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Guideline Summary
Guideline Title
Management of attention deficit and hyperkinetic disorders in children and young people. A national clinical guideline.
Bibliographic Source(s)
Scottish Intercollegiate Guidelines Network (SIGN). Management of attention deficit and hyperkinetic disorders in children and young people. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2009 Oct. 52 p. (SIGN publication; no. 112).  [155 references]
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Attention deficit and hyperkinetic disorders in children and young people. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2001. 26 p. (SIGN publication; no. 52). [155 references]

Any amendments to the guideline in the interim period will be noted on the Scottish Intercollegiate Guidelines Network (SIGN) Web site External Web Site Policy.

FDA Warning/Regulatory Alert

Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.

  • December 17, 2013 – Methylphenidate ADHD Medications External Web Site Policy: The U.S. Food and Drug Administration (FDA) is warning that methylphenidate products, one type of stimulant drug used to treat attention deficit hyperactivity disorder (ADHD), may in rare instances cause prolonged and sometimes painful erections known as priapism. Based on a recent review of methylphenidate products, FDA updated drug labels and patient Medication Guides to include information about the rare but serious risk of priapism. If not treated right away, priapism can lead to permanent damage to the penis.

Scope

Disease/Condition(s)
  • Attention deficit hyperactivity disorder (ADHD)
  • Hyperkinetic disorders (HKD)
Guideline Category
Counseling
Diagnosis
Evaluation
Management
Treatment
Clinical Specialty
Family Practice
Nutrition
Pediatrics
Psychiatry
Psychology
Intended Users
Advanced Practice Nurses
Dietitians
Nurses
Occupational Therapists
Physician Assistants
Physicians
Psychologists/Non-physician Behavioral Health Clinicians
Social Workers
Speech-Language Pathologists
Guideline Objective(s)
  • To provide a framework for evidence based assessment and management of attention deficit hyperactivity disorder/hyperkinetic disorder (ADHD/HKD), from which multidisciplinary and multiagency approaches can be developed locally
  • To update the previous version of this guideline, first published in 2001, to reflect the most recent evidence on psychological and pharmacological interventions, as well as to introduce new sections on nutrition and complementary and alternative therapies
Target Population

Children and young people with attention deficit hyperactivity and hyperkinetic disorders

Interventions and Practices Considered

Initial and Specialist Assessment

  1. Parent/carer interview, including, history of presenting complaint, obstetric and perinatal history, developmental history, family history, and family functioning
  2. Child/young person interview
  3. Laboratory measures (considered but not recommended)
  4. Questionnaires
  5. Psychoeducational assessment
  6. Clinical examination (systems inquiry, details of previous health problems, current drug treatment, physical examination, vision and hearing tests)
  7. Ancillary assessments, including physical investigations for underlying medical problems, psychiatric assessments, psychological assessments

Psychological Interventions

Psychosocial interventions, including behavioral parent training and school-based intervention

Pharmacological Therapy

  1. Psychostimulants, such as methylphenidate and dexamphetamine
  2. Atomoxetine
  3. Unlicensed medications including clonidine and tricyclic antidepressants (should only be considered when licensed medications have failed)

Nutrition and Complementary and Alternative Therapies

  1. Avoidance of foods and drink with artificial colors and preservatives
  2. Consideration of iron status and iron supplementation as appropriate
  3. Omega-3 and omega-6 fatty acids, zinc, and antioxidant supplementation (considered but not recommended because of insufficient evidence)
  4. Complementary and alternative therapies (considered but not recommended because of insufficient evidence base)

Treatment Selection

Treatment selection based on age, severity of symptoms, and comorbid conditions

Major Outcomes Considered
  • Rate of attention deficit hyperactivity disorder (ADHD)
  • Rate of persistence of ADHD
  • Core symptom control
  • Developmental delays
  • Comorbid conditions
  • Learning problems
  • Emotional and behavioural disorders
  • Quality of life

