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.