Disclaimer: Placement of a listing on the AADD-UK website does not represent an endorsement by AADD-UK, nor does it represent any testimony by AADD-UK as to the quality of the services provided. AADD-UK does reserve the right to accept or reject listings on the AADD-UK website at any time. Inclusion on this list may not be used for advertising or endorsement purposes.

We have borrowed the following quote from the National Institute for Clinical Excellence (NICE) because it clearly states the current situation for adults with ADHD in the UK:

NICE statement regarding services for adults with ADHD

The identification of ADHD in adults in the UK is uncommon. There are very few specialist or generic mental health services in the NHS for adults with ADHD, despite evidence of effectiveness; in addition, clinicians often feel ill equipped to treat adults with ADHD. Young people often leave children’s services with no readily identifiable adult service to support them, even though most young people with a sustained diagnosis will go on to have significant difficulties in adulthood. These, may include continuing ADHD, comorbid psychiatric disorders, emotional and social difficulties, substance misuse, unemployment and involvement in crime. This also means that there is a pool of adult patients in whom the diagnosis of ADHD has been unidentified and where ineffective treatments have been put in place for alternative diagnoses, which may account for the high rates of contact reported with mental health services for adults with ADHD and in turn the associated cost implications. In addition, many people with ADHD, and their parents or carers, experience stigma and other difficulties because of the symptoms and impairment associated with ADHD and current practice within healthcare and education (more information about the commissioning of services for adults with ADHD is available from NICE).

NICE statement regarding benefits of services for adults with ADHD

The potential benefits of robustly commissioning an effective service for the diagnosis and management of ADHD in adults include:

• better care of young people with ADHD during the transition between child and adolescent mental health services (CAMHS) or paediatric services, and adult mental health services, which improves clinical, educational and social outcomes
• decreasing the number of people who disengage from services at a time when they are most vulnerable, and reducing the likelihood of them re-presenting in crisis in the future
• improving the recognition, diagnosis and treatment of ADHD in adults and reducing the risk of misdiagnosis, which can improve the quality of care and may reduce the number of mental health contacts, with the associated costs
• reducing the distress from the symptoms of ADHD in young people and adults and their parents and/or carers
• improving clinical and social care outcomes
• reducing inequalities by improving access to adult psychiatric services for ADHD and addressing differences in referral rates for different ethnic groups
• increasing patient choice, and improving partnership working, patient experience and engagement
• better value for money, through helping commissioners to manage their commissioning budgets more effectively – this may include opportunities for clinicians to undertake local service redesign to meet local requirements in novel ways.

NICE statement regarding key components of ADHD services

The key components of a service for the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in adults and young people in transition are:

The transition of young people with ADHD into adult services

The NICE clinical guideline CG72 on ADHD states that young people with ADHD receiving treatment and care from child and adolescent mental health services (CAMHS) or paediatric services should normally be transferred to adult services if they continue to have significant symptoms of ADHD, or coexisting conditions that require treatment. Transition should be planned in advance by both referring and receiving services. An assessment at school-leaving age to establish the need for continuing treatment into adulthood should be carried out.

Flexibility in the timing of transition is important. The precise timing of arrangements may vary locally but should usually be completed by the time the young person is 18 years old.

Transition arrangements should normally include:

details of the anticipated treatment and services that the young person will require

consideration of a formal meeting involving CAMHS and/or paediatrics and adult psychiatric services, and provision of full information about adult services to the young person

the use of the care programme approach as an aid to transfer between services for young people aged 16 years and older

the involvement of the young person, and when appropriate the parent or carer, in the planning.

Appropriate referral, diagnosis and management of adults with ADHD

It is important to ensure that people with symptoms suggestive of ADHD are referred for appropriate assessment, diagnosis and treatment in order to improve the recognition and management of ADHD in adults, and to reduce the risk of potentially vulnerable young people lacking access to appropriate treatment and services.

The NICE clinical guideline CG72 on ADHD recommends that:

Adults presenting with symptoms of ADHD in primary care or general adult psychiatric services, who do not have a childhood diagnosis of ADHD, should be referred for assessment by a mental health specialist trained in the diagnosis and treatment of ADHD, where there is evidence of typical manifestations of ADHD (hyperactivity/impulsivity and/or inattention) that:

began during childhood and have persisted throughout life

are not explained by other psychiatric diagnoses (although there may be other coexisting psychiatric conditions)

have resulted in or are associated with moderate or severe psychological, social and/or educational or occupational impairment.

Adults who have previously been treated for ADHD as children or young people and present with symptoms suggestive of continuing ADHD should be referred to general adult psychiatric services for assessment.

The symptoms should be associated with at least moderate or severe psychological and/or social or educational or occupational impairment.

A diagnosis of ADHD should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified health care professional with training and expertise in the diagnosis of ADHD.

The details of the diagnosis are described in the NICE clinical guideline CG72 on ADHD.

This guideline also notes that drug treatment for adults should:

be the first-line treatment unless the person prefers psychological treatment

be started under the guidance of a psychiatrist, nurse prescriber specialising in ADHD or other clinical prescriber with training in ADHD diagnosis and management

always form part of a comprehensive treatment programme that addresses psychological, behavioural and educational or occupational needs

be prescribed by an appropriately qualified healthcare professional with expertise in managing both ADHD and substance misuse for adults who also misuse substances.

developing a high-quality service for the diagnosis and management of ADHD in adults and young people in transition

NICE clinical guideline CG72 on attention deficit hyperactivity disorder recommends that:

trusts should ensure that specialist ADHD teams for children, young people and adults jointly develop age-appropriate training programmes for the diagnosis and management of ADHD for mental health, paediatric, social care, education, forensic and primary care providers and other professionals who have contact with people with ADHD

child and adult psychiatrists, paediatricians, and other child and adult mental health professionals (including those working in forensic services) should undertake training so that they are able to diagnose ADHD and provide treatment and management.

the organisation and planning of services.

NICE clinical guideline CG72 on ADHD recommends that multidisciplinary specialist ADHD teams and/or clinics for children and young people should be established, with separate teams and/or clinics for adults. Initially these could be provided by a specialist team, but over time should be integrated within generic mental health services.

The guideline also recommends that these teams and clinics should have expertise in the diagnosis and management of ADHD, and should:

provide diagnostic, treatment and consultation services for people with ADHD who have complex needs, or where general psychiatric services are in doubt about the diagnosis and/or management of ADHD

put in place systems of communication and protocols for information sharing among paediatric, child and adolescent, forensic, and adult mental health services for people with ADHD, including arrangements for transition between child and adult services

produce local protocols for shared care arrangements with primary care providers, and ensure that clear lines of communication between primary care secondary care are maintained

ensure age-appropriate psychological services are available for young people and adults with ADHD, and for parents or carers.

The size and commitment of these teams should depend on local circumstances (for example, the size of the trust, the population covered and the estimated referral rate for people with ADHD).

More information is available in the NICE clinical guideline CG72 on ADHD

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Review date: 00/09/2015

Next review due: 00/09/2016

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