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CPG Minor Update 2022

In the meeting of the Saudi ADHD Society’s Psychological and Medical Committee held on 15 Dec 2022, the following minor updates to the Saudi ADHD CPG were approved:

Update 2022-1a

It is now recommended [“should”] to perform a cardiovascular assessment even in the absence of family history or risk factors.

Update 2022-1b

ECG was previously recommended if it “may affect QT interval”, but is now recommended in the presence of a history of congenital heart disease or previous cardiac surgery, history of sudden death in a first-degree relative under 40 years suggesting a cardiac disease, shortness of breath on exertion compared with peers, fainting on exertion or in response to fright or noise, palpitations that are rapid, regular and start and stop suddenly (fleeting occasional bumps are usually ectopic and do not need investigation), chest pain suggesting cardiac origin, signs of heart failure, a murmur heard on cardiac examination, blood pressure that is classified as hypertensive for adults.

Update 2022-2

Added note that MPH for children aged 5 years is considered off-label.

Update 2022-3a

Added note that LDX is considered off-label for “adults with no ADHD symptoms in childhood”.While this change adopted from NICE may be interpreted as implying so-called “adult-onset ADHD”, the committee members agreed that it actually refers to adult-diagnosed ADHD with an absence of evidence for childhood-onset, such as when an adult cannot remember the existence or absence of childhood symptoms.

Update 2022-3b

Added note that some preparations of MPH are not licenced for ADHD in adults.

Update 2022-4a

Added note that ATX is off label for “adults with no ADHD symptoms in childhood”.

Update 2022-4b

Added note that clonidine is “off-label use for children”.

Update 2022-4c

Added restriction on clonidine use in primary and secondary care.

Updates 2022-5 and 2022-6

Added cross-references to related Saudi guidelines (ASD) to add value for guideline users. The ASD CPG is currently in draft form, so the specific wording of the cross-references shall be updated once the final ASD guideline is published.

For further details, please see the Updates page.