Attention deficit hyperactivity disorder

Implementing NICE guidance

2008

NICE clinical guideline 72

Related guidance

This guideline incorporates recommendations from two technology appraisals:

•Methylphenidate, atomoxetine and dexamfetamine for attention deficit hyperactivity disorder (ADHD) in children and adolescents. NICE technology appraisal guidance 98

•Parent-training/education programmes in the management of children with conduct disorders. NICE technology appraisal guidance 102

What this presentation covers

Background

Key priorities for implementation

Costs

Discussion

Find out more

Background: 1

• Definition of ADHD

- a heterogeneous behavioural syndrome with core symptoms of inattention, hyperactivity and impulsivity

• Incidence of ADHD

• Symptoms of ADHD

Background: 2

• Diagnosis

• Assessing severity

Key priorities for implementation

•Assessment and diagnosis of ADHD

•Training and the role of specialist teams

•Parent-training/education

•Comprehensive treatment plans

•Drug treatment

• ADHD symptoms should:- meet diagnostic criteria in DSM-IV or ICD-10, and- be associated with at least moderate impairment in multiple settings, and- be pervasive, occurring in two or more settings

• Diagnosis should include assessment of:- the person’s needs- coexisting disorders- social, family, educational/occupational circumstances- physical health

Assessment and diagnosis

For children and young people, assess parent or carer mental health

•Trusts should ensure that specialist ADHD teams develop age-appropriate training programmes

•Teachers who have received training about ADHD

should provide behavioural interventions in class

Training and the role of specialist teams

•Offer parents or carers of pre-school children referral to a parent-training/education programme as first-line treatment

•Offer parents or carers of school-age children with moderate impairment referral to a group parent-training/education programme

•A group treatment programme for school-age children (CBT and/or social skills training) may also be offered

Parent-training/education

•Drug treatment for children and young people with ADHD should always form part of a comprehensive treatment plan that includes psychological, behavioural and educational advice and interventions

•Develop transition service models according to best practice guidance

Comprehensive treatment plans: children and young people

•Drug treatment for adults with ADHD should always form part of a comprehensive treatment programme that addresses psychological, behavioural and educational or occupational needs

Comprehensive treatment plans: adults

Drug treatments: 1

•Pre-drug treatment assessment •Choice of drug treatment•Response to treatment •Licensing

School-age children or young people Adults

DrugSevere ADHD - offer drug treatment as

first line for:

Moderate/severe impairment -

offer drug treatment as first

line

methylphenidate

• ADHD without significant comorbidity• ADHD with comorbid conduct disorder• Tics, Tourette’s syndrome, anxiety disorder, stimulant misuse or risk of stimulant diversion

Normally first choice

atomoxetine

• Treatment with methylphenidate ineffective• Intolerance to low or moderate dose methylphenidate• Tics, Tourette’s syndrome, anxiety disorder, stimulant misuse or risk of stimulant diversion

As for children

Drug treatments: 2

Costs

Recommendations with significant costsFirst year

(£000s)

At full implementation

(£000s)

Group programmes (recurrent cost) 66 331

Drug treatment and monitoring of adults with ADHD (recurrent cost)

7,099 39,399

Individual psychological interventions (such as CBT and/or social skills training) for older adolescents aged 16 or 17 years (recurrent cost)

51 229

Estimated recurrent cost of implementation 7,216 39,958

Assessment for adults with ADHD before starting drug treatment (non-recurrent cost)

3,855 19,277

For discussion• What training is available locally for healthcare professionals who come into contact with a young person or adult with ADHD?

• How do we involve young people or adults with ADHD and their parents/carers in making decisions about their care?

• To what extent is current provision of parent/carer training programmes or group training programmes meeting local needs?

• What is our local care pathway (for all ages) and how does this integrate with other organisations?

• How do young people transfer to adult services in our area?

Find out more

Visit www.nice.org.uk/cg072 for:

•Other guideline formats•Costing report and template•Audit support•Implementation advice