Synopsis
Identify developmentally persistent attention, activity and impulse-regulation difficulties across settings, obtain specialist diagnosis, and deliver multimodal adult treatment with safe cardiovascular, psychiatric and diversion monitoring.
- Adult ADHD is a neurodevelopmental disorder: impairing inattention and/or hyperactivity-impulsivity began in childhood, persist, occur in at least two important settings and are not better explained elsewhere.
- Refer adults without a childhood diagnosis to a trained ADHD specialist when typical manifestations began during childhood, persisted and cause at least moderate impairment.
- Diagnosis requires full clinical, developmental, psychiatric, physical and functional assessment with observer information when useful; rating scales cannot be the sole basis.
- Assess sleep, mood, anxiety, autism, learning disability, trauma, substance use, epilepsy, brain injury and environmental demands because overlap and comorbidity are common.
- Before medicine, record pulse, blood pressure, height and weight, cardiovascular history, current medicines, mental health and diversion risk; routine ECG is unnecessary without a clinical indication.
- NICE offers lisdexamfetamine or methylphenidate as adult first-choice pharmacological options, with atomoxetine after intolerance or inadequate separate trials, alongside environmental modifications and information.
- Monitor symptoms and function as well as adverse effects, pulse and blood pressure around dose changes and at least six-monthly, adult weight every six months, and treatment need at least yearly.
Key red flags
Symptoms that began only after head injury, substance use, mood episode, sleep disorder or another adult illness do not establish developmental ADHD and require an alternative-cause assessment.
Exertional syncope, cardiac-origin chest pain, sudden death in a first-degree relative under forty, congenital heart disease or a murmur prompts cardiovascular opinion before ADHD medication.
Current psychosis, mania, severe depression, suicide risk, uncontrolled substance use or safeguarding crisis changes treatment priority and may require same-day specialist care.
Rapid dose escalation, repeated lost prescriptions, early refill requests, intoxication or third-party demand raises diversion or misuse risk without automatically proving it.
Investigation priorities
Confirm childhood onset, persistence, cross-setting symptoms, impairment and alternative explanations.
Management branches
Adult attention, restlessness or impulsivity suggests persistent childhood-onset ADHD with significant impairment.
- Document current examples, childhood evidence, affected settings, functional impact, strengths, sleep, substances, mental health and possible neurodevelopmental overlap.
- Refer for assessment by a professional trained in adult ADHD diagnosis rather than diagnosing solely from a screening score or medicine response.
- Address immediate suicide, psychosis, mania, intoxication, driving and safeguarding risks while useful organisational adjustments begin.