During the last few years several clinical guidelines on attention-deficit hyperactivity disorder (ADHD) have been published by national and international medical societies. To systematically review and compare recommendations of selected ADHD guidelines, we performed a systematic search in online guideline databases and PubMed in order to retrieve guideline texts. Guidelines meeting inclusion criteria were reviewed and recommendations on assessment and treatment extracted. The AGREE instrument was used to assess methodological quality. Of the 26 guidelines identified, 13 were selected for further analysis: 11 guidelines deal with ADHD in childhood and adolescence and 5 guidelines cover transitional patients and/or ADHD in adults. The methodological quality of ADHD guidelines is moderate to good. They reflect similarities and differences of healthcare systems. Diagnosis throughout the lifespan is based on a detailed clinical history. There is greater agreement on evidence-based pharmacological treatment than on psychosocial interventions, reflecting the strength of evidence.

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Introduction:ADHD is a well-established neurodevelopmental disorder affecting a significant population across the lifespan. Driven by the need to provide adequate clinical care, several national and international medical societies have published guidelines on ADHD. Our objectives were to compare the recommendations set out by these guidelines and their methodological quality.Methods:To meet the inclusion criteria the guidelines had to be published by national or international medical societies or governmental bodies and focus on diagnosis or management of ADHD. To assess their methodological quality we used the Appraisal of Guidelines for Research & Evaluation (AGREE) instrument.Results:We identified 13 guidelines on diagnosis and/or management of ADHD meeting our inclusion criteria. They represented the recommendations from 9 different bodies from 4 different countries and 1 European group. All guidelines made recommendations on both diagnosis and treatment. Seven made recommendations concerning children and adolescents, four are about ADHD in adulthood and two made brief comments on specific aspects of treatment in adulthood. All groups have used DSM-IV criteria but differed on their assessment recommendations to varying degrees. All of them recommended stimulants as the core of pharmacological treatment. Only one (NICE 2008) recommends specifically methylphenidate as the first-line treatment.Discussion:Most of the diagnostic and treatment recommendations are consistent across the guidelines with few but important exceptions. This may reflect differences of service provision and target audiences. Convergent recommendation of psychostimulant treatment and differences with respect to psychosocial interventions reflect the strength (and weakness) of underlying evidence.