Evidence-based or consensus-driven guidelines for the treatment of attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), have become an important framework for consolidating practice across countries and helping to improve the quality of care.1-4
A number of clinical guidelines for the management of ADHD have been developed over the years (Figure) and are intended to improve the process and outcomes of healthcare by:
- Providing evidence-based recommendations for the management of ADHD to help guide appropriate and rational choice of treatment.1-4
- Assisting patients and their families or carers in making informed decisions about treatment options for ADHD.2
- Improving communication between clinicians, patients and their families.2
- Improving the quality of care in clinical practice.2
2017/2018 ADHD Guidelines
A summary of recommendations for pharmacological treatment from selected guidelines
There are multiple guidelines available to guide clinicians working in the field of ADHD in children, adolescents and adults, and different guidelines may also have different recommendations about specific treatment approaches.1-4 These guidelines have been continually updated as new evidence comes to light and new therapeutics are developed, including updates to the NICE, CADDRA and German guidelines in 2018 and the Spanish guidelines in 2017.1-4
Figure: A timeline of ADHD guidance1-21
What do the updated guidelines recommend?
Utilising the guidelines to optimise the treatment of ADHD
How could the guideline bodies improve utilisation of the guidelines?
NICE guidelines 2018. Attention-deficit hyperactivity disorder: diagnosis and management
The NICE guidelines were updated in 2018 and stipulate that children, adolescents and adults with ADHD require a comprehensive, holistic, shared treatment plan that addresses a wide range of personal, social, educational and occupational needs, and that this care should be provided by healthcare professionals with training and expertise in diagnosing and managing ADHD.4
The Canadian ADHD Resource Alliance (CADDRA) Canadian ADHD Practice Guidelines (CAP-Guidelines)
The CADDRA guidelines for the management of children, adolescents and adults with ADHD were updated in March 2018, and recommend a comprehensive, collaborative and multimodal treatment approach to ADHD.2 Integrated treatment plans should include multiple interventions (Figure).2
Figure: CADDRA Canadian ADHD Practice Guidelines
The CADDRA core principle for the effective treatment of ADHD states that: a solid therapeutic alliance is best achieved by spending time listening to a patient’s concerns and understanding their perspective and goals.2
Der interdisziplinären evidenz- und konsensbasierten (S3) Leitlinie “Aufmerksamkeitsdefizit- / Hyperaktivitätsstörung (ADHS) im Kindes-, Jugend- und Erwachsenenalter”
The interdisciplinary evidence- and consensus-based (S3) guideline on attention-deficit/hyperactivity disorder (ADHD) in childhood, adolescence and adults
Updated German guidelines covering the diagnosis and management of ADHD in children, adolescents and adults were released in June 2018. The guidance is targeted at all healthcare professionals and associated roles who are involved with the care of patients with ADHD. The German guidelines emphasise that the treatment of ADHD should be delivered in the context of a multimodal treatment plan, which can combine psychosocial (including psychotherapeutic) and pharmacological and supplementary interventions, according to the individual symptoms, the level of functioning, participation, and the preferences of the patient and their social network.1
Read more about the 2018 Edition of the German ADHD guidelines here
Guía de Práctica Clínica sobre las Intervenciones Terapéuticas en el Trastorno por Déficit de Atención con Hiperactividad (TDAH)
Clinical Practice Guideline on Therapeutic Interventions in Attention-Deficit Hyperactivity Disorder (ADHD)
In an effort to consolidate available evidence, the Spanish guidelines for the management of ADHD were developed to promote effective decision-making with a focus on the patient. The guidelines, developed by a diverse group of healthcare professionals comprising different specialities and societies involved in the treatment of patients with ADHD, are described as a set of recommendations based on a systematic review of available evidence and a benefit/risk evaluation of treatment alternatives, with the aim of optimising healthcare for patients.3
The current clinical practice guidelines focus on providing a therapeutic approach to the management of ADHD that takes into account psychological, psychosocial, psychoeducational and pharmacological interventions. These evidence-based multidisciplinary-team–focused recommendations on specific therapeutic interventions aim to assist with decision-making in the clinic as well as areas closely related to many of those with ADHD, e.g. the education system.3
Pharmacological treatment in school-aged children and adolescents is only recommended by the updated Spanish guidelines when psychotherapy and/or psychosocial therapy has not provided the desired results, or in severely affected individuals. In adults with mild ADHD, the guidelines provide a choice between psychological and pharmacological treatment, although pharmacological treatment is the recommended treatment of first choice for adults with moderate or severe ADHD.3
Read more about the 2017 Edition of the Spanish ADHD guidelines here
These overviews are not exhaustive of all recommendations and should not be used as the basis to treat patients. Please refer to the relevant complete guideline documents.
- Banaschewski T, Hohmann S, Millenet S. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Kindes-, Jugend- und Erwachsenenalter. DGKJP, DGPPN and DGSPJ German guidelines. 2018.
- Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines. Fourth Edition. Toronto, ON; CADDRA, 2018.
- Guías de Práctica Clínica en el SNS. Grupo de trabajo de la Guía de Práctica Clínica sobre las Intervenciones Terapéuticas en el Trastorno por Déficit de Atención con Hiperactividad (TDAH). 2017.
- NICE guideline 2018. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng87. Accessed February 2019.
- American Academy of Pediatrics. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics 2000; 105: 1158-1170.
- American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108: 1033-1044.
- American Academy of Pediatrics, Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128: 1007-1022.
- Banaschewski T, Coghill D, Santosh P, et al. Long-acting medications for the hyperkinetic disorders. A systematic review and European treatment guideline. Eur Child Adolesc Psychiatry 2006; 15: 476-495.
- 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.
- Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines. Third. Toronto, ON; CADDRA, 2011.
- Cortese S, Adamo N, Del Giovane C, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry 2018; 5: 727-738.
- Danish Health Authority. National Clinical Guideline for the assessment and treatment of ADHD in adults – with disturbance of activity and attention and attention deficit disorder without hyperactivity. 2016. Available at: https://www.sst.dk/da/udgivelser/2015/~/media/BC4627AAE27B4FF18205713A57934070.ashx. Accessed February 2019.
- Ebert D, Krause J, Roth-Sackenheim C. [ADHD in adulthood–guidelines based on expert consensus with DGPPN support]. Nervenarzt 2003; 74: 939-946.
- Kölch M, Fegert J, Berg G, et al. [Reports. Joint statement by the Societies of Child and Adolescent Psychiatry and the professional associations DGKJP, BAG KJPP, BKJPP]. Z Kinder Jugendpsychiatr Psychother 2016; 44: 75-80.
- Kooij SJJ, 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.
- Kooij JJS, Bijlenga D, Salerno L, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 2019 [Epub 2018]; 56: 14-34.
- NICE guideline 2008. Clinical Guideline 72. Available at: https://www.nice.org.uk/guidance/CG72. Accessed February 2019.
- NICE guideline 2016. 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. Accessed February 2019.
- Nutt DJ, Fone K, Asherson P, et al. Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2007 [Epub 2006]; 21: 10-41.
- Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007; 46: 894-921.
- 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.