on the scope of the guideline).

Although the evidence base is rapidly expanding, there are a number of major gaps; future revisions of this guideline will incorporate new scientific evidence as it develops. The guideline makes a number of research recommendations specifically to address gaps in the evidence base. In the meantime, it is hoped that the guideline will assist clinicians, people with ADHD and their carers by identifying the merits of particular treatment approaches where the evidence from research and clinical experience exists.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• ACKNOWLEDGEMENTS
• 1. PREFACE
  • 1.1. NATIONAL GUIDELINES
  • 1.2. THE NATIONAL ADHD GUIDELINE
• 2. ATTENTION DEFICIT HYPERACTIVITY DISORDER
  • 2.1. THE DISORDER
  • 2.2. DIAGNOSIS AND ASSESSMENT
  • 2.3. EPIDEMIOLOGY
  • 2.4. AETIOLOGY
  • 2.5. CURRENT CARE AND TREATMENT OF ADHD FOR CHILDREN IN THE NHS
  • 2.6. ADHD FROM AN EDUCATIONAL PERSPECTIVE
  • 2.7. ADULTS WITH ADHD
  • 2.8. THE ECONOMIC COST OF ADHD
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. CLINICAL QUESTIONS
  • 3.5. SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. FOCUS GROUP METHODOLOGY
  • 3.8. STAKEHOLDER CONTRIBUTIONS
  • 3.9. VALIDATION OF THIS GUIDELINE
• 4. THE EXPERIENCE OF TREATMENT AND CARE FOR ADHD
  • 4.1. INTRODUCTION
  • 4.2. THE EXPERIENCES OF CHILDREN AND YOUNG PEOPLE OF ADHD AND STIMULANT MEDICATION
  • 4.3. THE EXPERIENCE OF DIAGNOSIS IN ADULT LIFE
  • 4.4. PERSONAL ACCOUNTS FROM PEOPLE WITH ADHD AND THEIR CARERS
  • 4.5. LIVING WITH ADHD
  • 4.6. RECOMMENDATIONS
• 5. DIAGNOSIS
  • 5.1. INTRODUCTION
  • 5.2. DEFINITIONS OF TERMS
  • 5.3. THE VALIDITY OF ADHD AS A DIAGNOSTIC CATEGORY
  • 5.4. METHODOLOGY
  • 5.5. REVIEWING THE VALIDITY OF THE DIAGNOSIS: SUMMARY OF THE EVIDENCE
  • 5.6. IS THE CLUSTER OF SYMPTOMS THAT DEFINES ADHD ASSOCIATED WITH SIGNIFICANT CLINICAL AND PSYCHOSOCIAL IMPAIRMENTS?
  • 5.7. IS THERE EVIDENCE FOR A CHARACTERISTIC PATTERN OF DEVELOPMENTAL CHANGES, OR OUTCOMES ASSOCIATED WITH THE SYMPTOMS, THAT DEFINE ADHD?
  • 5.8. IS THERE CONSISTENT EVIDENCE OF GENETIC, ENVIRONMENTAL OR NEUROBIOLOGICAL RISK FACTORS ASSOCIATED WITH ADHD?
