Diagnosis and management
Diagnosis
Diagnosing ADHD is challenging as there is no definitive blood test or scan. A comprehensive assessment is needed, including ruling out other causes that may better explain the presentation. Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria or International Classification of Disease (ICD) are used.
Management
NICE guidance recommends that a parent training/education programme is utilised, particularly in conjunction with medication.
Insomnia is a common co-morbidity. Symptoms of chronic insomnia include lack of concentration, mood swings and irritability. Some of these symptoms may be misconstrued as ADHD or deterioration of ADHD so it is vital that patients and their parents are supported to optimise sleep. Medication may be clinically warranted in some patients.
As patients with ADHD spend a lot of time in school, they will inevitably find the classroom environment difficult due to the expectation to sit still, not make noise, wait their turn, listen to and follow instructions and concentrate for periods of time. Equally, playtime or free time can be challenging as it is unstructured with fewer boundaries. Transition from primary to secondary school can be a turbulent time for any child but particularly so for a patient with ADHD
NICE guidance recommends medication in patients with either severe or moderate impairment where non-drug measures have been ineffective or cannot be attempted. Medication must be used as part of a comprehensive treatment programme which will include all of the previously mentioned supportive measures.
Driving with ADHD
Adolescents with ADHD may be keen to drive a car once they reach 17. Satisfactory control of ADHD symptoms is very important for such patients, so adolescents and clinicians should discuss the need for this while driving. ADHD medications are centrally acting and can therefore impair judgement. They can also cause dizziness and affect vision. Adolescents should be counselled to only drive if they are unaffected by these symptoms.