Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Acute behavioural or treatment-related danger
ADHD itself is not an emergency, but acute psychosis or mania, suicidal intent, severe aggression, stimulant overdose and exertional cardiovascular symptoms require urgent assessment.
Action: Use ABCDE, obtain observations and capillary glucose, secure immediate safety and seek emergency paediatric, mental-health or poisons advice according to the presentation. Stop ADHD medication during an acute psychotic or manic episode and arrange specialist reassessment before any restart. Chest pain, collapse, sustained tachyarrhythmia or severe hypertension after a stimulant needs urgent cardiovascular assessment; do not attribute these findings to behaviour. Suspected overdose requires exact drug, formulation, amount and time, ECG and National Poisons Information Service or TOXBASE-guided care. Escalate suicidal intent or inability to maintain safety through the local urgent mental-health pathway and safeguarding procedures.
Synopsis
Recognise developmentally inappropriate inattention, hyperactivity and impulsivity, establish impairment across settings through specialist assessment, distinguish common mimics and coexisting needs, and use environmental, behavioural and medicine interventions safely in children and young people.
ADHD is a neurodevelopmental disorder: symptoms are developmentally inappropriate, began before age 12, persist, occur in at least 2 important settings and cause clear functional impairment.
Diagnosis is specialist and clinical. Rating scales support multi-informant assessment but neither a positive nor a negative score can independently diagnose or exclude ADHD.
Always assess sleep, hearing, vision, language, learning, autism, tics, anxiety, depression, trauma, epilepsy and the classroom environment; coexistence is common.
Key red flags
Syncope on exertion, exertional chest pain, sudden-onset rapid regular palpitations, a murmur or a first-degree relative who died suddenly before age 40 requires cardiovascular opinion before ADHD medication.
Investigation priorities
01
Reference standard: specialist clinical diagnostic assessmentFirst stepReference standard
Integrate developmental and psychiatric history, symptom criteria, onset, persistence, multi-setting impairment, observation, collateral and differential diagnosis.
02
First-line: multi-informant history and collateralFirst line
Obtain concrete examples from child, caregivers and education, including strengths, impairment, age of onset, masking and environmental support.
Management branches
DiagnosisEstablish a persistent multi-setting pattern
Inattention, hyperactivity or impulsivity is causing concern.
Screen immediately for acute risk, regression, seizures, sleep disorder, sensory loss, trauma and safeguarding concerns.
Gather developmental history and concrete child, caregiver and education examples, then refer for specialist assessment when symptoms persist and impair function.
Key medicines
Methylphenidate immediate releaseChild 6–17 years: start 5 mg orally once or twice daily, increasing by 5–10 mg at weekly intervals; maximum 60 mg daily in divided doses. Space doses by about 4 hours. Age 5 use is specialist and off-label.
Methylphenidate modified release, approximately 12-hour tabletFor a suitable licensed formulation from age 6: start 18 mg orally each morning and increase by 18 mg at approximately weekly intervals; usual child maximum 54 mg daily. Follow the chosen product's SmPC.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.