  • 5.9. LIMITATIONS
  • 5.10. SUMMARY OF VALIDATION OF THE DIAGNOSIS OF ADHD
  • 5.11. DEFINING SIGNIFICANT IMPAIRMENT
  • 5.12. POSITION STATEMENT ON THE VALIDITY OF ADHD
  • 5.13. CONSENSUS CONFERENCE
  • 5.14. SUMMARY FROM REVIEW OF THE DIAGNOSIS
  • 5.15. IMPLICATIONS FOR PRACTICE
  • 5.16. DIFFERENTIATING ADHD IN ADULTS FROM OTHER COEXISTING CONDITIONS
  • 5.17. RECOMMENDATIONS
  • 5.18. RESEARCH RECOMMENDATIONS
• 6. THE ORGANISATION OF CARE FOR ADHD
  • 6.1. INTRODUCTION
  • 6.2. STEPPED CARE MODEL FOR ADHD: SCHOOL-AGE CHILDREN AND YOUNG PEOPLE
  • 6.3. STEPPED-CARE MODEL FOR ADHD: PRE-SCHOOL CHILDREN
  • 6.4. SERVICES FOR ADULTS WITH ADHD
  • 6.5. MODELS OF CARE FOR ADULTS WITH ADHD IN ESTABLISHED SERVICES
  • 6.6. COMPETENCIES FOR EVALUATION OF ADHD IN CHILDREN AND YOUNG PEOPLE
  • 6.7. ASSESSMENT FRAMEWORK AND COMPETENCIES FOR EVALUATION OF ADHD IN ADULTS
  • 6.8. RECOMMENDATIONS
• 7. PSYCHOLOGICAL INTERVENTIONS AND PARENT TRAINING
  • 7.1. INTRODUCTION
  • 7.2. PSYCHOLOGICAL INTERVENTIONS FOR CHILDREN WITH ADHD
  • 7.3. PSYCHOLOGICAL INTERVENTIONS FOR ADULTS WITH ADHD
  • 7.4. OTHER NON-PHARMACOLOGICAL APPROACHES
  • 7.5. RECOMMENDATIONS
  • 7.6. RESEARCH RECOMMENDATIONS
• 8. INTERVENTIONS FOR CHILDREN WITH ADHD IN EDUCATIONAL SETTINGS
  • 8.1. INTRODUCTION
  • 8.2. DATABASES SEARCHED AND INCLUSION CRITERIA
  • 8.3. STUDIES CONSIDERED
  • 8.4. CLINICAL EVIDENCE FOR SCREENING FOR ADHD IN EDUCATIONAL SETTINGS
  • 8.5. CLINICAL EVIDENCE FOR ADVICE TO TEACHERS ABOUT ADHD, EFFECTIVE CLASSROOM INTERVENTIONS AND TEACHER TRAINING
  • 8.6. FROM EVIDENCE TO RECOMMENDATIONS
  • 8.7. RECOMMENDATIONS
  • 8.8. RESEARCH RECOMMENDATIONS
• 9. DIETARY INTERVENTIONS
  • 9.1. INTRODUCTION
  • 9.2. ELIMINATION DIETS
  • 9.3. SUPPLEMENTATION DIETS
  • 9.4. RECOMMENDATIONS
• 10. PHARMACOLOGICAL TREATMENT
  • 10.1. INTRODUCTION
  • 10.2. PRESCRIBING FOR CHILDREN, YOUNG PEOPLE AND ADULTS
  • 10.3. THE REGULATORY FRAMEWORK
  • 10.4. DATABASES SEARCHED AND INCLUSION/EXCLUSION CRITERIA FOR CLINICAL EVIDENCE
  • 10.5. STUDIES CONSIDERED IN THE SYSTEMATIC REVIEW OF CLINICAL EVIDENCE
  • 10.6. METHYLPHENIDATE (STIMULANT)
  • 10.7. DEXAMFETAMINE (STIMULANT)
  • 10.8. ATOMOXETINE
  • 10.9. CLONIDINE
  • 10.10. BUPROPION
  • 10.11. MODAFINIL
  • 10.12. ANTIDEPRESSANTS
  • 10.13. ATYPICAL ANTIPSYCHOTICS
  • 10.14. EFFICACY/HARMS IN SPECIAL CIRCUMSTANCES
  • 10.15. CONCLUSION FROM CLINICAL EVIDENCE
  • 10.16. HEALTH ECONOMICS EVIDENCE
