03. ADHD NICE Guideline 2009.pdf
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Attention deficit
hyperactivity
disorder
THE NICE GUIDELINE ON DIAGNOSIS AND
MANAGEMENT OF ADHD IN CHILDREN,
YOUNG PEOPLE AND ADULTS
Praise for
Attention Deficit Hyperactivity Disorder:
Diagnosis and Management of ADHD in children,
young people and adults
“This book provides a comprehensive and discerning reference
that will be of interest to students, clinicians and researchers, not
only for its clinical practice guidelines but also for its thorough
review of the history, epidemiology and aetiology of ADHD.
The guideline development group has tackled thorny issues in a
systematic and evidenced-based manner. Readers will find sound
answers to the many questions about ADHD that arise in research
and practice: Does it remit in adulthood? Is it caused by genes or
environment? How should it be diagnosed and treated throughout
the lifespan? What impairments afflict patients and families?
And what are the costs to society? Although this book was
developed to provide a national clinical practice guideline
for the UK, that description does not do justice to the breadth
and depth of the work. It is most certainly relevant to students
and researchers and to clinicians around the world who will likely
keep it close at hand as a definitive guide to ADHD.”
STEPHEN V. FARAONE,
Professor of Psychiatry and of Neuroscience and Physiology,
SUNY Upstate Medical University
“This NICE clinical guideline provides clear, authoritative advice
on the diagnosis and management of ADHD. It is most helpful
that there should be such a strong, evidence-based document
available to guide practitioners in this controversial field.
It should be essential reading for all commissioners,
managers, primary care and specialist clinicians who are
involved with people with this diagnosis.”
PHILIP GRAHAM,
Emeritus Professor of Child Psychiatry,
Institute of Child Health, University of London
ATTENTION DEFICIT
HYPERACTIVITY
DISORDER
Diagnosis and management
of ADHD in children, young
people and adults
National Clinical Practice Guideline Number 72
National Collaborating Centre for Mental Health
commissioned by the
National Institute for Health
& Clinical Excellence
published by
The British Psychological Society and The Royal College of
Psychiatrists
© The British Psychological Society
& The Royal College of Psychiatrists, 2009
The views presented in this book do not necessarily reflect those of the British
Psychological Society, and the publishers are not responsible for any error of
omission or fact. The British Psychological Society is a registered charity
(no. 229642).
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from
the publishers. Enquiries in this regard should be directed to the British
Psychological Society.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from
the British Library.
ISBN-: 978-1-85433-471-8
Printed in Great Britain by Alden Press.
Additional material: data CD-Rom created by Pix18
(www.pix18.co.uk)
developed by
National Collaborating Centre for Mental Health
Royal College of Psychiatrists’ Research and Training Unit
4th Floor, Standon House
21 Mansell Street
London
E1 8AA
www.nccmh.org.uk
commissioned by
National Institute for Health and Clinical Excellence
MidCity Place, 71 High Holborn
London
WCIV 6NA
www.nice.org.uk
published by
The British Psychological Society
St Andrews House
48 Princess Road East
Leicester
LE1 7DR
www.bps.org.uk
and
The Royal College of Psychiatrists
17 Belgrave Square
London
SW1X 8PG
www.rcpsych.ac.uk
Contents
CONTENTS
1.
PREFACE
10
1.1
National guidelines
10
1.2
The national ADHD guideline
13
2.
ATTENTION DEFICIT HYPERACTIVITY DISORDER
15
2.1
The disorder
15
2.2
Diagnosis and assessment
18
2.3
Epidemiology
26
2.4
Aetiology
28
2.5
Current care and treatment of ADHD for children in the NHS
29
2.6
ADHD from an educational perspective
33
2.7
Adults with ADHD
34
2.8
The economic cost of ADHD
38
3.
METHODS USED TO DEVELOP THIS GUIDELINE
41
3.1
Overview
41
3.2
The scope
41
3.3
The Guideline Development Group
42
3.4
Clinical questions
44
3.5
Systematic clinical literature review
45
3.6
Health economics methods
56
3.7
Focus group methodology
58
3.8
Stakeholder contributions
61
3.9
Validation of this guideline
62
4.
THE EXPERIENCE OF TREATMENT AND CARE FOR ADHD
63
4.1
Introduction
63
4.2
The experiences of children and young people of ADHD
and stimulant medication
63
4.3
The experience of diagnosis in adult life
67
4.4
Personal accounts from people with ADHD and their carers
69
4.5
Living with ADHD
87
4.6
Recommendations
92
5.
DIAGNOSIS
94
5.1
Introduction
94
5.2
Definitions of terms
94
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