This site is intended for health professionals only

At the heart of general practice since 1960

GPs urged to look out for ADHD symptoms in female patients

GPs should be aware that ADHD is likely to be under-recognised in girls and that they are less likely than boys to be referred for specialist assessment, NICE has said in new ADHD guidance.

The guideline warns that ADHD is under-recognised in girls and women and also highlights other groups, such as people born preterm, looked-after children and people with mental health conditions, which have an increased prevalence of ADHD compared with the general population.

The guideline also recommends that GPs should ensure continuity of care for people receiving treatment for ADHD and that their treatment plan is holistic, taking in to account their psychological, behavioural and occupational needs. Doctors should also consider obtaining consent and contacting the patient's school, college or university during educational transitions to explain the diagnosis. 

NICE recommends methylphenidate as a first-line treatment option for children aged five and over and young people, switching to lisdexamfetamine if they have not derived sufficient benefit after six weeks.

Professor Mark Baker, NICE guidelines director, said in September when the draft guidance was released that he hoped the guidance would ‘raise awareness’ of people who are more likely to be ‘wrongly diagnosed with ADHD, those with ADHD who are wrongly diagnosed with another condition and those whose ADHD is missed altogether’. 

He added: ‘Not having an accurate diagnosis can have a negative effect on people and their families. It means they cannot access the best treatment and support.’

Guideline in full

  • Be aware that ADHD may be more prevalent in groups such as people born preterm, those with epilepsy, those with mental health problems and looked-after children and young people, among others.
  • Be aware that ADHD is likely to be under-recognised in girls and women and they are less likely to be referred for assessment and more likely to be misdiagnosed.
  • Have a structured discussion with the patient after a diagnosis, with their parents or carers if applicable, covering the positive and negative impacts of diagnosis, educational, employment and social issues and any management challenges if they have a coexisting mental health or neurodevelopmental condition.
  • Offer methylphenidate as a first-line treatment in children over five years of age and young people, switching to lisdexamfetamine if they haven’t benefited after six weeks. Offer dexamfetamine if their symptoms respond but they cannot tolerate lisdexamfetamine.
  • Inform the patient and their parents or carers if applicable about support available to them
  • If the patient has an ADHD diagnosis and there is transition between educational establishments, obtain consent and contact the school, college or university to explain how the diagnosis impacts them.
  • Ensure that people with ADHD have a comprehensive, holistic shared treatment plan that addresses psychological, behavioural and occupational or educational needs.
  • Medication should only be initiated by a healthcare professional with expertise in diagnosing and managing ADHD.
  • Monitor the effectiveness of any medication and regularly review patients, whether or not they are on medication.

Source: NICE

 

 

Readers' comments (10)

  • GPs are urged to look at everything and solve all problems for free! Yeap, we should sacrifice our lives for the privilege patient contact. Not to mention prescribing street drugs for children.

    Unsuitable or offensive? Report this comment

  • This is a specialist service at best done as shared care, Oh wait that service as been cut in the name of austerity.Sorry can't do as I dont have the specialist training.It also not funded so can be done in 10 minute appointments.More BS blue sky thinking from the powerpoint and prawn sandwich brigade.FFS

    Unsuitable or offensive? Report this comment

  • Totally agree with my esteemed colleagues comments above. Ludicrous!

    Unsuitable or offensive? Report this comment

  • fully resourced shared care or not my problem

    Unsuitable or offensive? Report this comment

  • Adult ADHD is a totally made up diagnosis. This is what the mental health industry sector do these days. Adult personalities are fixed. If you can't cope with your personality and want a psychopathology sticker, then that seems to be your right these days.

    Unsuitable or offensive? Report this comment

  • "Have a structured discussion with the patient after a diagnosis, with their parents or carers if applicable, covering the positive and negative impacts of diagnosis, educational, employment and social issues and any management challenges if they have a coexisting mental health or neurodevelopmental condition". How many minutes have I got?

    Unsuitable or offensive? Report this comment

  • Perhaps the school based educational psychology service would be ideally placed to manage this. If they did the screening tests on all children, instead of waiting until parents reported 'issues' then the pick up rate would increase dramatically.

    Of course you would need a lot more psychologists, and a lot more LD 2ry care, and a lot more drugs, and 'austerity' is far more important than lives. So it's not going to happen.

    Unsuitable or offensive? Report this comment

  • David Banner

    Bit pointless when there is nowhere to refer them for treatment. Adult service non existent, and CAMHS will bounce the referral back faster than a squash ball.

    Unsuitable or offensive? Report this comment

  • They can urge all they bloody like.

    Unsuitable or offensive? Report this comment

  • Many adults with ADHD get diagnosed and treated for anxiety, depression and bipolar or personality disorder. Mood instability is common. They can be the patients with chronic mental health problems who keep coming back because they do not respond to treatments such as antidepressants, Mood stabilisers and antipsychotics - when they need drugs that are known to treat ADHD. If the disorder was made up why are so many already being diagnosed and treated for other mental health disorders and given strong drugs they do not need. Wake up - it’s an established disorder that can be severe and can destroy lives without the right support.

    Totally agree most of the tasks listed by NICE should be secondary care - not meant to be done in 10 minutes by GP.

    Unsuitable or offensive? Report this comment

Have your say