Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, and for many of the children, this will last until adulthood and is often referred to as a chronic condition (1–3). Symptoms are manifested across several areas of life and may vary between home, school, and leisure activities. Attention-deficit/hyperactivity disorder is also often associated with comorbid conditions (4). Management can be difficult and time consuming, and there is a need to ensure that evidence-based approaches are implemented. The life course perspective in ADHD becomes crucial where detection and intervention in early life have implications for later outcomes (5). Several families also describe their daily living as demanding and ask for additional support with siblings (6).

In 2019, AAP introduced a revised edition of Clinical Practice Guidelines for the diagnosis, evaluation, and treatment of ADHD in children and adolescents (7, 8). The guidelines give several detailed recommendations including comprehensive follow-up programs, in addition to pharmacotherapy and behavioral intervention. The implementation of these extended guidelines challenges child and adolescent mental health services (CAMHS) both in relation to the organization of the service and in how to collaborate across service levels.

Some studies have identified that the shortage of psychiatrists in CAMHS often becomes a bottleneck both for diagnostics and for treatment of ADHD children (4, 9, 10). In response to this, some have suggested that nurses are a resource in the management of ADHD (4). In addition, there is an ongoing discussion whether primary health care should play a more pronounced role in the assessment process (4, 11). Coghill, however, argues that because of the ongoing need to monitor symptoms, impairments, functioning, and comorbidities, the overall responsibility for ADHD should remain within specialist mental health services (4, 11).

Given the above challenges and the fact that ADHD is a major aspect of the work within CAMHS, it is pertinent to explore which of the tasks suggested in the American Psychological Association (AAP) guidelines need to be profession-specific. The aim of this study was to review literature regarding existing and recommended roles for nurses in the assessment and treatment of children with ADHD.

Results from the literature search are described in the flowchart in Figure 1. Among the 77 identified references, abstract reviewed identified 43 references as eligible for further assessment. In the review process, we identified the following topics:

The nurse role in ADHD management seemed to vary, and the requirements for training and certification for specialties within nursing differed between countries. In this review, we found nurses working either independently or as a part of a team with delegated responsibility. With only a few scientific evaluations available, we also included articles describing the nurse role and knowledge gaps. This was done in order to get an overview and gain knowledge in how nursing roles are designed across different countries.

In the present literature review, we found five articles formally evaluating the nurse role with two for medical prescription, one for ADHD follow-up care, one survey of nurses' use of guidelines in diagnostics and treatment, and lastly one evaluating the effect of a nurse-led solution-focused approach. No concerns about safety were identified regarding the prescription and monitoring of ADHD medication. However, more studies are needed.

Nurses' compliance with guidelines was found to be low. In addition, this was not compared with doctors' use of guidelines, making the results difficult to interpret.

Even though no studies were found, several articles described nurses both assessing and diagnosing children for ADHD. Independent assessment by nurses seemed to vary between different regions, and nurses were recommended to undertake specialized training in ADHD.

In addition, two Scottish Healthcare reports included audits of a nurse-led clinical care pathway (Scotland, H.I.). From these reports, it was concluded that long-term follow-up of children and adolescents with ADHD appeared useful, in particular from a user perspective. Regular reviews are identified as crucial, given that ADHD symptoms change during the course of development and during times of change, for instance, during transfer to infant and secondary school. Furthermore, continuity of care has been highlighted as important and recommended to be delivered by nurses. The follow-up of children and adolescents with ADHD is different from other chronic conditions, for example, diabetes mellitus, which can be maintained through simple medical consultations. Impairment associated with ADHD often includes more than core symptoms such as emotional and social impairments in addition to comorbid conditions. Qualitative studies (6, 13) focused on families' need for support and for collaboration across home, school, and primary care.

In this review, we found descriptions of nurses involved with ADHD management in 28 articles. Nurses already carry out many key tasks relating to children and adolescents with ADHD, although the extent of this practice seems to vary between areas and countries. In fact, nurses were recommended to be involved in almost every aspect of ADHD management including assessment and diagnostics, psychosocial support, medical, and non-medical treatment, and in the lead of entire ADHD services. The contribution of nurses was suggested by some authors to involve a caring and supportive quality. Providing support and care may be of particular importance for lifelong chronic conditions (5, 52, 53). Anker found that ADHD outcomes are largely associated with social characteristics and history of depression rather than intellectual functioning or ADHD symptom severity (52).

The reports evaluating a nurse-led care pathway gave favorable reviews of implementation and adherence to clinical guidelines.

Although there is a need for further evaluation and development of the nurse role, there seem to be good indications that nurses are already successfully integrated in teams for children and adolescents with ADHD and that they can provide a life course and family perspective (13) and support in both medical and non-medical treatment. For medical treatment, nurses can have a role in both prescribing medication and the monitoring process.

This literature review gives information to suggest that nurses can play a major role in providing continuity of care for children and adolescents with ADHD.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

LK has participated in preparing the literature search, in reviewing papers, and writing of the manuscript. LV has conducted the literature search. IE has participated in preparing the literature search, reviewing papers, writing of the manuscript, and for the method and result section. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.