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ADHD diagnosis

–

Start

Has a comprehensive mental health assessment been done?
Assess

no

yes

Does the young person have significant personal and social impairment
Exit

no

yes

Do the problems include severe developmentally inappropriate
inattention, impulsivity and hyperactivity that impairs functioning?
Consider other
diagnoses

no

yes

Are these problems present in more than the home environment?

no

yes

Have these problems been present since before age 7?

no

yes

Have reliable and valid rating scales been administered
to parent and teacher (or other caregivers)
Can it be done?

no

yes

no

Do the ratings indicate ADHD?

no

yes

yes

Is there good
evidence of ADHD
from other sources?

Diagnose ADHD

yes

no

Are the problems of hyperactivity, impulsivity and inattention
equally disabling?

no

yes

Diagnose ADHD
Mixed HI and
Inattentive type

yes

Diagnose
ADHD HI type

yes

Diagnose ADHD
Inattentive type

Are the problems primarily hyperactivity and impulsivity?

no
Are problems primarily inattention?
Consider other
diagnoses

no

re-enter

Are there other severe behavioural or learning problems?

yes

no

Are these longstanding, serious, cross-situational problems of intentional,
developmentally inappropriate defiance and/or rule breaking?

no

yes

Are these serious problems of learning not due to inadequate education?

no

yes

Are there other serious problems not accounted for by any of the above?

Diagnose comorbid
Oppositional Defiant or
Conduct Disorder & consider
ODD/CD guidelines
re-enter
Diagnose comorbid learning
disorders or Mental Retardation and
appropriate care
re-enter

no
Go to
ADHD Care Plan Decision Tree
over

yes

Consider other comorbid
diagnoses (eg; Anxiety Dis)
and appropriate care
re-enter

New Zealand Guidelines for the Assessment and Treatment of ADHD. July 2001

ADHD care plan

Start
–

Have the needs of the young person and family/whanau for holistic and
culturally safe care been considered?

no

yes

Holistic/cultural care guidelines

Have all the care plans for comorbid diagnoses been considered?

no

yes

Other diagnoses care guidelines

Has written information on ADHD, medication and care been given?

yes

no

Give information

no

Consider other stimulant or
antidepressant
(or behaviour therapy)

Can stimulant (other) medication be safely given?

yes

Are guardian and young person willing to try this medication?
Discuss further or other med or
behaviour therapies

no

yes

Have systems of assessment of effect/side effects been set up for
home and school systems?

no

yes

Set up assessment systems

Is 24-hour medical advice on medication available to caregivers?

no

yes

Set up 24-hour call system

Commence stimulant (other) medication in low dosage
Assess 1–2 weekly. Adjust dosage and regimen
To behaviour therapies
Do caregivers, young person, teachers etc notice significant improvement
judged to be in young person’s best interest and without overriding
side effects and with response and timing consistent with medication?

no

yes

Review no less than 3–12 monthly
Re-enter at any time or tree point

yes

Go to “Consider other stimulant”
(above)

Consider other stimulant or antidepressant?

no

Consider evidence-based caregiver/youth/social behavioural interventions?

no

yes

Has information been given and informed consent and assent obtained?

no

yes

Give information
Get consent

Have caregiver/school systems of assessing behavioural interventions
been set up?

no

yes

Set up systems

Start behavioural interventions

Do caregivers, young person, teachers etc notice significant improvement judged
to be in young person’s best interest and without overriding negative effects?

no

yes

Is response to medication and/or behavioural interventions partial
and insufficient?

Re-assess often
Re-enter decision tree at any point
if needed still

no

yes

Consider neuroleptic medication instead of or in combination with
above treatments?

no

yes

Is modified care plan still unsatisfactory?

no

yes

Reconsider diagnosis (eg PDD, Anxiety or Conduct Disorder)
Get second opinion or refer to another facility if possible

Exit

Re-enter above at
“Can stimulant (other) medication
be safely given”