In September 2008, the National Institute for Health and Clinical Excellence (NICE) published a clinical guideline on the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in children, young people and adults.
ADHD is a common behavioural disorder in children and young people and is estimated to affect up to three per cent of school-age children and young people in the UK. Symptoms of ADHD include regular inattentiveness, long periods of hyperactivity and impulsive behaviour, such as speaking without thinking and being unable to wait or take turns. These symptoms are usually present from an early age and some people will continue to have ADHD into their adult life.
SEN Magazine: As a teacher, were you aware of any myths associated with ADHD? For example, that it is not a medical condition but children behaving badly.
Dr Merrell: One of the reasons I wanted to get involved in developing this guideline was to help dispel some of the myths about ADHD, for example that the condition is caused by “bad parenting”. ADHD is a real disorder with real consequences for the child affected and their family, but up until now there has been widespread variation in diagnosing and managing it.
Children with ADHD appear to be running on a motor, have continual energy and little focus on one thing. This is not simply a case of bad behaviour. They often have problems making friends and completing work and can be involved in more accidents. If this is ignored it can have serious implications for the child in later life.
SEN Magazine: How will this guideline impact on the role of teachers?
Dr Merrell: Teachers and early year’s practitioners are well placed to identify children and young people with disorders of conduct and behaviour, such as ADHD. The NICE guideline will help to ensure teachers are aware of the possible signs of the condition and the support that is available to them, both from the SENCO at the school and the child’s healthcare professionals.
The guideline recommends that school staff who are trained in the management of behavioural conditions, such as ADHD, should identify appropriate interventions that the teacher can apply in the classroom environment. Additionally, with the consent of the child’s parent or carer, healthcare professionals working with a child should provide advice to the school on the severity of a child’s symptoms and their treatment plan. This communication can provide more streamlined care for the child both in and outside the classroom.
The guideline also outlines how, at a national level, the Department for Children Schools and Families (DCSF), in discussions with the Training and Development Agency for Schools (TDA), should consider enhancing the education of trainee teachers so that they are better able to recognise the signs and symptoms of ADHD.
SEN Magazine: Do you think parents will feel reassured by this guideline?
Dr Merrell: I hope so; this guideline really puts ADHD on the map and says that it is time to take the condition seriously. In this guideline, we recommend parent training and education programmes to provide everyone working with children with strategies for dealing with difficult children and small steps they can take, for example giving children a smaller breakdown of tasks or providing pictures to help make things easier for the child to understand.
SEN Magazine: What are your hopes for this guideline?
I hope this guideline will be implemented successfully in order to provide effective help for children with ADHD. It is a real condition that not only impacts on the life of the child with the condition, but also siblings, family members, and other people they come into contact with as they go into adult life. I believe these guidelines will make people with ADHD and their families feel more confident that the problem can be recognised and managed.
I hope that more teachers will be properly trained to recognise ADHD and manage individuals within existing classes. In each large class, an average of one pupil will have ADHD. By identifying and diagnosing ADHD, more children, young people and adults can be supported to achieve their full potential.
Key recommendations from the NICE guideline include:
- trusts should ensure that specialist ADHD teams for children, young people and adults jointly develop age-appropriate training programmes for the diagnosis and management of ADHD for professionals who have contact with people with ADHD
- parent-training/education programmes should be offered as first line treatment of ADHD. Healthcare professionals should offer parents or carers of pre-school children with ADHD a referral to a parent-training/education programme as the first-line treatment
- teachers who have received training about ADHD and its management should provide behavioural interventions in the classroom to help children and young people with ADHD
- if the child or young person with ADHD has moderate levels of impairment, the parents or carers should be offered referral to a group parent-training/education programme, either on its own or together with a group treatment programme (cognitive behavioural therapy and/or social skills training) for the child or young person
- in school-age children and young people with severe ADHD, drug treatment should be offered as the first-line treatment. Parents should also be offered a group-based parent-training/education programme
- drug treatment for children and young people with ADHD should always form part of a comprehensive treatment plan that includes psychological, behavioural and educational advice and interventions
- drug treatment for adults with ADHD should always form part of a comprehensive treatment programme that addresses psychological, behavioural and educational or occupational needs
The NICE guideline is available at: www.nice.org.uk/Guidance/CG72