Optimal efficacy
Titration ensures the medication is working effectively to manage ADHD symptoms, such as inattention, hyperactivity, and impulsivity.
Right to choose titration for children and young people
This page contains information and guidance on medication and titration for children and young people diagnosed with ADHD through our NHS Right to Choose service. The purpose is to provide you with all the information needed to help you decide if it's the right option for your child.
About our ADHD titration service for Right to Choose
In September 2024, we expanded our services to include medication titration for people diagnosed with ADHD through our NHS Right to Choose service. If your child has received a diagnosis from us, we will contact you by email to offer them a place on our waiting list.
We will work through our waiting list in order of appointment date, prioritising people who received their diagnosis earliest.
If you are interested in this service, you do not need to contact us. We will send you an email containing a link to confirm your interest. Once you've clicked the link, you will be automatically added to our waiting list.
What is titration?
If your child needs medication, titration is the process that ensures the prescribed medicine is right for them. The goal is to find the dose of medicine that controls their ADHD symptoms most effectively with the fewest side effects.
They will likely be prescribed a low dose at first, but this may be raised gradually until the effective target dose is reached. This approach limits potential side effects by allowing time to see how they react to the medicine.
Why titration is important
Working with a specialist over time and making adjustments where required will help reach the optimal medication to help effectively manage your child's ADHD symptoms.
Minimised side effects
By gradually adjusting the dosage, healthcare professionals aim to minimise or manage side effects, such as insomnia, decreased appetite, or increased heart rate.
Personalisation
There's no one-size-fits-all treatment for ADHD. Titration will help us tailor the treatment plan to your child's specific needs.
How ADHD titration works
1
Initial medication appointment
Your child's first appointment usually lasts about 50 minutes, during which we will discuss treatment goals, symptoms, and medication options. We will also review any relevant physical health information.
2
Follow-up titration appointments
Your child will then usually need several 30-minute appointments. In these sessions, their clinician will monitor them while you they trial different dosages and, potentially, different types of medication. Once we have established the most appropriate medication and dosage, we will pass your child's future prescriptions to their GP.
3
Monitor medication
Once your child is stabilised on the medication, their GP will monitor their physical health as long as the GP agrees to shared care. Our FAQs below explain what happens if the GP doesn't accept shared care. You will receive monthly repeat prescriptions and will need to return to us every six months for medication reviews, during which we will see how your child is responding to the medication and make any necessary adjustments.
FAQs
The current wait time is 12 to 18 months.
Our waitlist will be worked through fairly and equitably, in order of referral.
Shared care is a formal agreement between someone's GP and the specialist provider who is monitoring or treating their condition. In this instance, the agreement will allow us to manage your child's titration appointments. Once they are stabilised on the medication, the GP will monitor their physical health. However, we will invite you back at least once per year for a comprehensive medication review with a specialist clinician.
If the GP is not able to enter a shared care agreement with us, we can still provide medication titration for your child. They will remain with us for their ongoing care, receiving monthly prescriptions and attending medication reviews every six months.
In the absence of a shared care agreement, you would need to submit your child's up-to-date height, weight, pulse, and blood pressure before each monthly repeat prescription. If you have any questions about this, we will be happy to talk you through the process.
If your GP does not agree to shared care but you still want to pursue it, you will need to talk to them about their reasons for declining. Your GP might be able to offer an alternative solution, or you may want to consider seeking a GP who is willing to accept shared care.
Titration varies from one person to another but usually takes between two and four months, depending on how quickly the right medication and dosage are found.
While medication works well for many people with ADHD, others find non-medication strategies like cognitive behavioural therapy (CBT), mindfulness, exercise, and lifestyle adjustments extremely helpful. Many people find the best results come from a combination of medication and behavioural strategies.
The clinician managing your child's ADHD titration will write the prescriptions while they have titration appointments with us. Once on shared care, the GP will write the prescriptions.
Your Clinical Partners clinician will typically manage this during your child's six-monthly review. However, if you feel like the medication isn't helping your child or is having a negative effect, please let us know right away.
Yes, they will still have check-ups with us every six months to review their overall treatment. If adjustments to the medication are needed, your child's clinician will manage those changes.
Once shared care begins, your child's GP and their Clinical Partners clinician will monitor how they respond to the medication every six months. If any adjustments or a different medication are needed, the Clinical Partners clinician will oversee this to ensure that any changes are carefully managed and monitored.
If in shared care, your child will need to visit the GP for physical health checks, such as monitoring growth, blood pressure, or other key health indicators, to ensure the medication is safe for them over time.
Our ADHD service, which includes assessments and titration appointments, is funded by the NHS through its Right to Choose service. This means you can receive the support and care you need, and the process is provided by NHS funding.
All children under 16 are automatically entitled to free NHS prescriptions. If your child is between 16 and 18 and is in full-time education, they are also eligible for free NHS prescriptions. Therefore, you will not need to pay for your child’s ADHD medication if they meet these criteria.
The agreement will usually stay in place unless your child's condition changes and they require additional treatment or support. For example, if there are significant changes in someone's health, they may be returned to specialist care for closer monitoring and adjustment.
No. In the UK, ADHD medication must be initially prescribed by a specialist, typically a psychiatrist or a specialist ADHD clinic. Once someone is stabilised on medication, their GP can continue to prescribe your medication and monitor their physical health for the duration of your treatment.