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

The evidence base for this guideline was synthesised in accordance with Scottish Intercollegiate Guidelines Network (SIGN) methodology. A systematic review of the literature was carried out using an explicit search strategy devised by a SIGN Information Officer. Databases searched include Medline, Embase, CINAHL, PsychInfo, ERIC and the Cochrane Library. The year range covered was 2004–2009, although searches for certain questions went back as far as 1990. The main searches were supplemented by material identified by individual members of the guideline development group. All selected papers were evaluated using standard methodological checklists. The Medline version of the main search strategies can be found on the SIGN Web site External Web Site Policy.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Levels of Evidence

1++: High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias

1+: Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias

1-: Meta-analyses, systematic reviews, or RCTs with a high risk of bias

2++: High quality systematic reviews of case control or cohort studies
High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal

2+: Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal

2-: Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal

3: Non-analytic studies (e.g., case reports, case series)

4: Expert opinion

Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence

Once papers have been selected as potential sources of evidence, the methodology used in each study is assessed to ensure its validity. The result of this assessment will affect the level of evidence allocated to the paper, which will in turn influence the grade of recommendation that it supports.

The methodological assessment is based on a number of key questions that focus on those aspects of the study design that research has shown to have a significant influence on the validity of the results reported and conclusions drawn. These key questions differ between study types, and a range of checklists is used to bring a degree of consistency to the assessment process. Scottish Intercollegiate Guidelines Network (SIGN) has based its assessments on the MERGE (Method for Evaluating Research and Guideline Evidence) checklists developed by the New South Wales Department of Health, which have been subjected to wide consultation and evaluation. These checklists were subjected to detailed evaluation and adaptation to meet SIGN's requirements for a balance between methodological rigour and practicality of use.

The assessment process inevitably involves a degree of subjective judgement. The extent to which a study meets a particular criterion — e.g., an acceptable level of loss to follow-up — and, more importantly, the likely impact of this on the reported results from the study will depend on the clinical context. To minimise any potential bias resulting from this, each study must be evaluated independently by at least two group members. Any differences in assessment should then be discussed by the full group. Where differences cannot be resolved, an independent reviewer or an experienced member of SIGN executive staff will arbitrate to reach an agreed quality assessment.

Evidence Tables

Evidence tables are compiled by SIGN executive staff based on the quality assessments of individual studies provided by guideline development group members. The tables summarise all the validated studies identified from the systematic literature review relating to each key question. They are presented in a standard format to make it easier to compare results across studies, and will present separately the evidence for each outcome measure used in the published studies. These evidence tables form an essential part of the guideline development record and ensure that the basis of the guideline development group's recommendations is transparent.

Additional details can be found in the companion document titled "SIGN 50: A Guideline Developers' Handbook." (Edinburgh [UK]: Scottish Intercollegiate Guidelines Network. [SIGN publication; no. 50]), available from the SIGN Web site External Web Site Policy.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Synthesising the Evidence

Guideline recommendations are graded to differentiate between those based on strong evidence and those based on weak evidence. This judgement is made on the basis of an (objective) assessment of the design and quality of each study and a (perhaps more subjective) judgement on the consistency, clinical relevance and external validity of the whole body of evidence. The aim is to produce a recommendation that is evidence based, but which is relevant to the way in which health care is delivered in Scotland and is therefore implementable.

It is important to emphasise that the grading does not relate to the importance of the recommendation, but to the strength of the supporting evidence and, in particular, to the predictive power of the study designs from which these data were obtained. Thus, the grading assigned to a recommendation indicates to users the likelihood that, if that recommendation is implemented, the predicted outcome will be achieved.

Considered Judgement

It is rare for the evidence to show clearly and unambiguously what course of action should be recommended for any given question. Consequently, it is not always clear to those who were not involved in the decision making process how guideline developers were able to arrive at their recommendations, given the evidence they had to base them on. In order to address this problem, SIGN has introduced the concept of considered judgement.

