As previously stated, the specific aims of this Clinical Programme are:
- To provide for the assessment of adults with symptoms suggestive of ADHD by trained and skilled staff.
- To provide multi-modal treatment involving a combination of pharmacological and non pharmacological interventions.
- To ensure that young people attending CAMHS for ADHD who continue to have significant symptoms of ADHD and/or co-morbid mental illness who require treatment can be transferred to adult mental health services. That this transfer is planned in advance to ensure it occurs smoothly.
- That all of the above is delivered through a clearly defined and integrated clinical pathway.
- The first three aims are based largely on the NICE Guidelines on Attention Deficit Hyperactivity Disorder: diagnosis and management (2018) together with the NICE Quality Standards on ADHD (2013). Their sum objective is to ensure adults with ADHD have access to assessment and treatment. The fourth aim reflects the core principle of integrated care. The scope of each is outlined under each aim.
1. Assessment of adults with ADHD
- Adults with symptoms suggestive of ADHD should be referred to the relevant local adult psychiatry service for the usual assessment. They should also complete the two ADHD screening assessments.
- Adults who have previously been treated for ADHD as children and/or adolescents and who have current symptoms suggestive of ADHD should likewise be referred to their local adult psychiatry service for the same assessment. The ADHD symptoms should be associated with at least moderate or severe psychological and/or social, educational or occupational impairment.
- If screening is positive, an ADHD specific assessment should be then carried out by a psychiatrist who has received training in the diagnosis and treatment of ADHD. Other mental health professionals who have been trained in the diagnosis and treatment of ADHD should work jointly with the psychiatrist in this assessment process.
2. Treatment of adults with ADHD
- Treatment should be multimodal involving a combination of pharmacological and nonpharmacological interventions.
- The treatment should be delivered by mental health professionals trained in the treatment of ADHD.
3. Transition to adult services
- Young people with ADHD receiving care and treatment from CAMHS or paediatric services will be transitioned to General Adult Psychiatry services or directly to the proposed ADHD Clinic depending on their diagnoses (syndromal ADHD, significant co-morbid mental illness or other mental illness). The General Adult Psychiatry Service and ADHD Clinic will discuss each such referral jointly and make a decision on the most appropriate service based on the guidelines in Chapter 6. A current diagnosis of ADHD should be confirmed by re-assessment by CAMHS one year prior to school leaving age to establish the need for continued treatment into adulthood (NICE 2018).
- The point of transfer will be 18 years of age unless there is a clinically significant reason to remain in CAMHS.
- Joint planning between CAMHS and General Adult Psychiatry Services and ADHD Clinic for this transition should start six months in advance of the transition. A lead clinician in the CAMHS team should be appointed to ensure the process runs smoothly.
4. Integrated Care
- The individual care plan should be based on an integrated approach.
- This should include relevant statutory and voluntary agencies: both health and non health such as:
- primary care health services, in particular psychology
- social protection
- ADHD specific support and information services
- coaching services
Further details on the objectives are described in the relevant chapters of this Clinical Programme.