• ADHD Nursing Service

    We are a Team of Specialist Nurses and Non-Medical Prescribers who work within the Community Paediatric Service. We specialise in working with young people with a diagnosis of ADHD and supporting them with their medication.

*****ADHD MEDICATION SHORTAGES*****

The Department of Health and Social Care (DHSC) has issued a National Patient Safety Alert on supply disruptions affecting various strengths of the following medications for the treatment of attention deficit hyperactivity disorder (ADHD):

There are supply disruptions affecting various strengths of the following medications which are licensed for the treatment of (ADHD):

Methylphenidate:

Equasym XL® 10, 20 and 30 mg capsules

Xaggitin XL® 18 and 36 mg prolonged-release

tablets

Concerta XL® 54 mg prolonged-release

tablets

Xenidate XL® 27 mg prolonged-release

tablets

Lisdexamfetamine/ Elvanse® 20, 30, 40, 50, 60 and 70 mg

capsules

Guanfacine:      

Intuniv® 1, 2, 3 and 4 mg

prolonged-release tablets

The supply disruption of these products is caused by a combination of manufacturing issues and an increased global demand.

At present, the supply disruptions are expected to resolve at various dates between October and December 2023.

About us

Who we care for

We work with children and young people from age 6 -18 that have a formal diagnosis of ADHD and would like to trial or continue medication as a treatment option for supporting ADHD symptoms.

ADHD Team memeber  ADHD Team memeber  Nicola Eaton  Tanya Allen  ADHD3  ADHD4

 

The care we offer

The role of our service is to monitor and manage ADHD medication in children and young people with a diagnosis of ADHD.

Prior to your appointment we will send out a letter to school asking for an update and completion of a rating scale to better understand if the medication is working whilst your child / young person is in class.

ADHD scale

 

 

 

 

What happens at a medication review?

We will need to do some checks such as your height, weight, blood pressure and pulse.

Med review check 1 Med review check Med review check 3

We will also talk about physical health and mental well-being.

Talking

As part of our medication reviews we may liaise with other services, complete onward referrals and gain feedback from schools to inform treatment plans.

 

When do appointments take place?

ADHD medication review appointments are usually once every 6-12 months but you can contact us in between times although we are not an urgent or emergency service so it can sometime take us a few days to return calls.

Calendar

 

Where are the appointments?

We see young people at various locations across Norfolk.

Norfolk map ADHD

Appointment sites include Norwich community hospital, Kings Lynn St James, Swaffham community hospital, North walsham community hospital, Attleborough and long Stratton health centres. Please advise us of your preferred location when appointments are made by our bookings team.

ADHD bookings team 01603 508958

 

How children and families can access our service

Referrals are made internally only via the Paediatric Medical Service (Community Paediatrics 0-18). ADHD medication is usually commenced within the service by your child’s / young person's Paediatrician and follow-up reviews and ongoing care is supported by the ADHD nursing team alongside your child’s / young person's Paediatrician.

 

While you are waiting for an appointment

Please review and make use of the tools and resources on this page while you are waiting to be seen by our service.

What is ADHD

ADHD is a neurodevelopmental condition with a range of symptoms that can cause difficulties across at least 2 different settings, home life, education and or work life.

The main symptoms of ADHD are listed below with some examples.

Inattention Impulsivity Hyperactivity
Forgetful Doing or saying things before thinking them through Fidgets or fiddles
Loses things Risky behaviour Struggles to stay seated for long periods
Daydreams Interrupts conversations Always on the go as if being driven by a motor
Unorganised Difficulty waiting their turn Chatty
Distracted    
Unable to concentrate    
Lack of focus    

ADHD can present differently for each person; in addition, the symptoms of ADHD can change as we grow older. Please see the section on transition for how ADHD can present differently across different ages and stages of life.

ADHD can have a number of co-morbidities (conditions associated with ADHD).

ADHA comorbities

 

Video for younger children

Video for teens and adolescents

Video for parents

ADHD and exercise

We have all heard that exercise is important to help keep our bodies fit and healthy and maintain a healthy weight. It also helps with heart health, helps to keep our bones strong, as well as helping with our mental health and self-esteem.

In addition to all these benefits, exercise and keeping fit is a key part of treatment for ADHD. Exercise can help reduce symptoms of ADHD by increasing the number of neurotransmitters in the brain such as dopamine. Dopamine is one of the brain chemicals that help with focus, concentration, and the ability to think more clearly. 

For children and young people aged 5-18 the recommended amount of daily exercise is 60 minutes a day of moderate exercise.