  • 10.17. FROM EVIDENCE TO RECOMMENDATIONS
  • 10.18. RECOMMENDATIONS
  • 10.19. RESEARCH RECOMMENDATIONS
• 11. COMBINING AND COMPARING PSYCHOLOGICAL AND PHARMACOLOGICAL INTERVENTIONS
  • 11.1. INTRODUCTION
  • 11.2. COMBINED INTERVENTIONS FOR CHILDREN WITH ADHD
  • 11.3. COMPARING PSYCHOLOGICAL AND PHARMACOLOGICAL INTERVENTIONS FOR CHILDREN WITH ADHD
  • 11.4. THE MTA STUDY: IMPLICATIONS FOR TREATMENT DECISIONS
  • 11.5. HEALTH ECONOMICS EVIDENCE
  • 11.6. FROM EVIDENCE TO RECOMMENDATIONS: TREATMENT DECISIONS AND COMBINED TREATMENT FOR CHILDREN WITH ADHD
  • 11.7. RECOMMENDATION
• 12. SUMMARY OF RECOMMENDATIONS
  • 12.1. PREREQUISITES OF TREATMENT AND CARE FOR ALL PEOPLE WITH ADHD
  • 12.2. IDENTIFICATION, PRE-DIAGNOSTIC INTERVENTION IN THE COMMUNITY AND REFERRAL TO SECONDARY SERVICES
  • 12.3. DIAGNOSIS OF ADHD
  • 12.4. POST-DIAGNOSTIC ADVICE
  • 12.5. TREATMENT FOR CHILDREN AND YOUNG PEOPLE
  • 12.6. TRANSITION TO ADULT SERVICES
  • 12.7. TREATMENT OF ADULTS WITH ADHD
  • 12.8. HOW TO USE DRUGS FOR THE TREATMENT OF ADHD
  • 12.9. RESEARCH RECOMMENDATIONS
• APPENDICES
  • APPENDIX 1. SCOPE FOR THE DEVELOPMENT OF THE CLINICAL GUIDELINE
  • APPENDIX 2. DECLARATIONS OF INTERESTS BY GDG MEMBERS
  • APPENDIX 3. SPECIAL ADVISERS TO THE GDG
  • APPENDIX 4. STAKEHOLDERS AND REVIEWERS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 5. RESEARCHERS CONTACTED TO REQUEST INFORMATION ABOUT UNPUBLISHED OR SOON-TO-BE PUBLISHED STUDIES
  • APPENDIX 6. CLINICAL QUESTIONS
  • APPENDIX 7. REVIEW PROTOCOLS
  • APPENDIX 8. SEARCH STRATEGIES FOR THE IDENTIFICATION OF DIAGNOSTIC STUDIES, CLINICAL STUDIES AND REVIEWS
  • APPENDIX 9. CLINICAL STUDY INFORMATION DATABASE
  • APPENDIX 10. QUALITY CHECKLISTS FOR DIAGNOSTIC STUDIES, CLINICAL STUDIES AND REVIEWS
  • APPENDIX 11. SEARCH STRATEGIES FOR THE IDENTIFICATION OF HEALTH ECONOMICS EVIDENCE
  • APPENDIX 12. QUALITY CHECKLIST FOR FULL ECONOMIC EVALUATIONS
  • APPENDIX 13. DATA EXTRACTION FORM FOR ECONOMIC STUDIES
  • APPENDIX 14. EVIDENCE TABLES FOR ECONOMIC STUDIES
  • APPENDIX 15. FOCUS GROUP STUDY OF CHILDREN AND YOUNG PEOPLE’S EXPERIENCE OF PSYCHOSTIMULANT MEDICATION
    Ilina Singh, (IS), Sinead Keenan, and Alex Mears.
  • APPENDIX 16. ADHD CONSENSUS CONFERENCE
  • APPENDIX 17. STUDY CHARACTERISTICS TABLES
  • APPENDIX 18. CLINICAL EVIDENCE FOREST PLOTS
  • APPENDIX 19. GRADE EVIDENCE PROFILES
• REFERENCES
• ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity(no. 229642).