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Primary Care

How to refer to our ADHD clinic - A Guide for GPs

We operate a specialist ADHD clinic seeing children who have issues with concentration and or hyperactive/ impulsive behaviour without significant co-morbidity such as Autism, conduct disorder or mental health problems. Children with these co-morbidities should be referred to other service providers.

In order to screen children appropriately, we need this referral form to be completed and parents and teachers to fill in the SNAP and Australian questionnaires.

Please use the email address Paediatric.2@asph.nhs.uk or ask to speak to a clinician on helpline 0193272 (2126), (2538) or (2764) for clarification, if needed.

If you are using the email address above, it should not contain patient details.

Assessment

Australian Scale Questionnaire Click to download in Word format Click to download in PDF format
ADHD Clinic Referral Form Click to download in Word format Click to download in PDF format
School Report   Click to download in PDF format
SNAP Click to download in Word format Click to download in PDF format

Shared Care Protocols

For the use of Atomoxetine (Strattera®) in Attention Deficit Hyperactivity Disorder in Childhood





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  • Atomoxetine is indicated for use as part of a comprehensive treatment programme, where remedial behavioural methods alone have failed. Treatment must be initiated by a Child Psychiatrist or a Specialist Paediatrician for children and adolescents, for adults treatment must be initiated by a Psychiatrist with appropriate knowledge and experience of ADHD.
  • Atomoxetine is licensed for children 6 years of age and older, adolescents and adults.
  • Atomoxetine is usually given as a single dose in the morning, however if patients experience unwanted side effects when taking atomoxetine as a single daily dose they may benefit from taking it as a twice daily evenly divided divided dose in the morning and late afternoon or early evening. Atomoxetine can be taken with or without food; however gastrointestinal side effects can be decreased by administering atomoxetine with food.
For the use of Dexamfetamine (Dexedrine®) in Attention Deficit Hyperactivity Disorder in Childhood





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  • Dexamfetamine is indicated for use as part of a comprehensive treatment programme, where remedial behavioural methods alone have failed. Various trials show that the most effective treatments are those combining treatments with medication, but the resource implications of this means that many children would receive no care and medication alone does show significant gains.
  • Dexamfetamine is not licensed for children under three and is usually discontinued during adolescence.
  • Dexamfetamine is a controlled drug subject to safe custody and handwriting regulations on prescriptions were total quantity to be supplied must be specified in both words and figures.
  • For children <6 years: the dose starts at 2.5mg a day and is gradually titrated up if necessary by weekly increments of 2.5mg of the total daily dose to a maximum of 20mg daily. For children >6 years: the dose starts at 5-10mg a day and is gradually titrated up if necessary by weekly increments of 5mg of the total daily dose to a maximum of 40mg daily. The maintenance dose should be given as divided doses (usually 2-3 times daily).
  • Twice daily doses are usually given in the morning and at lunchtime, however if the effect of the drug wears off to early in the evening disturbed behaviour and or inability to sleep may recur. A small evening dose may help to solve this problem.
  • If improvement of symptoms is not observed after appropriate dosage adjustment over a one month period the drug should be discontinued by the consultant.
For the use of Methylphenidate (Ritalin®, Equasym®, Equasym XL, Concerta XL® Medikinet, Medikinet XL) in Attention Deficit Hyperactivity Disorder in Childhood





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  • Methylphenidate is indicated for use as part of a comprehensive treatment programme, where remedial behavioural methods alone have failed. Various trials show that the most effective treatments are those combining treatments with medication, but the resource implications of this means that many children would receive no care and medication alone does show significant gains1. A Canadian meta-analysis and another trial show that drug therapy alone is as efficacious as combined drug/ psychosocial therapy, but that either may not improve academic performance.
  • A study looking at stimulant treatment over five years indicates that children with ADHD continue to derive benefit and continue to experience adverse effects from ongoing use of stimulants. They conclude that for children with significant symptoms, using stimulants consistently over several years remains therapeutic with ongoing clinical monitoring required to maximise benefit and to limit adverse effects.
  • Methylphenidate is not licensed for children under 6, but may be so used under certain circumstances by the consultant. It is usually discontinued during adolescence.
  • Methylphenidate is a controlled drug subject to safe custody and handwriting regulations on prescriptions where total quantity to be supplied must be specified in both words and figures.
  • Dose initially starts at 5mg once or twice daily (morning and lunch time) and is then gradually titrated up to a maximum of 60mg daily in divided doses at intervals of 3-4 hours. The dose should be titrated up by weekly increments of 5-10mg of the total daily dose.
  • The patient can be changed to the m/r preparation if appropriate up to a maximum of 54mg once daily (see Concerta XL SPC for details)
  • Twice daily doses are usually given in the morning and at lunchtime, however if the effect of the drug wears off to early in the evening disturbed behaviour and or inability to sleep may recur. A small evening dose may help to solve this problem.
  • If improvement of symptoms is not observed after appropriate dosage adjustment over a one month period the drug should be discontinued by the consultant.
Lisdexamfetamine (Elvanse®) for the Treatment of ADHD





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  • Lisdexamfetamine dimesylate is indicated as part of a comprehensive treatment programme for attention deficit/hyperactivity disorder (ADHD) in children aged 6 years of age and over when response to previous methylphenidate treatment is considered clinically inadequate.

  • Lisdexamfetamine dimesylate is a pharmacologically inactive prodrug. After oral administration, lisdexamfetamine dimesylate is rapidly absorbed from the gastrointestinal tract and hydrolysed primarily by red blood cells to dexamfetamine.

DOSE: The starting dose for all patients is 30mg once daily in the morning. This may be increased at approximately weekly intervals by 20mg increments, to a maximum of 70mg once daily. The lowest effective dose should be administered.
  • Lisdexamfetamine dimesylate may be taken with or without food. The capsules should be swallowed whole or opened, the contents dispersed in a glass of water (stir until completely dispersed) and the resulting solution swallowed immediately (a film of inactive ingredients may remain in the glass).
  • Afternoon doses should be avoided (risk of insomnia). If there is a missed morning dose, wait until the following morning before administering the next dose.
  • Treatment should be stopped if the symptoms do not improve after 1 month at an appropriate dose. Reduce the dosage if paradoxical aggravation of symptoms/other intolerable adverse events emerge.
Note: Lisdexamfetamine dimesylate is a Prescription Only Medicine (POM) however recent guidance from the Royal Pharmaceutical Society has advised that is should be treated as a Schedule 2 controlled drug.

Abuse liability- the SmPC gives details of abuse liability studies which showed that lisdexamfetamine dimesylate has less potential for abuse than dexamfetamine.
Melatonin (Circadin®) (off label use) for the Treatment of Persistent Sleep Disorders in Children over 3years old with ADHD





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Insomnia is a widespread problem in children with neurodevelopmental or psychiatric disorders such as autistic spectrum disorder and attention deficit hyperactivity disorder (ADHD).

Behavioural therapy can be very effective in some forms of paediatric insomnia however children with neuropsychiatric disorders tend to have a lower response rate to behavioural therapy and may require drug treatment.


Melatonin (N-acetyl-5-methoxytryptamine) is a neurohormone produced by the pineal gland during the dark hours of the day and night which appears to support the normal circadian rhythm and aid sleep onset. It is used as a treatment of sleep disorders in children. It is most helpful where sleep onset is a significant problem, but is rarely useful to maintain sleep if a child is waking during the night. Melatonin should not be used in isolation but should be combined with a behavioural programme, involving Clinical Psychology where necessary.

The use of a weekly sleep diary before and during treatment will assist the monitoring of response.
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