Under the heading of considered judgement, guideline development groups summarise their view of the total body of evidence covered by each evidence table. This summary view is expected to cover the following aspects:

  • Quantity, quality, and consistency of evidence
  • External validity (generalisability) of study findings
  • Directness of application to the target population for the guideline
  • Any evidence of potential harms associated with implementation of a recommendation
  • Clinical impact (i.e., the extent of the impact on the target patient population, and the resources needed to treat them in accordance with the recommendation)
  • Whether, and to what extent, any equality groups may be particularly advantaged or disadvantaged by the recommendations made
  • Implementability (i.e., how practical it would be for the National Health Service [NHS] in Scotland to implement the recommendation)

The group is finally asked to summarise its view on all of these issues, both the quality of the evidence and its potential impact, before making a graded recommendation. This summary should be succinct, and taken together with its views of the level of evidence represent the first draft of the text that will appear in the guideline immediately before a graded recommendation.

Additional detail about SIGN's process for formulating guideline recommendations is provided in Section 6 of the companion document titled "SIGN 50: A Guideline Developers' Handbook." (Edinburgh [UK]: Scottish Intercollegiate Guidelines Network. [SIGN publication; no. 50], available from the SIGN Web site External Web Site Policy.

Rating Scheme for the Strength of the Recommendations

Grades of Recommendation

Note: The grade of recommendation relates to the strength of the evidence on which the recommendation is based. It does not reflect the clinical importance of the recommendation.

A: At least one meta-analysis, systematic review, or randomised controlled trial (RCT) rated as 1++ and directly applicable to the target population; or

A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results

B: A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or

Extrapolated evidence from studies rated as 1++ or 1+

C: A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or

Extrapolated evidence from studies rated as 2++

D: Evidence level 3 or 4; or

Extrapolated evidence from studies rated as 2+

Good Practice Points: Recommended best practice based on the clinical experience of the guideline development group

Cost Analysis

A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents was reviewed.

Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

The national open meeting is the main consultative phase of Scottish Intercollegiate Guidelines Network (SIGN) guideline development.

Peer Review

All SIGN guidelines are reviewed in draft form by independent expert referees, who are asked to comment primarily on the comprehensiveness and accuracy of interpretation of the evidence base supporting the recommendations in the guideline. A number of general practitioners (GPs) and other primary care practitioners also provide comments on the guideline from the primary care perspective, concentrating particularly on the clarity of the recommendations and their assessment of the usefulness of the guideline as a working tool for the primary care team. The draft is also sent to at least two lay reviewers in order to obtain comments from the patient's perspective.

It should be noted that all reviewers are invited to comment as individuals, not as representatives of any particular organisation or group. Corporate interests, whether commercial, professional, or societal have an opportunity to make representations at the national meeting stage where they can send representatives to the meeting or provide comment on the draft produced for that meeting. Peer reviewers are asked to complete a declaration of interests form.

The comments received from peer reviewers and others are carefully tabulated and discussed with the Chair and with the guideline development group. Each point must be addressed and any changes to the guideline as a result noted or, if no change is made, the reasons for this recorded.

As a final quality control check prior to publication, the guideline and the summary of peer reviewers' comments are reviewed by the SIGN Editorial Group for that guideline to ensure that each point has been addressed adequately and that any risk of bias in the guideline development process as a whole has been minimised. Each member of the guideline development group is then asked formally to approve the final guideline for publication.

Recommendations

Major Recommendations

Note from the Scottish Intercollegiate Guidelines Network (SIGN) and National Guideline Clearinghouse (NGC): In addition to these evidence-based recommendations, the guideline development group also identifies points of best clinical practice in the full-text guideline document.

The grades of recommendations (A–D) and levels of evidence (1++, 1+, 1-, 2++, 2+, 2-, 3, 4) are defined at the end of the "Major Recommendations" field.

Assessment

D: Parental report of their children's symptoms is an essential component of the diagnostic assessment.

D: A history should be obtained of obstetric and perinatal complications.

C: A developmental history should be obtained to show a chronological development of difficulties.

C: Laboratory assessments should not be used routinely.

D: An assessment of the child's presentation in their educational placement is important for confirming diagnosis and identifying educational underachievement.

