NHS and Community Care Act 1990

This information sheet has been formulated to assist in the implementation of the NHS and Community Care Act 1990. The contents are, however, applicable to all services, present and future, provided for people with ADHD.

Factors to be considered during assessment of people with ADD/ADHD

ADD/ADHD is a perplexing life-long disability, believed to be caused by organic brain damage rather than emotional trauma. The spectrum of autistic conditions covers a wide range. It varies from profound severity in some through to subtle problems of understanding in others of apparently average or above average intelligence. ADD/ADHD often occurs with other learning difficulties.

People with ADD/ADHD have a disability characterised by a triad of impairments as follows:

• absence or impairment of two-way social interaction
• absence or impairment of comprehension and the use of language and non-verbal communication
• absence or impairment of true flexible imaginative activity, with the substitute of a narrow range of repetitive, stereotyped pursuits

This disability leads to related problems which may include:

• resistance to change
• obsession or ritualistic behaviour
• high levels of anxiety
• lack of motivation
• inability to transfer skills from one setting to another
• vulnerability, and susceptibility to exploitation
• depression
• challenging behaviour
• self injury

Additional Specifications for the Provision of Care Services for People with ADD/ADHD

People with ADD/ADHD need and the service should provide:

1. individual and detailed IPPs (Individual Pro- gramme Plans)
2. detailed and specific strategies to achieve social interaction, communication and independence skills
   highly planned structured activity
3. appropriate staff levels to implement the strategies and provide staff support in all areas
4. an appropriate physical environment

The service and the staff should provide:

1. consistency and stability in the environment and in all interaction
2. continuous external motivation and positive intervention

The service also needs to provide:

1. a support system to handle and relieve staff stress
2. specialised staff training providing both an induction programme and an ongoing pro- gramme to reinforce and update the needed staff skills

The staff role is crucial in enabling people with ADD/ADHD to participate more fully in everyday life. Staff need a thorough understanding of the underlying impairment and to be attuned to the way the person with ADD/ADHD sees the world.

The staff training programmes should aim to provide:

1. an ability to understand and interpret the verbal or non-verbal communications of the person with ADD/ADHD
2. an ability to translate situations, events and concepts, into language that can be understood and grasped by the person with ADD/ADHD
3. a sensitivity in the recognition of anxiety levels
4. skills in the managemen

NHS and Community Care Act 1990

1. t and reduction of challenging behaviour
2. recognition of the value of repetitive reinforcement and the ability to make careful use of structure in order to counteract the lack of motivation inherent in this disability

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