Identification and referral of children and young adults with possible ADHD

Identification and referral in children and young people with ADHD

• when a child or young person presents in primary care with behavioural and/or attention problems suggestive of ADHD, primary care practitioners should determine the severity of the problems, how these affect the child or young person and the parents or carers and the extent to which they pervade different domains and settings
• when a child or young person with disordered conduct and suspected ADHD is referred to a school's special educational needs coordinator (SENCO), the SENCO, in addition to helping the child with their behaviour, should inform the parents about local parent-training/education programmes
• referral from the community to secondary care may involve health, education and social care professionals (for example, GPs, paediatricians, educational psychologists, SENCOs, social workers) and care pathways can vary locally. The person making the referral to secondary care should inform the child or young person's GP
• if the child or young person's behavioural and/or attention problems suggestive of ADHD are having an adverse impact on their development or family life, healthcare professionals should consider:
  • a period of watchful waiting of up to 10 weeks
  • offering parents or carers a referral to a parent-training/education programme (this should not wait for a formal diagnosis of ADHD).
• if the behavioural and/or attention problems persist with at least moderate impairment
  • then the child or young person should be referred to secondary care (that is, a child psychiatrist, paediatrician, or specialist ADHD CAMHS) for assessment
• if the child or young person's behavioural and/or attention problems are associated with severe impairment, referral should be made directly to secondary care (that is, a child psychiatrist, paediatrician, or specialist ADHD CAMHS) for assessment

• primary care practitioners should not make the initial diagnosis or start drug treatment in children or young people with suspected ADHD
  • a child or young person who is currently treated in primary care with methylphenidate, atomoxetine, dexamfetamine, or any other psychotropic drug for a presumptive diagnosis of ADHD, but has not yet been assessed by a specialist in ADHD in secondary care, should be referred for assessment to a child psychiatrist, paediatrician, or specialist ADHD CAMHS as a matter of clinical priority

Reference:

• (1) NICE (March 2018). Attention deficit hyperactivity disorder Diagnosis and management of ADHD in children, young people and adults