SCIE Research briefing 7: ADHD - background, assessment and diagnosis

Published August 2004

Updated August 2005

Introduction

A SCIE Research briefing provides up-to-date information on a particular topic. It is a concise document summarising the knowledge base in a particular area and is intended to act as a 'launch pad’ or signpost to more in-depth material. The briefing is divided into the different types of knowledge relevant to health and social care research and practice, as defined by the Social Care Institute for Excellence (SCIE).

The topic of this particular briefing is Attention Deficit/Hyperactivity Disorder (ADHD), and the related disorder or sub-type, Hyperkinetic Disorder (HKD), although the literature generally does not distinguish between the two in its recommendations or evaluations of assessment or management strategies. The client group being considered by this briefing is children and adolescents only. The behavioural disorder ADHD is characterised by early onset and three particular elements: hyperactivity, inattention and impulsiveness. There are three principal sub-types: predominantly inattentive type; predominantly hyperactive or impulsive type; and a combination of the two types. The basic definition of ADHD is "a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparative level of development". The essential diagnostic criteria for ADHD demands that a child must be under seven years of age and demonstrate clear social and functioning impairment across more than one setting, for example, home and school, for more than six months. Diagnosis is often difficult because other problems, such as epilepsy, autism, oppositional defiant disorder (ODD), conduct disorder, anxiety, depression, and a range of learning difficulties, can result in similar behaviour to ADHD and/or mask symptoms.

Key messages

  • If ADHD and its symptoms are not managed appropriately, this can have a detrimental effect on a child’s ability to interact with his or her peers and to develop socially and educationally
  • It has been demonstrated that undiagnosed and untreated ADHD can lead to major social and behavioural difficulties
  • A number of key tools to diagnose ADHD are available
  • Guidance documents are available outlining recommended pathways and models of practice for the diagnosis of ADHD, and the roles of relevant professionals, but there are few actual required standards
  • A number of local protocols on the diagnosis of ADHD are available
  • Research and guidance literature stresses how diagnosis should be an extensive and thorough process, involving clinical examination and the collection and analysis of diagnostic information from as many relevant parties as possible, including teachers, parents and the children themselves
  • The evidence suggests that diagnosis is very often made by health professionals with reference to information from teachers, social services and parents
  • Access to specialist services for the formal diagnosis of ADHD lies with GPs, but has been found to rely especially heavily on parents’ perceptions of their child’s behaviour and its possible explanation by ADHD
  • Research into the opinions of parents or children about assessment and diagnosis of ADHD is lacking

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