ADHD in Adults: A NICE NG87 Guide for Care and Health Staff

Attention deficit hyperactivity disorder (ADHD) is often thought of as a childhood condition, yet many adults are diagnosed for the first time in their thirties, forties or later, and many more carry a childhood diagnosis into adult life. For staff in care homes, supported living, community teams, primary care and workplaces, that means working with adults who may be managing ADHD medicines, waiting for an assessment, or struggling without support. NICE guideline NG87 covers diagnosis and management of ADHD across the life course. This guide pulls out the parts that matter to care and health staff. It is general information, not clinical advice.

What ADHD looks like in adults

ADHD involves persistent difficulty with attention, impulsivity and, for some people, hyperactivity that affects daily life. In adults, hyperactivity often shows up as restlessness rather than running around. Typical day-to-day effects include losing track of tasks and appointments, difficulty starting or finishing work, trouble with time and money management, impulsive decisions, and emotional ups and downs. Many people also have other conditions alongside it, such as anxiety, depression, autism or a learning disability, which can mask or complicate the picture. See, for example, our guide to Tourette syndrome and tics, which frequently co-occurs with ADHD.

How adults are assessed

NG87 says that an adult who did not have a childhood diagnosis should be referred for assessment by a mental health specialist trained in the diagnosis and treatment of ADHD when their symptoms started in childhood, have persisted, are not explained by another diagnosis, and cause moderate or severe psychological, social or occupational impairment. In other words, a diagnosis rests on history over time and impact on daily life, not on a single questionnaire. Staff cannot diagnose ADHD, but they can help by recording what they observe, supporting the person to gather childhood information such as school reports where possible, and making sure the referral does not stall.

Medicines and why monitoring matters

For adults who need medicine, NG87 says to offer lisdexamfetamine or methylphenidate as the first-line medicine. The guideline asks that physical health is monitored while someone is on ADHD medicine, including blood pressure, pulse and weight, and that clinicians watch for tics, sexual problems, seizures, sleep problems and any worsening of behaviour. NICE also says that an appropriately trained health professional should review ADHD medicine at least once a year and talk with the person about whether it should continue. After the dose has been titrated and stabilised, prescribing and monitoring are expected to continue under shared care arrangements with primary care.

For care staff, this has practical consequences:

• Record sleep, appetite and weight changes, because ADHD medicines can affect all three.
• Pass on any palpitations, chest pain, new or worse anxiety, tics or seizure-like events to the prescriber promptly.
• Make sure the annual review is booked, and that a person who is moving between services does not fall through a gap in shared care.
• Follow your medicines policy for controlled drugs, which many ADHD medicines are, including safe storage and accurate records.

Support that is not medicine

NG87 says that people who do not take medicine, or who do not respond well enough to it, should be offered a structured supportive psychological intervention focused on ADHD, with regular follow-up in person or by phone. Everyday strategies that staff can encourage include visual timetables and reminders, breaking tasks into short steps, setting a regular routine for sleep and meals, reducing distractions, and using body-doubling or checklists for tasks that are easily abandoned. These are not a substitute for treatment, but they make daily life easier and are often valued by the person.

Risks to look out for

People with untreated ADHD are more likely to experience job loss, debt, relationship breakdown and accidents. The person may also be more vulnerable to exploitation because of impulsivity. Where there are signs of low mood or hopelessness, follow your suicide and self-harm procedures, and make sure staff are confident to ask directly. Alcohol and drug use can also be a way of coping with ADHD symptoms, so be alert to substance misuse alongside it.

ADHD at work and in learning

ADHD can count as a disability under the Equality Act 2010 where the effects are long term and substantial, in which case employers and education providers have a duty to consider reasonable adjustments. Adjustments might include a quiet workspace, written instructions, regular check-ins, flexible deadlines or assistive software. Managers and supervisors benefit from the same awareness training as clinical staff; our guide to equality and diversity training is a useful starting point, and the principles in Oliver McGowan training on learning disability and autism apply well to neurodiversity more broadly.

Frequently asked questions

Can a care worker raise a concern that a resident may have ADHD?

Yes. You can share your observations with the person's GP or care coordinator, but you should not tell them they have ADHD. Only a trained specialist can diagnose it.

Is ADHD medicine addictive?

Many ADHD medicines are controlled drugs and carry misuse risks, which is why monitoring, safe storage and regular review matter. Decisions about starting or stopping belong to the prescriber and the person.

What training should staff do?

Neurodiversity awareness, medicines safety and recognising when someone needs more support are good starting points. Explore the Learnsignal CPD hub for healthcare compliance courses.

Source: NICE guideline NG87, Attention deficit hyperactivity disorder: diagnosis and management. Always check the current version, which NICE updates periodically. This article is general information, not clinical advice.