There are several guidelines for clinicians working in the field of attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), that are applicable to European clinical practice, including:
- The European Society for Child and Adolescent Psychiatry (ESCAP) European Clinical Guidelines for HKD1
- The National Institute for Health and Care Excellence (NICE) guidelines2
- The British Association for Psychopharmacology guidelines3
- The European Network Adult ADHD Consensus Statement.4
ESCAP guidelines for HKD
The European Clinical Guidelines for HKD were developed on behalf of ESCAP.1
- The ESCAP guidelines recommend that psychoeducation for the child or adolescent with ADHD, their family and their teacher should form the basis of any treatment plan; which, in itself, should make available a range of non-pharmacological and pharmacological interventions1
- For children aged less than 6 years, psychological interventions and parent training are recommended, and should continue unless persisting significant impairments warrant specialist review1
- For children and adolescents aged greater than 6 years with no pervasive, severe disability, parent or teacher training and advice to the child or adolescent with ADHD is recommended if problems are occurring in the home or at school1
- For children and adolescents aged greater than 6 years with persisting, significant impairment and severe disability, medication is advocated; stimulants are recommended in the first-line setting, following which non-stimulants may be trialled.1
The NICE guidelines stipulate that children, adolescents and adults with ADHD require integrated care that addresses a wide range of personal, social, educational and occupational needs – and that this care should be provided by adequately trained healthcare and education professionals.2
Recommended treatment for individuals with ADHD is stratified by age in the NICE guidelines, and by impairment in school-aged children with ADHD.2
European clinical guidelines: National Institute for Health and Care Excellence (NICE)
British Association for Psychopharmacology
The British Association for Psychopharmacology’s evidence-based guidelines for the management of ADHD in children, adolescents and adults were developed from a consensus of national experts in ADHD.3
- These guidelines recommend that for children with severe ADHD, and children with moderate ADHD who have not responded to psychological interventions, pharmacological treatment should be offered. Furthermore, non-pharmacological child- and family-based interventions are recommended to be made available to all children with ADHD. These interventions should be tailored to the needs of the child, and not be restricted by local availability of services. The preferences of the patient and the parent/carer should also be taken into account. Finally, it is recommended that teachers of children with ADHD be provided with evidence-based information about ADHD, in order to facilitate classroom-based intervention where appropriate.3
- For individuals with ADHD transitioning from adolescence into adulthood, it is recommended that effort be made to facilitate and support this transition. This support may include education of those involved in the care of the individual with ADHD – such as family members, teachers and clinicians – as well as the development of shared-care protocols to guide the transition process.3
- For adults with ADHD, pharmacological treatment is recommended as the first-line intervention, and should be continued for as long as clinically useful.3
European Network Adult ADHD
The European Network Adult ADHD includes 40 professionals from 18 countries in Europe with an interest in adult ADHD. This network developed a consensus statement on the diagnosis and treatment of adult ADHD.4
The consensus statement emphasises the importance of treating adults with ADHD over the long term, in order to avoid depriving the patient of the chance to resolve any functional and psychosocial impairments at personal, relationship and professional levels.4
- The European Network Adult ADHD recommends that psychoeducation forms the first step and the basis of any multimodal treatment plan for adults with ADHD, which should involve educating the patient and their family and partner, where appropriate4
- Pharmacotherapy is advocated as the first-line treatment of adult ADHD to address core symptoms, with family therapy, behavioural coaching and cognitive behavioural therapy used to relieve behavioural, social, cognitive and other functional impairments and address comorbidities.4
- Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder — first upgrade. Eur Child Adolesc Psychiatry 2004; 13(Suppl 1): I/7-I/30.
- National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg72/resources/attention-deficit-hyperactivity-disorder-diagnosis-and-management-975625063621. Last updated 2016. Accessed 05 January 2017.
- Bolea-Alamañac B, Nutt DJ, Adamou M, et al. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2014; 28: 179-203.
- Kooij SJ, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10: 67.