Nice Guidelines:
The National Institute for Health and Care Excellence (NICE) provides guidance and advice to improve health and social care as well as recommendations on the use of drugs for specific conditions. NICE quality standards are designed to encourage measurable quality improvements within a particular area of health or care and are derived from the best available evidence. The standards are developed independently by NICE in collaboration with health and social care professionals, their partners, and service users. Quality standards are relevant to a variety of different audiences including commissioners of health and social care, primary care staff, local authorities, social care provider organisations, public health staff, people working in hospitals or in the community, and the users of services and their carers.
The NICE Guidelines for ADHD is contained in a document that makes various recommendations for both parents and clinicians. The most recent version (2018) can be downloaded here. An update in 2019 can be accessed via this link: https://www.nice.org.uk/guidance/ng87
NICE Guidelines recommend that parent-training/education programmes on ADHD should be available for parents or carers of pre-school, school-age, and young people with ADHD.
The guidelines also state:
“When using group treatment (Cognitive Behavioural Therapy and/or social skills training) for the child or young person in conjunction with a parent-training/education programme, particular emphasis should be given to targeting a range of areas, including social skills with peers, problem solving, self-control, listening skills and dealing with and expressing feelings. Active learning strategies should be used, and rewards given for achieving key elements of learning.”
In respect of drug therapy, the guidelines for prescribers recommends
For Children and Young People
Drug treatment should be reserved for those with severe symptoms and impairment or for those with moderate levels of impairment who have refused non-drug interventions, or whose symptoms have not responded sufficiently to parent-training/education programmes or group psychological treatment. The 2019 update states: “Offer methylphenidate (either short or long acting) as the first line pharmacological treatment for children aged 5 years and over and young people with ADHD.
Consider switching to lisdexamfetamine for children aged 5 years and over and young people who have had a 6‑week trial of methylphenidate at an adequate dose and not derived enough benefit in terms of reduced ADHD symptoms and associated impairment.
Consider dexamfetamine for children aged 5 years and over and young people whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate the longer effect profile.
dexamfetamine is only licensed to treat ADHD in children and young people aged 6 to 17 years when response to methylphenidate is clinically inadequate. It is not licensed for children and young people aged 5 to 17 years who have responded to but are intolerant of lisdexamfetamine.
Offer atomoxetine or guanfacine to children aged 5 years and over and young people if (1) they cannot tolerate methylphenidate or lisdexamfetamine or (2) their symptoms have not responded to separate 6‑week trials of lisdexamfetamine and methylphenidate, having considered alternative preparations and adequate doses.”
For Adults
Environmental factors should be assessed and recommendations made prior to drug treatment for adults with ADHD who have moderate or severe levels of impairment unless the person would prefer a psychological approach. The 2019 update states: “Offer lisdexamfetamine or methylphenidate as first-line pharmacological treatment for adults with ADHD.
Consider switching to lisdexamfetamine for adults who have had a 6‑week trial of methylphenidate at an adequate dose but have not derived enough benefit in terms of reduced ADHD symptoms and associated impairment.
Consider switching to methylphenidate for adults who have had a 6‑week trial of lisdexamfetamine at an adequate dose but have not derived enough benefit in terms of reduced ADHD symptoms and associated impairment.
Consider dexamfetamine for adults whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate the longer effect profile.
Offer atomoxetine to adults if (1) they cannot tolerate lisdexamfetamine or methylphenidate or (2) their symptoms have not responded to separate 6‑week trials of lisdexamfetamine and methylphenidate, having considered alternative preparations and adequate doses.
In cases where residual impairment remains despite some benefit from drug treatment, or there is no response to drug treatment, Cognitive Behavioural Therapy (CBT) may be considered. Psychological interventions without medication may be effective for some adults with moderate impairment, but there are insufficient data to support this recommendation.”
