How should I approach the assessment of a child with suspected ADHD in a primary care setting?

Assessment approach for a child with suspected ADHD in primary care:

• Begin by determining the severity of the child's behavioural and/or attention problems and how these affect their development, family life, and functioning across multiple settings such as home, school, and social environments.
• Assess the social and educational impact of symptoms, including self-care, relationships, school achievement, and emotional well-being.
• Use validated rating scales like the Strengths and Difficulties Questionnaire or Conners' rating scales as adjuncts to clinical judgment, but do not rely solely on these tools for diagnosis.
• If symptoms cause only moderate impairment, consider a period of watchful waiting up to 10 weeks, during which self-help strategies and simple behavioural management can be encouraged, and offer referral to group-based ADHD-focused support for parents or carers.
• If behavioural and attention problems persist with at least moderate impairment after watchful waiting or parent support, or if symptoms cause severe impairment, refer the child promptly to secondary care specialists such as child psychiatrists, paediatricians, or specialist ADHD CAMHS for formal assessment.
• Do not make an initial diagnosis or start medication for ADHD in primary care; diagnosis and treatment initiation should be done by specialists with appropriate training and expertise.

This approach ensures early support while reserving formal diagnosis and treatment initiation for specialist services, in line with NICE guidelines.

References: ¹,²