PATIENT PRESENTATION

Patient presents with suspected

diagnosis of ADHD (Attention
Deficit Hyper-activity Disorder)

ADHD - Diagnosis in Adults

FUNCTIONAL DISABILITY?
Does patient have a psychiatric co-morbidity
or significant functional disability? REFERRAL NOT REQUIRED
Functional disability may include difficulties in No Referral for diagnosis and treatment
the following settings: of ADHD would not normally be
 At home indicated in these patients.
 In educational environment or at work
 With friends or relatives
 In other activities

Yes

PREVIOUS DIAGNOSIS REFERRAL

Yes Consider routine referral to
Has patient previously been
Community Mental Health
diagnosed with ADHD?
team - “Adult Psychiatry”

No

REFERRAL
Consider referral for advice
to Community Mental Health
team - “Adult Psychiatry”

FURTHER ASSESSMENT
Following discussion within the community
mental health team, further information may
be sought from the referring clinician or from
the patient directly (including ASRS-1).
Pending the outcome of further information,
the outcome will be either:
 Face to face assessment ± treatment
 Advice back to GP and patient

This guidance is issued for the use of Primary Care Clinicians in NHS Grampian who are seeking
diagnostic and treatment advice regarding adults who may have Attention Deficit Hyper-activity
Disorder (ADHD).

It is not designed to be used where an adult with a previous diagnosis of ADHD has been
established in childhood or adolescence and the patient continues into adulthood on treatment, or
has lapsed from follow up and treatment. In those circumstances a referral to the Community
Adult Psychiatric Service is appropriate.

Version – 1 Title – ADHD - Diagnosis in Adults Department – Mental Health FINAL

Creator – Iain Small and Alastair Palin Lead – Alastair Palin Last Review – 28 January 2020 Next Review – 28 January 2022
All guidance will routinely be reviewed every 24 months from the “last review” date. Information contained in this document is intended as guidance of best practice.
 ADHD - Diagnosis in Adults

1) Can Primary Care Clinicians refer a patient who suspects they have undiagnosed ADHD?

Information about the Adult ADHD referral pathway will be available on the Referral Guidance
section of the NHS Grampian Intranet. In addition, a presentation to the GP Sub Committee will take
place in early 2020.

2) At what level of disability is referral appropriate?

Adult patients with suspected but undiagnosed and untreated ADHD require specialist input only
where they suffer from functional disability as a consequence of their symptoms, and/or they have
significant co-morbid psychological or psychiatric symptoms.

Useful assessment tools to identify this sub-group of people who may present seeking a diagnosis
would include:

 ASRS-1 – although primarily a tool validated in children and adolescents, there is a body of opinion
that it is useful in undiagnosed adults
 PHQ9 for the assessment of depression
 HADS anxiety and depression score

It is not appropriate to refer patients who seek a diagnosis where such a diagnosis will not influence
the person’s clinical outcome. As gatekeepers to specialist investigation, NHS Grampian supports
Primary Care clinicians in declining such requests from residents.

3) Where should referrals be sent?

Where Primary Care assessment has identified functional impairment or significant co-morbidity,
referrals should be made to the local Community Adult Mental Health Team in the same way as
other routine referrals are made.

The referral will include electronic and confidential contact details for referrer. Referrals will be
triaged by the Community Adult Mental Health team, with the facility for a clinician to clinician
discussion as required on a case by case basis.
This will negate the need for complex ‘mandatory field’ referral protocols.

Patients should understand that this is an assessment service, and that not all referrals will
automatically generate an appointment with a specialist.

Version – 1 Title – ADHD - Diagnosis in Adults Department – Mental Health FINAL

Creator – Iain Small and Alastair Palin Lead – Alastair Palin Last Review – 28 January 2020 Next Review – 28 January 2022
All guidance will routinely be reviewed every 24 months from the “last review” date. Information contained in this document is intended as guidance of best practice.
 ADHD - Diagnosis in Adults

4) What happens next?

All referrals will be screened by the Community Mental Health Team. They will seek an opportunity
to discuss some cases further before either accepting them or giving supportive advice. This
discussion may be by e mail, video conference or telephone.

The Community Adult Mental Health team may request additional information such as a completed
ASRS questionnaire directly from the patient.

Not all referrals will generate further correspondence, and not all referrals will generate an outpatient
appointment, where the problem can be resolved or treatment advice given without use of an OPD
appointment this will be facilitated.

Where a Community Mental Health Assessment is deemed un-necessary, this will be communicated
to the GP and the patient by the team.

5) Face to face assessment and follow up.

Where it is clinically necessary, the Community based adult Psychiatry team will see and assess
patients, as part of their existing service. Once a diagnosis has been confirmed and a treatment plan
agreed, this will be communicated back to Primary Care in the usual way. On-going prescribed
treatment will be mutually agreed with the Patient, Psychiatry and Primary Care, and a review plan
set out, in a manner similar to DMARDs and other significant shared care situations, and in line with
‘Prescribing across Secondary and Primary Care’ [NHSG January 2020].

In a situation where a patient becomes lost to follow up, and where considerable effort has been
made to contact and review the patient, it is reasonable and safe for either Primary or Secondary
Care to discontinue prescribed medication.

Version – 1 Title – ADHD - Diagnosis in Adults Department – Mental Health FINAL

Creator – Iain Small and Alastair Palin Lead – Alastair Palin Last Review – 28 January 2020 Next Review – 28 January 2022
All guidance will routinely be reviewed every 24 months from the “last review” date. Information contained in this document is intended as guidance of best practice.