Introduction

ADHD (attention deficit hyperactivity disorder) is a heterogeneous behavioural syndrome characterised by maladaptive levels of hyperactivity, impulsivity and inattention. ADHD (as defined by DSM-IV-TR) is a common disorder affecting 3.6% of boys and 0.85% of girls between the ages of 5 and 15 years in the UK.1 DSM-IV describes three subtypes of ADHD according to the mixture of symptoms: predominantly inattentive (ADHD-I), predominantly hyperactive-impulsive (ADHD-HI) and combined type (ADHD-C). The ICD-10 definition of hyperkinetic disorder (HKD) describes a severe subgroup of the DSM-IV combined type ADHD and affects about 1.5% of primary school-age boys. In recent years there has been an increase in the clinical recognition of ADHD/HKD with a corresponding rise in the numbers diagnosed and treated, from an estimate of 0.5 per 1000 children diagnosed in the UK 30 years ago2 to more than 3 per 1000 receiving medication for ADHD in the late 1990s.3 This article summarises the main recommendations from the ADHD guideline produced by the National Institute for Health and Clinical Excellence. Readers should refer to the full guideline for the complete set of recommendations and supporting evidence4 (www.nice.org.uk/CG072).