The ADHD Assessment Quality Assurance Standard for Children and Teenagers (CAAQAS)

Susan Young; Michael Absoud; Zainab Al-Attar; Cornelius Ani; William Colley; Samuele Cortese; Jo Crame; Gisli Gudjonsson; Peter Hill; Jack Hollingdale; Raja A S Mukherjee; Susan Ozer; Gavin Partridge; Jade Smith; Emma Louise Woodhouse; Alexandra Lewis

doi:10.2147/NDT.S472923

The ADHD Assessment Quality Assurance Standard for Children and Teenagers (CAAQAS)

Neuropsychiatr Dis Treat. 2024 Dec 24:20:2603-2628. doi: 10.2147/NDT.S472923. eCollection 2024.

Authors

Susan Young^{1

2}, Michael Absoud³, Zainab Al-Attar^{4

5}, Cornelius Ani^{6

7}, William Colley⁸, Samuele Cortese^{9

10

11

12

13}, Jo Crame¹⁴, Gisli Gudjonsson^{2

15}, Peter Hill¹⁶, Jack Hollingdale¹⁷, Raja A S Mukherjee^{18

19}, Susan Ozer²⁰, Gavin Partridge²¹, Jade Smith²², Emma Louise Woodhouse^{17

23}, Alexandra Lewis²⁴

Affiliations

¹ Independent Practice, Psychology Services Limited, London, UK.
² Department of Psychology, Reykjavik University, Reykjavik, Iceland.
³ Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK.
⁴ Independent Practice, Psychiatry UK, London, UK.
⁵ Department of Psychiatry, University of Oxford, Oxford, UK.
⁶ Division of Psychiatry, Imperial College London, London, UK.
⁷ Neurodevelopmental Team, Children and Young People's Service, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK.
⁸ Independent Practice, CLC Consultancy, Dunkeld, UK.
⁹ Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
¹⁰ Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
¹¹ Child and Adolescent Mental Health Service, Solent NHS Trust, Southampton, UK.
¹² Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA.
¹³ DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy.
¹⁴ Service-User Representative, Surrey, UK.
¹⁵ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹⁶ Independent Practice, London, WC1N 3HB, UK.
¹⁷ Independent Practice, Compass Psychology Services Ltd, London, UK.
¹⁸ ASD and ADHD Service, Horizon, Epsom, UK.
¹⁹ University of Surrey Medical School, Guildford, UK.
²⁰ Child Development Centre, East and North Hertfordshire NHS Trust, Stevenage, UK.
²¹ Partridge ADHD Clinic, Oxford, UK.
²² Children and Young People's Neurodevelopmental Service, Humber NHS Foundation Trust, Hull and East Riding, UK.
²³ Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
²⁴ Fulbourn Hospital, Cambridgeshire and Peterborough Foundation NHS Trust, Cambridge, UK.

Abstract

Around 5% of the children and teenagers worldwide are affected by Attention-Deficit/Hyperactivity Disorder [ADHD], making it a major public health concern. Recently, demand for assessments has substantially increased, putting strain on healthcare and waiting lists. There is concern that pressure to clear service bottlenecks is leading to variable quality and reliability of ADHD assessments in this population. The ADHD Assessment Quality Assurance Standard for Children and Teenagers [CAAQAS] aims to address this by proposing a quality framework for ADHD assessments in this population. CAAQAS is intended to complement formal training, provide support to clinicians, inform commissioners, and empower children, teenagers, and caregivers on what to expect from an assessment and assessment report. Our goal is to promote evidence-based high-quality assessments, improve diagnostic accuracy, and reduce the risks of overdiagnosis, misdiagnosis, and underdiagnosis. Seven key topics were identified by authors which guided the development of this expert consensus statement. It was agreed that a high-quality diagnostic assessment of ADHD in this population commences with advance preparation to facilitate engagement of the child or teenager and caregivers. The consensus agreed that the minimum/essential standards for assessing and diagnosing ADHD adopt a systematic approach from pre-assessment through assessment to post-diagnostic stage, enabling ADHD to be disentangled from differential diagnoses. The process applies multi-source information to inform an assessment of development history and early risk factors, history of physical, mental health and other neurodevelopmental conditions, family, educational, and social histories. Assessment of core ADHD symptoms should include specific developmentally appropriate examples of associated difficulties and impairments. Neuropsychiatric and physical comorbidities should be assessed and identified. Recommendations for report writing are intended to facilitate effective communication between ADHD specialists and other services, and we highlight the importance of linking the diagnosis to an appropriate post-diagnostic discussion. Further, we discuss core competencies required to conduct a diagnostic assessment of ADHD in children and teenagers.

Keywords: assessment; attention deficit hyperactivity disorder; children; diagnosis; practice guidelines; teenagers.