Psychological Interventions

B: Behavioural parent training is recommended for parents of pre-school children with symptoms of attention deficit hyperactivity disorder/hyperkinetic disorder (ADHD/HKD). This should be delivered by trained facilitators.

A: In pre-adolescent children with ADHD/HKD and comorbid symptoms of oppositional defiant disorder and/or aggressive behaviour, behavioural programmes are recommended to treat the comorbid problems.

B: In pre-adolescent children with ADHD/HKD and comorbid generalised anxiety, behavioural programmes are recommended to treat the comorbid problems.

A: Children with ADHD/HKD require an individualised school intervention programme including behavioural and educational interventions.

Pharmacological Therapy

A: Psychostimulants are recommended as the first choice medication for the core symptoms of ADHD/HKD in children.

D: Psychostimulants should not be first line medication for children with ADHD/HKD where there are known (or where there is a family history of) cardiac abnormalities.

A: Atomoxetine is recommended as treatment for the core symptoms of ADHD/HKD in children where psychostimulant medication is not appropriate, not tolerated or is ineffective.

C: Clonidine can be considered in children unresponsive to or unable to tolerate treatment with psychostimulants or atomoxetine. It may be used on its own or in combination with methylphenidate on an individual case basis.

B: Tricyclic antidepressants should not be routinely used in treatment of ADHD/HKD in children and should only be considered where children have not responded to licensed medications.

Treatment Selection

A: For school aged children and young people with hyperkinetic disorder (severe ADHD) medication is recommended.

A: For school aged children and young people with ADHD/HKD and comorbid symptoms of oppositional defiant disorder and/or aggressive behaviour a combination of medication and behavioural treatments is recommended.

B: For school aged children and young people with ADHD/HKD and comorbid generalised anxiety disorders, a combination of medication and behavioural treatments is recommended.

Definitions:

Grades of Recommendation

Note: The grade of recommendation relates to the strength of the evidence on which the recommendation is based. It does not reflect the clinical importance of the recommendation.

A: At least one meta-analysis, systematic review, or randomised controlled trial (RCT) rated as 1++ and directly applicable to the target population; or

A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results

B: A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or

Extrapolated evidence from studies rated as 1++ or 1+

C: A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or

Extrapolated evidence from studies rated as 2++

D: Evidence level 3 or 4; or

Extrapolated evidence from studies rated as 2+

Good Practice Points: Recommended best practice based on the clinical experience of the guideline development group

Levels of Evidence

1++: High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias

1+: Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias

1-: Meta-analyses, systematic reviews, or RCTs with a high risk of bias

2++: High quality systematic reviews of case control or cohort studies
High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal

2+: Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal

2-: Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal

3: Non-analytic studies (e.g., case reports, case series)

4: Expert opinion

Clinical Algorithm(s)

A clinical algorithm is provided in the original guideline document for treatment selection.

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits
  • Improvement of core symptoms
  • Improvement of social, emotional, and cognitive functioning
  • Reduced morbidity and dysfunction
  • Improved quality of life
Potential Harms

Psychostimulants

  • The adverse effects of psychostimulants include insomnia, reduced appetite, abdominal pain, gastrointestinal disturbance, headache and dizziness and less frequently, anxiety, irritability or tearfulness.
  • A systematic review of heterogeneous studies found reduced growth velocity in some children during initial methylphenidate treatment.
  • There remains debate about the association of tics with psychostimulant use.
  • Concerns have been raised about a small number of sudden deaths attributed to cardiovascular events in children taking psychostimulants including methylphenidate based and dexamfetamine based medications in the U.S. Some of these cases were found to have pre-existing cardiac risk factors at autopsy, others were coprescribed other treatments. The reported number of cases was extremely low compared with the overall number of prescriptions dispensed. Psychostimulant medication results in small mean increases in pulse and blood pressure. The potential harm as a result of this is currently being investigated.

