Clinical update

Improving diagnosis, care and support for ADHD

New guidance from NICE aims to improve recognition, diagnosis, quality of care and support for people with ADHD

New guidance from NICE aims to improve recognition, diagnosis, quality of care and support for people with ADHD


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Essential facts

Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms including hyperactivity, impulsivity and inattention. Symptoms tend to be noticed at an early age and most cases are diagnosed when children are six to 12 years old.

Common coexisting conditions in children include disorders of mood, conduct, learning, motor control, anxiety disorders, and language and communication. It is thought that around 2% to 5% of school-age children may have ADHD, according to the NHS.

What’s new

ADHD is under-diagnosed in girls, says new guidance from the National Institute for Health and Care Excellence (NICE).

The guidance, which aims to improve recognition, diagnosis, quality of care and support for people with ADHD, says females are less likely to be sent for assessment, more likely to be undiagnosed and more likely to be given an incorrect diagnosis of another condition.

The guidance also highlights other groups who are also more likely to be overlooked, including those with co-existing conditions such as epilepsy, a mental health condition, a mood disorder or a learning disability.

Signs and symptoms

Most children with ADHD will have signs that fall within the two categories of inattentiveness or hyperactivity and impulsiveness.

Signs of inattentiveness include being easily distracted, making careless mistakes, appearing forgetful or losing things, being unable to persevere at tasks, appearing unable to listen to or carry out instructions, and poor organisation skills.

The main signs of hyperactivity and impulsiveness are being unable to sit still, constantly fidgeting, unable to concentrate, excessive movement and talking, unable to wait their turn, interrupting conversations and little or no sense of danger.

Causes and risk factors

Genetic factors can have an influence, with family members frequently affected.  NICE says there may be increased prevalence in people born preterm, children with mood disorders, and people with epilepsy or neurodevelopmental disorders including learning disabilities.

How you can help your patient

Consider all the risk factors for ADHD to improve diagnosis in groups who may be overlooked. Not having an accurate diagnosis limits access to treatment and support, NICE says.

Nurses should be aware of the impact of an ADHD diagnosis on a family. Encourage parents and carers to seek an assessment of their personal, social and mental health needs, and to join self-help and support groups if appropriate.

Nurses should stress the value of a balanced diet, good nutrition and regular exercise for children, young people and adults with ADHD.  But do not advise elimination of artificial colouring and additives from the diet.

Expert comment

Steve Gibbin, mental health nurse at the ADHD Foundation

‘This guidance is a step in the right direction, and to be welcomed in principle. However, there are still concerns.

‘There is still widespread ignorance and misunderstanding by most healthcare practitioners about ADHD and co-morbid conditions. The guidelines are also dismissed by some GPs who say they don’t believe in ADHD. This is quite simply discrimination and further stigmatisation of patients with ADHD.

‘It is unclear how this will be funded, and most clinical commissioning groups and trusts are not adhering to NICE guidelines.

‘Medication is often the first and only line of treatment, and patients including children are discharged if they refuse medication as a treatment option.’


Erin Dean is a freelance health journalist

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