ADHD
Attention deficit hyperactivity disorder — diagnosis and prescribing
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by persistent inattention, hyperactivity, and impulsivity that significantly impairs daily functioning. NICE NG87 requires specialist diagnosis, and medication — when indicated — provides significant benefit for both children and adults.
What is ADHD?
ADHD is a neurodevelopmental disorder with a prevalence of around 3–5% in children and 2–3% in adults. It arises from differences in dopamine and noradrenaline signalling in the prefrontal cortex and striatum. ADHD is not a lack of intelligence or willpower — it reflects genuine neurological differences in attention regulation, impulse control, and executive functioning. Symptoms must be present before age 12, persistent for ≥6 months, present in more than one setting (e.g. home and school), and cause significant impairment. ADHD frequently co-occurs with other conditions including anxiety, depression, autism spectrum disorder, learning disabilities, and substance misuse.
Types & presentation
DSM-5 recognises three presentations: predominantly inattentive (formerly ADD) — difficulty sustaining attention, forgetfulness, easily distracted, losing items; predominantly hyperactive-impulsive — excessive movement, interrupting others, difficulty waiting, risk-taking; and combined presentation — features of both. Inattentive ADHD is often underdiagnosed, particularly in girls, as it presents less disruptively. Adults may present with chronic disorganisation, time management problems, difficulty completing tasks, emotional dysregulation, and relationship difficulties. Comorbid anxiety and depression are very common.
Diagnosis
NICE NG87 states that diagnosis must be made by a specialist — a CAMHS clinician, paediatrician, or adult psychiatrist. GPs do not diagnose ADHD but should refer for assessment when symptoms are suggestive. The diagnostic process includes structured clinical interview, standardised rating scales (Conners Rating Scales, SNAP-IV, DSMV-based checklists), information from multiple informants (parent, teacher, patient), and exclusion of other causes. Baseline physical assessment before medication includes height, weight, BP, HR, and cardiac history. ECG is required if there is a personal or family history of cardiac disease.
Non-pharmacological & lifestyle
For children under 5 years, NICE NG87 recommends parent training programmes as the first-line intervention before medication. A holistic evaluation of each child's educational, emotional, and social needs should inform the support plan. CBT is effective for adults with ADHD and helps with executive functioning, organisation, and emotional regulation. School-based support including Educational, Health and Care Plans (EHCPs) should be explored for children with significant educational impact. Structured daily routines, environmental modifications (reducing distractions, using timers and lists), regular physical activity, and psychoeducation for the patient and family are all important components of holistic ADHD management.