Atomoxetine

  • Adverse effects of atomoxetine include nausea and appetite reduction, dry mouth, insomnia, constipation and mood swings. Unlike psychostimulants, somnolence is commonly seen with atomoxetine.
  • Disturbance of hepatobiliary function has been reported in adults and children treated with atomoxetine with a very small number of the hepatic events directly attributable to the medication.
  • Small but significant heart rate and blood pressure increases were found in randomised controlled trials. These changes were greater in individuals identified as being poor metabolisers of atomoxetine, as are some other adverse effects (decreased appetite, reduced weight gain). Post-marketing reports included several cases of prolonged QT interval and described concern about atomoxetine and risk of seizures.
  • Isolated cases of sudden death have been reported in individuals taking atomoxetine treatment at usual doses. These individuals were described as having structural cardiac abnormalities or other serious heart problems.
  • Suicidal ideation was significantly more frequent in paediatric patients treated with atomoxetine compared to those treated with placebo in a meta-analysis conducted by the manufacturer. There have been no suicides attributed to atomoxetine treatment.

Unlicensed Medications

  • Clonidine: In one study individuals who had received clonidine had a greater reduction in systolic blood pressure measured standing than controls, and had transient sedation and dizziness. Clonidine discontinuation should be carried out gradually to avoid the risk of rebound hypertension.
  • Tricyclic antidepressants: Where tricyclic antidepressants are used, electrocardiographic monitoring should be conducted before and during treatment. Caution is warranted in patients with a personal or family history of cardiac problems.

Qualifying Statements

Qualifying Statements

This guideline is not intended to be construed or to serve as a standard of care. Standards of care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advance and patterns of care evolve. Adherence to guideline recommendations will not ensure a successful outcome in every case, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgement must be made by the appropriate healthcare professional(s) responsible for clinical decisions regarding a particular clinical procedure or treatment plan. This judgement should only be arrived at following discussion of the options with the patient, covering the diagnostic and treatment choices available. It is, however, advised that significant departures from the national guideline or any local guidelines derived from it should be fully documented in the patient's case notes at the time the relevant decision is taken.

Recommendations within this guideline are based on the best clinical evidence. Some recommendations may be for medicines prescribed outwith the marketing authorisation (product licence). This is known as "off label" use. It is not unusual for medicines to be prescribed outwith their product licence and this can be necessary for a variety of reasons.

Generally the unlicensed use of medicines becomes necessary if the clinical need cannot be met by licensed medicines; such use should be supported by appropriate evidence and experience.

Medicines may be prescribed outwith their product licence in the following circumstances:

  • For an indication not specified within the marketing authorisation
  • For administration via a different route
  • For administration of a different dose

Prescribing medicines outside the recommendations of their marketing authorisation alters (and probably increases) the prescribers' professional responsibility and potential liability. The prescriber should be able to justify and feel competent in using such medicines.

Any practitioner following a Scottish Intercollegiate Guidelines Network (SIGN) recommendation and prescribing a licensed medicine outwith the product licence needs to be aware that they are responsible for this decision, and in the event of adverse outcomes, may be required to justify the actions that they have taken.

Prior to prescribing, the licensing status of a medication should be checked in the current version of the British National Formulary (BNF).

Implementation of the Guideline

Description of Implementation Strategy

Implementation of national clinical guidelines is the responsibility of each National Health Service (NHS) Board and is an essential part of clinical governance. Mechanisms should be in place to review care provided against the guideline recommendations. The reasons for any differences should be assessed and addressed where appropriate. Local arrangements should then be made to implement the national guideline in individual hospitals, units and practices.

Table 4 in Section 11.1 of the original guideline outlines recommendations that will have additional resource implications for NHSScotland.

Auditing Current Practice

A first step in implementing a clinical practice guideline is to gain an understanding of current clinical practice. Audit tools designed around guideline recommendations can assist in this process. Audit tools should be comprehensive but not time consuming to use. Successful implementation and audit of guideline recommendations requires good communication between staff and multidisciplinary team working.

Following the development of locally appropriate pathways or guidelines, prospective audit should be undertaken. Service providers should implement systems to ensure that the outcomes for children and young people with attention deficit hyperactivity disorder (ADHD) are routinely evaluated.

