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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