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 of the NICE Guidelines for ADHD can be downloaded here.

NICE Guidelines recommend that parent-training/education programmes should be the first-line treatment for parents or carers of pre-school children and school-age children and young people with ADHD and moderate impairment:

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 recommend:

FOR CHILDREN AND YOUNG PEOPLE:  Drug treatment is not indicated as the first-line treatment for all school-age children and young people with ADHD. It 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.

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. Methylphenidate is the first-line drug but if this is ineffective or unacceptable other options can be tried. 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.

The Guidelines also include comprehensive sections on assessment procedures, post diagnosis advice and treatment therapies, the use of drugs, and the transition of young people into adult services, as well as a specific section relating adults.