“The school says it’s ADHD and he needs medication — can you sort that out?”

When a school declares a child has ADHD and needs medication, the GP must neither dismiss the concern nor rubber-stamp it: ADHD is a clinical diagnosis made by a specialist neurodevelopmental service (paediatrics/CAMHS) after structured, multi-setting assessment, and is not diagnosed or medicated in primary care on a teacher’s report. Take the concern seriously and characterise the pattern — inattention, hyperactivity and impulsivity, their childhood onset, their pervasiveness across settings (present at home AND school, not only one), and the degree of impairment on learning, relationships and the child — since symptoms confined to one setting or explained by circumstances point away from ADHD. The key safety skill is to exclude and consider the many mimics and contributors: hearing or vision impairment (a child who cannot hear seems inattentive), sleep disorders (tired children are inattentive and hyperactive), learning difficulty, autism, anxiety or low mood, attachment difficulties, trauma and adverse childhood experiences, safeguarding concerns, and family or social stress — missing a hearing problem, a sleep disorder or a safeguarding issue while labelling "ADHD" is a serious error. Gather information from multiple sources (school reports and observations, standardised questionnaires completed by parents and teachers, developmental and family history) rather than acting on a single verbal report, and refer to the neurodevelopmental/ADHD pathway, managing expectations honestly: assessment takes time, diagnosis is specialist, and treatment is staged (NICE NG87): information, support and environmental modifications at school and home first, then — at age 5 and over — specialist-initiated medication if symptoms still cause persistent significant impairment after those modifications have been made and reviewed, not a GP-prescribed quick fix; elimination diets are not advised as a general treatment. Support the family meanwhile (school SENCO, behavioural strategies, support organisations; schools support on need without waiting for a diagnosis — SEND Code of Practice 2015). The hidden agenda is school pressure, parental exhaustion or feeling blamed, a wish for a label that brings help, possible family stress, the child’s distress, or fear of medication; take it seriously, do not pre-judge for or against ADHD, explore the wider picture, exclude mimics, support the family, and route it properly.