Children across the UK may be exposed to serious health risks due to practices at some ADHD private clinics, with senior doctors warning that powerful stimulant medications are being prescribed without essential physical examinations.
Concerns have intensified following a surge in remote-only ADHD assessments, where some children are diagnosed and medicated via video consultations alone. Health leaders in Greater Manchester have now tightened prescribing rules, requiring in-person medical checks before treatment can begin.
Clinicians say the move reflects growing anxiety about patient safety amid rising demand for ADHD services.
Doctors warn of unsafe remote prescribing
Rashad Nawaz, a consultant paediatrician working in Manchester and Liverpool, has alerted national regulators after encountering young patients who had been prescribed stimulant medication without proper physical assessment.
He said he had treated children with potential underlying heart conditions who were medicated by online providers without any face-to-face review.
ADHD medications commonly include stimulants such as methylphenidate — best known under the brand name Ritalin — as well as non-stimulant alternatives.
While research from the University of Southampton indicates the benefits of ADHD medication generally outweigh modest increases in blood pressure and heart rate, national clinical guidance is clear that safety checks are mandatory before treatment begins.
Missed heart conditions raise alarm
Nawaz reported identifying three children in the past year with previously undetected heart murmurs. One of those patients had already been prescribed ADHD medication by a large national provider.
Following specialist cardiology referrals, two children were found to have innocent murmurs. However, one child was diagnosed with a ventricular septal defect (VSD), commonly known as a hole in the heart.
“None of them had symptoms, but the one with a VSD may do in the future,” Nawaz said.
He warned that inadequate pre-prescription screening represents a significant clinical risk, adding that reports from families suggest thorough physical assessments are sometimes being skipped.
Guidelines require full physical checks
The National Institute for Health and Care Excellence (NICE) states that a full physical assessment — including cardiovascular history and heart examination — must take place before ADHD medication is started.
However, clinicians say some online providers rely heavily on parent-reported measurements such as weight and blood pressure, alongside checklist questionnaires.
In correspondence with the Royal College of Paediatrics and Child Health, Nawaz warned that many large national providers do not routinely see children in person before prescribing.
He also raised concerns about workforce expertise, suggesting some professionals primarily trained in adult care are treating children without sufficient paediatric experience.
Pressure from rising ADHD demand
The controversy comes as the NHS faces record demand for ADHD assessments, with long waiting lists pushing many families to seek private diagnoses through the “Right to Choose” pathway, where private care can be funded by the NHS.
Prof Marios Adamou, an NHS psychiatrist, said reliance on online-only services has created what he described as a dangerous clinical gap.
“Local GPs are frequently asked to perform these checks on behalf of private services or even start treatment,” he said. “This places clinicians in a difficult position, given that the prescribing clinician carries full legal and clinical responsibility.”
Greater Manchester introduces ‘safety first’ rules
In response to mounting concerns, NHS Greater Manchester has introduced a new prescribing pathway designed to strengthen safeguards for children.
Prof Manisha Kumar, the region’s chief medical officer, said the reforms were necessary to protect young patients.
“Children’s safety has to come first,” she said. “We are now implementing new pathways that require face-to-face assessments and physical health checks before ADHD medication is prescribed.”
Under the updated system, providers effectively cannot initiate ADHD drug treatment in the region unless they can demonstrate that robust in-person clinical assessments have been completed.
Wider national debate expected
The issue is likely to fuel broader scrutiny of private ADHD providers, particularly those operating largely through remote assessments.
Patient groups and clinicians have long warned that surging demand, workforce shortages and expanding telemedicine services are placing pressure on quality controls.
While many specialists stress that ADHD medication is safe and effective when properly prescribed, the latest warnings highlight growing concern that inconsistent standards across providers could expose vulnerable children to avoidable risks.
Regulators are now expected to face increasing pressure to clarify national rules governing remote ADHD assessments and prescribing practices.