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Professor Mark Baker, NICE guidelines director, said in September when the draft guidance was released that he hoped the guidance would ‘raise awareness’ of people who are more likely to be ‘wrongly diagnosed with ADHD, those with ADHD who are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