1.2 Background
Attention-Deficit/Hyperactivity Disorder (ADHD), historically thought of
as a problem seen in childhood, is now recognised as an adult
neurodevelopmental disorder1. There is evidence that
impairments relating to ADHD persist into adulthood, with two thirds of
children diagnosed with ADHD continuing to either have full or partial
traits beyond the age of 182.
Numerous longitudinal and cross-sectional studies have illustrated that,
when compared to control groups, ADHD is associated with lower academic
attainment3 and occupational
performance4, as well as increased likelihood of
health problems5, psychiatric
comorbidity6, marital/relationship
issues7, and imprisonment8.
Follow-up studies suggest treatment with medication significantly
improves an individuals’ quality of life9. However, in
previous controlled trials of pharmacotherapy, 20% to 50% of adults
were considered ‘non-responders’, due to insufficient symptom reduction
or an inability to tolerate medication10. This raises
questions as to whether a service model that only offers pharmacological
intervention is effective at reducing the impact of ADHD symptoms on
service users’ functioning.
The 2018 NICE guidelines11 alongside other published
research12,13 provide an evidence base for the need
for services for adults with ADHD, as well as clear recommendations for
the assessment and management for ADHD in adulthood.
NICE11 recommends medication to adults with ADHD if
their ADHD symptoms are still causing a significant impairment in at
least 1 domain after environmental modifications have been implemented
and reviewed. Non-pharmacological treatment should be considered if the
service user has made an informed choice not to have medication, has
difficulty adhering to medication, or has found medication to be
ineffective or they cannot tolerate it. A combination of
non-pharmacological treatment and medication should be considered for
service users who have benefitted from medication but whose symptoms are
still causing a significant impairment in at least 1 domain.
Recent evaluations of Adult ADHD Services in the
UK14,15 have focused on adherence to NICE guidelines,
but to the best of our knowledge, none have focused on service user
outcomes.