Clinical practices in ADHD management across Europe: findings from the ESCAP research academy survey

In several European countries, national clinical guidelines for the management of ADHD are lacking. In others, guidelines are outdated or do not address more detailed aspects of care, such as medication titration procedures or specific recommendations for school adjustments. Perceptions of the appropriateness of treatment, which influence the delivery of care for ADHD, are shaped by sociocultural aspects. Consequently, practices in the management of ADHD are expected to substantially vary across Europe. To better understand current practices in both pharmacological and non-pharmacological management of ADHD, as well as clinicians' perceptions of treatment appropriateness, we conducted an online survey among European qualified child and adolescent (neuro)psychiatrists and general psychiatrists or trainees involved in the care of children and adolescents with ADHD. The survey was developed and implemented by the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy, with input from the European ADHD Guidelines Group (EAGG). It was completed by 1,441 clinicians of varying seniority from 23 European countries. The findings provide updated insights into ADHD management across Europe and highlight three key unmet needs. First, several clinically relevant areas lack sufficient evidence, including how to personalise treatment and identify practical predictors of treatment response. Second, some existing evidence has not yet been adequately translated into clinical guidelines or routine practice, particularly regarding comparative treatment effects and dose-response relationships relevant to medication titration. Third, some respondents reported needs that are already addressed in existing international guidelines, suggesting that language barriers may limit access to guidance and underscoring the importance of developing country-specific recommendations in local languages. Overall, this survey - to our knowledge the largest of its kind conducted in Europe - provides valuable information to inform future clinical guidelines, research priorities, and health policy. It also informs future training programmes aimed at reducing bias in the perception and delivery of ADHD treatment.