Table 1 Category 1 Delphi statements (n=24) reaching consensus on both importance and feasibility
Delphi statement numberCategory 1 statementsImportance median scoreFeasibility median scoreSource: NICESource: MTA/TexasSource: stakeholderSource: study team
1Baseline assessment of ADHD should include a description of impairment (severe/mild-moderate).98
5Baseline assessment should routinely document comorbid conditions99
6Drug treatment should be offered to all children with severe ADHD98.5
43A physical examination, including recording of pulse, blood pressure, height and weight should occur before starting medication99
44Cardiovascular risk factors should be asked about and documented99
45The starting dose of methylphenidate should be the lowest available dose of the prescribed formulation8.59
49Atomoxetine should be titrated on a ‘milligram per kilogram’ basis77
50The dose of atomoxetine should be increased 7 days after initiation7.59
62Side-effects should be recorded at each dose change by parents8.59
86Compliance with medication should be assessed by discussion with the parent/carer and the child/young person99
95Height should be measured every 6 months99
96Weight should be measured 3 and 6 months after drug treatment has started and every 6 months thereafter99
97Height and weight should be recorded on a growth chart99
101The continuing benefit of medication should be formally reviewed and a decision documented on an annual basis with input from the parent/carer, young person and school99
14Where drug treatment is considered appropriate, methylphenidate, atomoxetine or dexamfetamine should be used9n/aa
16Reasons to choose atomoxetine should include unresponsive to methylphenidate or intolerable adverse effects9n/aa
13Clinicians should check and document whether or not the child can swallow pills77.3
48Stimulant drugs should be titrated with regular step-wise dose increases to achieve the minimum effect dose99
56The titration schedule should be documented at initiation specifying drug, dose, duration of each step and review date99
15Methylphenidate should normally be considered the first-line drug for treatment of ADHD9n/aa
25Before initiation of medication, different drug options in terms of benefits (e.g. different duration of action) and adverse effects should be discussed with parents and children (age >11)99
28Drug information sheets should include details of what parents should do if adverse effects occur99
29A medication protocol should include drug information sheets98.5
61The duration of the dose titration phase should be a maximum of 12 weeks (2–4 weeks between dose increments)88
84After the first 6 months (of medication maintenance) clinic follow-up should be every 6 months89
24A medication protocol should include a prescribing algorithm/flow chart8n/aa
59During titration the dose should be increased as required up to BNF limits88
32Before initiation of medication, parents and young people should be asked to list separately the 3 most desired outcomes of treatment88
Reasons to choose atomoxetine should include:
17Parent/child preference7n/aa
18History/risk of drug diversion7n/aa
19History/risk of substance misuse7n/aa
  • ADHD, attention-deficit hyperactivity disorder; BNF, British National Formulary; MTA, Multimodal Treatment of ADHD; n/a, not applicable; NICE, National Institute for Health and Care Excellence; Texas, Texas Children's Medication Algorithm Project.

  • a Additional statements (n=7) rated on importance only.