ADHD in the UK

The situation in the UK: timing is critical

Despite its presence in so many children, ADHD remains woefully underdiagnosed. Children develop quickly during their early years and a child’s experiences between birth and age five have a major impact on their future life chances.1 Delays in ADHD diagnosis – along with a lack of access to support services and subsequent management – can harm a child’s development, which has knock-on effects on later life including lower quality of life and a negative effect on work, relationships, and finances.2 Unfortunately, delays of nine months to up to five years from when a family may approach their GP to a child receiving a diagnosis by a specialist are not uncommon across the UK.3 Even once diagnosed, a diagnosis does not guarantee immediate care, with patients experiencing difficulties and long wait times for follow-up appointments and medication reviews.

How is ADHD diagnosed in the UK?

NHS Choices recommends that people who believe they, or their children, may have ADHD consider visiting their GP for an initial consultation.4 The doctor will then ask about the symptoms, when they started, and where they occur (i.e. at home, in school, or at work), asking to speak to family members or a teacher, if necessary. If the doctor sees that the symptoms are making it difficult to manage daily life, including school, work, or relationships with friends or family, a referral to an ADHD specialist is likely to be made.

Who makes the final ADHD diagnosis?

The NICE guidelines recommend that a diagnosis of ADHD should only be made by a specialist psychiatrist or paediatrician; however other appropriately qualified healthcare professionals with training and expertise in the diagnosis of ADHD can also make the diagnosis.5

How a specialist determines an ADHD diagnosis

A specialist will gather as much information as possible before diagnosing ADHD, including performing a full clinical and psychosocial assessment of the person, taking a developmental and psychiatric history and also talking with people close to the individual, such as parents, teachers or friends.5 While observational data and rating scales will not be used to alone to diagnose the condition, they will help healthcare professionals to identify the individual needs of each person with ADHD, and be used to inform treatment pathways.5

Treatment for ADHD in the UK

In the UK, the NICE guidelines lay out best practice in the treatment of ADHD, advising that both pharmacological and non-pharmacological treatments, such as group support and cognitive behavioural therapy (CBT), should be considered when treating adults and children.5 For those that do see an improvement from pharmacological treatment but whose symptoms still cause a significant impairment in at least one aspect of everyday life, NICE recommends considering a combination of pharmacological and non-pharmacological treatments.5

According to the recently updated NICE guidelines, pharmaceutical treatment (prescription medicines) should be considered for children and young people with ADHD aged 5 years and over if their ADHD symptoms are having a persistent impact in at least one domain of their everyday life after environmental modifications.5 In the first instance, parents and carers of all children and young people aged 5 years and over with ADHD should be offered group-based ADHD-focused support that includes education and information on causes and impacts of ADHD and advice on parenting strategies. This may be as few as 1 or 2 sessions and should include both parents and carers if feasible.5

References

1 Department for Education. Statutory Framework for the Early Years Foundation Stage. Available at : http://www.educationengland.org.uk/documents/pdfs/2012-eyfs-statutory-framework.pdf. Last accessed June 2018

2 Hamed AM et al. Why the Diagnosis of Attention Defic. Frontiers in Psychiatry 2015; 168

3 Klasen H, Goodman R. Parents and GPs at Cross-Purposes over Hyperactivity. British Journal of General Practice: 50 (452):199-202, 2000.

4 NHS Choices. ADHD – Diagnosis. Available at: https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/diagnosis/.  Last accessed June 2018.

5 NICE Clinical Guideline. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng87/chapter/Recommendations#diagnosis. Last accessed June 2018.