ADHD is a heterogeneous condition with multiple factors that contribute to the clinical picture.1–5 These include:
Each ADHD case is unique and every patient has diverse needs and may respond differently to treatment. Therefore, it is important to take an individualised approach to ADHD management.6–9
The NICE, CADDRA and German guidelines agree that management of ADHD in children and adults requires a comprehensive, integrated, multimodal treatment plan that may include educational, psychological and pharmacological interventions.6,7,9
|Intervention type||NICE7||CADDRA9||German guidelines6|
|Educational||Children||Adults||Individuals with ADHD||Individuals with ADHD|
|Children and their parents should receive ADHD-focused information and group-based support||Psychoeducation should be the first intervention||Comprehensive psychoeducation should always be offered|
|Environmental||Environmental modifications should be implemented for both children and adults with ADHD||Environmental interventions at home and school are recommended|
|Psychosocial||Cognitive behavioural therapy (CBT) may be considered in some young people and adults||These can be cognitive or behavioural, and have been shown to reduce impairments associated with ADHD symptoms and improve quality of life as part of a multimodal approach||Psychosocial interventions (including psychotherapeutic) should be offered depending on residual symptoms or disease severity|
|Pharmacological||Following a full baseline assessment, medication should only be offered for children aged 5 years* and over and young people if their ADHD symptoms are still causing a persistent significant impairment in at least one domain† after their parents have received ADHD-focused information, group-based support has been offered and environmental modifications have been implemented and reviewed||Following a full baseline assessment, medication should only be offered to adult ADHD patients if their ADHD symptoms are still causing a significant impairment in at least one domain† after environmental modifications have been implemented and reviewed||Medications are part of an integrated and multimodal treatment plan that may include educational and psychosocial interventions. As with all pharmacological treatments in medicine, risk/benefit ratios need consideration before initiating any medication||Pharmacological treatment can be combined with psychosocial and supplementary interventions in the context of a multimodal treatment plan, according to the individual symptoms, the level of functioning, participation and the preferences of the patient and their social network|
*ADHD medications are licensed for the treatment of children with ADHD who are aged 6 years and older.
†Domains refer to areas of function, for example, interpersonal relationships, education and occupational attainment, and risk awareness.
CADDRA also states that the risk of not treating ADHD should be considered when making the choice on the initiation of medication due to the high morbidity associated with ADHD.9
There are currently two main classes of medication for the treatment of ADHD: stimulants and non-stimulants.6,7,9,10
In patients who are candidates for pharmacotherapy, 91% respond to stimulants, but a study found that each patient responds differently to medication:11
Summary of responses to methylphenidate (MPH) or amfetamine (AMF) in 318 children and adolescents (mean age 8–10.3 years) from a pooled analysis of 8 randomised studies.11
This means that some patients with ADHD may benefit from an alternative to stimulants.11