As a result of this increase, services were strained and major gaps between research base and clinical practice were identified with only 50% of children receiving

care that corresponded to guidelines of the American Academy of Child and Adolescent Psychiatry [Hoagwood et al. 2000]. ADHD services around the UK are disparate [Tettenborn et al. 2008] and we would suggest that if audited against the recent NICE Guideline [National Institute for Health and Clinical Excellence, 2008b], the gaps between research base and clinical practice would be at least as high as in the US. Guidelines for ADHD existed in the UK from the beginning of the millennium [Nutt et al. 2007; National Institute for Health and Clinical Excellence, #CDK assay keyword# 2006, 2000; Scottish Intercollegiate Guidelines Inhibitors,research,lifescience,medical Network, 2001; British Psychological Society, 2000] and although the complete NICE Guidelines only arrived late in 2008 [National Institute for Health and Clinical Excellence, 2008a], there was adequate time for implementation. Indeed, the 20 centres

of excellence participating in a multinational study appeared to broadly follow the recommendations set out in national guidelines at the time [Tettenborn et al. 2008], but the same may not translate elsewhere in the country. This disparity in service delivery, in Inhibitors,research,lifescience,medical our opinion mainly a result of underinvestment, could have been the reason behind the disparity in the doses of stimulants for the sample we collected. Furthermore, the lack of clinical pharmacy services to the children and adolescent mental health and community paediatric teams may be a contributing factor as to why Inhibitors,research,lifescience,medical guidelines referring to medicines management are not implemented and/or adhered to. As far as transition is concerned, the experience of UK community paediatricians is

that there are not many Inhibitors,research,lifescience,medical places that their patients can go when they reach adulthood [Marcer et al. 2008]. The suggestion that ADHD is likely to become increasingly important for primary care [Thapar and Thapar, 2002] and that generic teams may take over the care of adults with ADHD cannot be supported not only by our findings, but by the fact that many families of children or adults with ADHD have complex ongoing needs which merit specialist input [Salmon and Kemp, 2002]. The transition period is therefore a landmark process where not only people Ribonucleotide reductase come together, but also different service cultures and therapeutic approaches aiming to meeting the patients’ needs. We would expect that during this process and with clinical pharmacy input, disparities in medicines management would be addressed. Our data also showed that comorbid disorders are common in adults with ADHD. Anxiety disorders, substance abuse disorders and mood disorders are all highly prevalent comorbidities in this patient population, and there is also a significant incidence of antisocial disorder [McGough et al. 2005; Biederman et al. 1993; Shekim et al. 1990].