ADHD and diet

Good nutrition and a healthy balanced diet is also important in ADHD.  We recommend eating a healthy balanced diet and we do not recommend eliminating foods. This should only be done under the care of a dietician. 

  • Eat at least 5 portions of a variety of fruit and vegetables a day
  • Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates
  • Eat some beans, pulses, fish, eggs, meat and other protein foods
  • Have some dairy or dairy alternatives (such as soya drinks and yoghurts)
  • Choose unsaturated oils and spreads, and eat in small amounts
  • Eat small amounts of foods high in fat, salt and sugar and eat them less often.

Some people may find that certain foods increase their ADHD symptoms, but everyone is different and if this is the case it is worth keeping a diary to see if there is a clear link between certain foods and ADHD behaviour. Some people need a referral to a dietician and keeping a food diary can help with the referral.

Drinks

Drink plenty of fluids – the government recommends 6 to 8 cups or glasses a day. Water, lower-fat milk, and lower-sugar or sugar-free drinks all count. Fruit juice and smoothies also count towards your fluid consumption, but they contain free sugars that can damage teeth, so limit these drinks to a combined total of 150ml a day.

Energy drinks contain high levels of sugar. They also contain high levels of caffeine - often twice the amount found in a strong cup of coffee. This can cause many health and wellbeing problems including high blood pressure, irregular heartbeats, anxiety, hyperactivity, and stomach aches.

Energy drinks do not provide any helpful vitamins and minerals so are best avoided by everyone – especially children and young people.

Click here for more information about eating a healthy and balanced diet.

Sleep

Sleep is really important, especially for those with ADHD. Not getting enough sleep can mimic the symptoms of ADHD.

You will often hear us talk about the use of screens. Here is a video to explain why:

Sleep services

https://www.nansa.org.uk/sleep-service/

Further information

Sleep advice

Medication for ADHD

For some people medication for ADHD can be helpful when used along side other strategies (please see strategies to support ADHD section).  For others medication is not an option and this could be for various reasons such as not being able to tolerate side effects or a family history of certain health risks.

Medication for ADHD is split into 2 main categories, stimulants and non-stimulants. Some of the medications used are controlled substances and should be handled with care and locked away.

ADHD differs from person to person and therefore a medication that is suitable for one person may not be suitable for another person.

Video to help understanding of how some medications work

Some of the medications for ADHD come with serious side effects and this why it is important to attend appointments to have the physical checks and also to report any side effects.

The NICE guidance sets out treatment of ADHD and recommends that ADHD medication should be used along side non-pharmacological strategies as mentioned above.

There maybe times when we need to have a planned break from medication for medical reasons or times when a young person decides to have a break from medication, but this will be discussed during the appointment.

The main thing to remember is that medication is only part of the picture, and it is not a “fix” or a “cure” for ADHD.

Sometimes we will prescribe medication for sleep, this medication is called melatonin but again this only works when used along side sleep strategies (please see section on sleep).

Tics and Tourette's

Tic disorders are a neurodevelopmental condition and are involuntary movements of a muscle that can happen in any part of the body. Tics can present as either Motor tics (moving tics) and vocal tics (vocal sounds) sometimes people have both motor and vocal tics.  Tics are a neurodevelopmental condition and be common in children and young people with ADHD and other neurodevelopmental conditions. Tics can come and go and can be triggered by emotional responses such as excitement or anxiety. There are a number of tic disorders including Tourette’s.

Tourette’s is a tic disorder for which there is certain diagnostic criteria; Onset before age 18. 2 or more motor tics, 1 or more vocal tics that have been persist for more than 1 year. Please visit the Tourette’s Action website for more information.

Transition to adulthood

Around two-thirds of young people will continue to experience ADHD symptoms into adulthood Price et al (2018).

We will continue to see young people to review their ADHD medication until they are 18. Your final appointment will be on or around your 18th Birthday, but we should be talking about transitioning from around the age of 16. In Norfolk there is an adult ADHD service that sees people from 18 years old onwards and they will continue to review your medication. More details about the Adult ADHD Service can be found on the Norfolk and Suffolk Foundation NHS Trust website.

We have developed a transition leaflet and pack which goes through transitioning in more detail and looks at FAQs (frequently asked questions).

 
This Royal college of Physiatrists web page has an explanation of what ADHD is, some nice self-help tips, and suggestions for books about ADHD.

Useful resources and further information

ADHD resource leaflet

Local resources and contacts

National ADHD charity’s/support groups

Support for teenagers (and parents/teachers)

Mental health

NICE guidance on diagnosis and treatment of ADHD