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Objectives We evaluated our Paediatric ADHD service to ensure compliance with NICE guidelines1 and optimise patient care. Methods Patients were identified from consultant clinics from September – October 2021. Documentation was reviewed for 65 patients diagnosed with ADHD after September 2018; gaining information on their demographics, diagnosis criteria, information and support offered, management, and monitoring whilst on medication. Results Most patients were male (83%) and had the combined subtype of ADHD (57%). The top three comorbidities were ASD/ASD features (n=47), sleep difficulties (n=30), and motor coordination difficulties (n=17). A full history was taken for 85% of patients, and 88% had symptoms observed in clinic. Quantitative assessments were conducted for 94% of patients. Post-diagnosis, information (verbal, written, and online) was provided to 59 patients. 54% were referred to a parenting program, and information was shared with the school for 80% of patients. Environmental modification was advised for 80% of patients. 49 patients were started on medication. In line with NICE guidelines methylphenidate was the first choice in most patients (n=47). Subsequent choices were also as per guidance. Prior to starting medication, blood pressure and heart rate were taken for 64% of patients, whilst growth was measured for 70%. Benefits and side effects were explained to 70% of patients. A full cardiovascular assessment was conducted before starting medication for only 10% of patients, while it was incomplete for 39%. Only a small percentage of patients on medication had the appropriate monitoring at the correct intervals (9% for growth and 10% for cardiovascular parameters) as specified by NICE, reflecting need for growth of our service. The BP centile was not calculated for any patients. Conclusion We have demonstrated proficiency in diagnosing ADHD through conducting thorough history and observation in clinic, using quantitative assessments, sharing guidance with schools and carers regarding environmental modification, and making appropriate medication choices. There is need for improvement in monitoring growth and cardiovascular parameters, assessing cardiovascular risk, signposting carers to standardised information post-diagnosis, and provision and commissioning for parenting training programs. Modifications being introduced to our service include creating unified resources for families and introducing an adverse effect questionnaire when starting medication. In-depth monitoring is essential for these patients, and we are committed to meeting this requirement. We are formulating a business case to add an ADHD nurse specialist to our team. This is just the beginning of our efforts to ensure that our service meets the growing recognition of ADHD in our population. Reference Attention deficit hyperactivity disorder: diagnosis and management. NICE Guideline NG87, March 2018.
Skinner et al. (Tue,) studied this question.