Objective:

To synthesize UK-wide evidence on adult ADHD diagnostic pathways and develop a policy case for a national commissioning and quality framework for England based on this evidence.

Approach:

• Review Design: A structured policy-oriented review informed by PRISMA guidelines, focusing on UK-wide evidence regarding adult ADHD diagnostic pathways.
• Literature Search: Conducted across multiple databases, including PubMed/MEDLINE, Scopus, and others, focusing on publications from 2010 onwards.
• Eligibility Criteria: Included peer-reviewed empirical studies, clinical audits, service assessments, and policy documents relevant to adult ADHD diagnostic pathways.

Key Findings:

• Variation exists in access routes, referral quality, screening and triage practices, assessment delivery, and service configuration.
• Clinical standards for diagnosis are stable across major guidelines, but operational delivery varies significantly.
• A national adult ADHD commissioning and quality framework is needed to define minimum diagnostic standards and core pathway functions.

Interpretation:

A national framework is necessary to address inconsistencies in adult ADHD diagnostic pathways and ensure equitable access and quality of care.

Limitations:

• The review is not a registered systematic review and did not undertake formal risk-of-bias scoring, which may affect the reliability of the findings.
• Operational criteria for implementation remain unspecified, which could hinder practical application.

Conclusion:

A framework is proposed to guide the development of adult ADHD services, focusing on defining minimum functions and governance expectations.