Firm outcome measures in the assessment and management of ADHD/hyperkinetic disorder (HKD) are difficult to characterise, although the use of standardised assessment measures in day to day clinical practice would be appropriate. Key areas for audit are provided in Section 11.2 of the original guideline.

Development of a national audit of the assessment and management of patients with ADHD/HKD should be considered.

See Section 11.3 of the original guideline document for additional advice to NHS Scotland.

Implementation Tools
Audit Criteria/Indicators
Clinical Algorithm
Patient Resources
Pocket Guide/Reference Cards
Quick Reference Guides/Physician Guides
Resources
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)
Scottish Intercollegiate Guidelines Network (SIGN). Management of attention deficit and hyperkinetic disorders in children and young people. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2009 Oct. 52 p. (SIGN publication; no. 112).  [155 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2001 Jun (revised 2009 Oct)
Guideline Developer(s)
Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]
Source(s) of Funding

Scottish Executive Health Department

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Guideline Development Group: Dr Fiona Forbes (Chair), Dr Dawn Adams, Ms Gazala Akram, Ms Juliet Brown, Dr Jackie Crum, Dr Johnny Graham, Dr Eleanor Kerr, Dr Rachel Oglethorpe, Ms Sue Reynolds, Dr Lorna Thompson, Ms Ruth Thomson, Ms Fiona Thomson

Financial Disclosures/Conflicts of Interest

Declarations of interests were made by all members of the guideline development group. Further details are available from the Scottish Intercollegiate Guidelines Network (SIGN) Executive.

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Attention deficit and hyperkinetic disorders in children and young people. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2001. 26 p. (SIGN publication; no. 52). [155 references]

Any amendments to the guideline in the interim period will be noted on the Scottish Intercollegiate Guidelines Network (SIGN) Web site External Web Site Policy.

Guideline Availability

Electronic copies: Available in Portable Document Format (PDF) from the Scottish Intercollegiate Guidelines Network (SIGN) Web site External Web Site Policy.

Availability of Companion Documents

The following are available:

  • Management of attention deficit and hyperkinetic disorders in children and young people. Quick reference guide. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network, 2009. 2 p. Available in Portable Document Format (PDF) from the Scottish Intercollegiate Guidelines Network (SIGN) Web site External Web Site Policy.
  • SIGN 50: A guideline developer's handbook. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network, 2008. (SIGN publication; no. 50). 112 p. Available from the SIGN Web site External Web Site Policy.
  • Appraising the quality of clinical guidelines. The SIGN guide to the AGREE (Appraisal of Guidelines Research & Evaluation) guideline appraisal instrument. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network, 2001. Available from the SIGN Web site External Web Site Policy.
  • Management of attention deficit and hyperkinetic disorders in children and young people. Recommendations online: Clinical Knowledge Evidence Translation (ROCKET). 6 p. Available from the SIGN Web site External Web Site Policy.
  • Management of attention deficit and hyperkinetic disorders in children and young people. Summary of the recommendations. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network, 2009. 2 p. Available from the SIGN Web site External Web Site Policy.
Patient Resources

The following is available:

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This summary was completed by ECRI on October 17, 2001. The information was verified by the guideline developer as of December 17, 2001. This summary was updated by ECRI on August 15, 2005, following the U.S. Food and Drug Administration advisory on antidepressant medications. This summary was updated by ECRI Institute on April 8, 2010. This summary was updated by ECRI Institute on April 7, 2014 following the U.S. Food and Drug Administration advisory on Methylphenidate ADHD Medications.

Copyright Statement

Scottish Intercollegiate Guidelines Network (SIGN) guidelines are subject to copyright; however, SIGN encourages the downloading and use of its guidelines for the purposes of implementation, education, and audit.

Users wishing to use, reproduce, or republish SIGN material for commercial purposes must seek prior approval for reproduction in any medium. To do this, please contact sara.twaddle@nhs.net.

Additional copyright information is available on the SIGN Web site External Web Site Policy.

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouseâ„¢ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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