FFinalistSouthampton · 2027
Psychiatry
AKT · Psychiatry/Neurodevelopmental

Attention deficit hyperactivity disorder (ADHD)

Overview

A neurodevelopmental disorder of persistent inattention and/or hyperactivity-impulsivity, present before age 12, in ≥2 settings, causing functional impairment. Persists into adulthood in many.

Recognise

  • Inattention: careless errors, distractibility, poor organisation, forgetfulness
  • Hyperactivity/impulsivity: fidgeting, can’t stay seated, interrupting, blurting
  • Pervasive and chronic (not episodic)

Red flags

  • Coexisting risk: substance misuse, conduct disorder, low mood

Differentials & how to tell them apart

Bipolar/maniaepisodic with elevated mood; ADHD is chronic and pervasive
Anxiety/depressionmood-driven inattention
ASDsocial-communication deficit primary; often coexists
Hearing impairment / absence seizuresmimic inattention in children

Investigations

Clinical diagnosis by specialist using full history (incl. developmental), school/collateral reports, validated rating scales (e.g. Conners). Baseline before stimulants: height, weight, pulse, BP, cardiac history/exam, ECG if indicated.

Management

  1. 1Children: ADHD-focused group parent-training first-line. Medication if symptoms persist with significant impairment.
  2. 2Children drug: methylphenidate first-line.Gate: Switch to lisdexamfetamine/dexamfetamine only if methylphenidate trial (adequate dose) fails; atomoxetine/guanfacine if stimulants unsuitable
  3. 3Adults: lisdexamfetamine or methylphenidate first-line; dexamfetamine or atomoxetine as alternatives.
Methylphenidate — first-line in children; ↓appetite, ↓growth, ↑HR/BP, insomnia
Lisdexamfetamine — first-line option (with methylphenidate) in adults; or if methylphenidate fails in children
Atomoxetine / guanfacine — non-stimulant alternatives

Key points

Stimulants: monitor growth (height/weight), pulse and BP; caution with cardiac disease. Atomoxetine: warn re suicidal ideation and hepatic injury.

Monitor & prognosis

Height/weight (6-monthly in children), pulse/BP every 6 months and after dose changes, appetite/sleep, mood.

Symptoms often improve with age; impairment may persist.

Source: NICE CKS ADHD (2025) / NG87