ADHD care should 'start in hospital'

Attention-deficit hyperactivity disorder (ADHD) should only be diagnosed in secondary care, according to new guidelines from NICE.

The guidelines stress that GPs should not make initial diagnoses of ADHD or start drug treatment for children and young people.

Those currently being treated for ADHD who have not been diagnosed in secondary care should be referred for assessment as a clinical priority.

GPs should, however, be involved in the ongoing prescribing of ADHD medication and monitoring of treatment, under shared care arrangements with ADHD specialists.

If children and young people present with symptoms suggestive of ADHD that are having a severe impact on their day-to-day life, they should be referred for assessment in secondary care by a child psychiatrist, paediatrician or specialist ADHD mental health service.

If symptoms are less severe, a 10-week period of watchful waiting should be considered before referral to secondary care and patients or carers can be offered a training or education programme.

GPs need not wait for a formal diagnosis of ADHD to be made to make such a referral, NICE says. Adults presenting with symptoms suggestive of ADHD should be referred to a mental health specialist for assessment.

After a diagnosis has been made in secondary care, group-based education and training is recommended as first-line treatment for school-age children and young people with moderate impairment.

In severe impairment, Ritalin should be used, or Strattera if Ritalin has been found to be ineffective or not tolerated.

However, drug treatment is not recommended for pre-school children with ADHD, NICE stressed.

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