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Clinical Algorithm

Clinical Algorithm for ADHD Management This algorithm describes the recommended steps to take from suspected ADHD, through diagnosis and treatment, for children, young people, and adults with ADHD. Person with suspected ADHD Recognition, identification and referral to secondary care Diagnosing ADHDSymptoms of hyperactivity/impulsivity and/or inattention should:• Meet the criteria in DSM-V or ICD-10 (hyperkinetic disorder).• Cause at least moderate impairment.• Be pervasive, occurring in 2 or more settings. Advice after diagnosis Children under 5 years • Offer an ADHD-focused group parent-training programme to parents or carers as first-line treatment.• Do not offer medication for ADHD for any child under 5 years without a second specialist opinion. Children 5 years and over and young people • Offer group-based education and information.• Offer cognitive behavioural therapy (CBT).• Offer medications if symptoms are causing persistent significant impairment.• First line therapy: Methylphenidate• Second-line therapy: Lisdexamfetamine or dexamfetamine (if available)• Third-line therapy: Atomoxetine or guanfacine Adults • Offer medication to adults with ADHD if their ADHD symptoms are still causing a significant impairment.• First line therapy: Lisdexamfetamine or methylphenidate• Second-line therapy: Dexamfetamine or atomoxetine (if available)• Consider non-pharmacological treatment, a structured supportive psychological intervention or CBT. Review and follow up
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