Lesson 9 - Risk Assessment in ADHD
1. Introduction
Why this topic matters
Risk assessment is an essential part of every ADHD assessment. Although ADHD is primarily characterised by difficulties with attention, hyperactivity and impulsivity, its clinical significance extends beyond these core symptoms. For some individuals, ADHD can contribute to patterns of behaviour that increase vulnerability to accidental harm, interpersonal difficulties, substance misuse, unsafe decision-making and other adverse outcomes.
Impulsivity is particularly relevant to understanding risk. Someone who acts before considering the consequences may be more likely to engage in dangerous driving, impulsive spending, substance use, unsafe sexual behaviour or other risk-taking activities. In children and young people, impulsivity and hyperactivity may contribute to accidents, running away, unsafe road behaviour, aggression or difficulties recognising danger.
Risk may also arise indirectly from the wider impact of ADHD. Repeated academic difficulties, relationship problems, occupational instability, criticism and low self-esteem can contribute to emotional distress. ADHD also commonly coexists with conditions such as depression, anxiety, behavioural disorders and substance misuse, which may substantially alter an individual's risk profile.
However, having ADHD does not mean that an individual is inherently dangerous or will engage in high-risk behaviour. Risk assessment should always be individualised. The purpose is not to assume risk on the basis of a diagnosis but to understand the particular circumstances, behaviours and vulnerabilities relevant to the person being assessed.
A good risk assessment therefore considers both current and historical risk. Clinicians should explore areas including:
self-harm and suicidal thoughts or behaviour
risk-taking and impulsive behaviour
accidental injury
aggression or risk to others
substance and alcohol use
driving-related risk where relevant
vulnerability and exploitation
safeguarding concerns
medication-related risks
the influence of co-occurring mental health conditions
Risk assessment should also consider protective factors. Supportive relationships, engagement with treatment, insight, stable accommodation, meaningful education or employment and willingness to seek help may all reduce risk. Understanding what keeps someone safe is just as important as identifying what increases their vulnerability.
Risk is also dynamic rather than fixed. A patient may have relatively low risk at one stage of their life but experience significant changes following relationship breakdown, loss of employment, worsening depression, substance misuse or another major stressor. Risk assessment should therefore be viewed as an ongoing clinical process rather than a single question completed during the initial assessment.
How it fits into the overall course
The previous lessons have developed the core skills required for comprehensive ADHD assessment. We have considered diagnostic criteria, developmental history, functional impairment, collateral information, screening questionnaires, differential diagnosis and comorbidity.
Risk assessment brings these areas together from a safety perspective.
For example, understanding comorbidity is essential because an individual with ADHD and severe depression may have a very different risk profile from someone with ADHD alone. Similarly, developmental history may reveal longstanding impulsive risk-taking while collateral information may identify concerns that the patient has not recognised or disclosed themselves.
This lesson will therefore examine how risk should be assessed within the context of ADHD rather than as a separate administrative exercise. Learners will consider the relationship between ADHD symptoms and different forms of risk, how co-occurring conditions can modify risk and how protective factors should be incorporated into a balanced clinical formulation.
Particular attention will be given to recognising situations requiring urgent intervention or escalation. Clinicians involved in ADHD assessment must be able to distinguish between longstanding vulnerabilities that can be incorporated into routine management and immediate concerns requiring more urgent action.
The overall aim is to develop a proportionate, individualised and clinically meaningful approach to risk assessment. Rather than simply documenting that risk has been considered, clinicians should be able to explain what the relevant risks are, what factors increase or reduce them and what needs to happen to keep the individual safe.
2. Learning Outcomes
By the end of this lesson, learners should be able to:
Explain the importance of risk assessment in ADHD, recognising how impulsivity, hyperactivity, executive functioning difficulties and associated functional impairment may contribute to risk in some individuals.
Conduct a structured and individualised risk assessment, considering self-harm and suicide risk, accidental harm, impulsive risk-taking, aggression, substance use, driving, vulnerability, exploitation and safeguarding concerns where clinically relevant.
Recognise how co-occurring conditions can influence risk, including depression, anxiety, behavioural disorders, substance misuse and other mental health difficulties.
Identify risk and protective factors and integrate these into a balanced clinical formulation, considering historical, current and potentially changeable factors rather than relying on the presence or absence of individual risk indicators.
Distinguish between longer-term vulnerabilities and immediate safety concerns, recognising that risk is dynamic and may change according to mental state, circumstances, substance use, relationships and other stressors.
Recognise when concerns require escalation or urgent intervention, including situations requiring senior clinical advice, safeguarding action, crisis assessment or involvement of other appropriate services.
3. The Lecture
Risk Assessment Is Part of ADHD Assessment
When we talk about risk assessment in psychiatry, clinicians often immediately think about suicide and self-harm. These are clearly important but risk assessment in ADHD needs to be broader.
Consider a 17-year-old with combined ADHD who denies suicidal thoughts and has never self-harmed. If we stop the risk assessment there, we might conclude that risk is low.
However, further questioning reveals that he regularly rides an electric bike through traffic without paying attention to road signals, drinks heavily with friends, has been involved in several impulsive fights and recently got into a car with a driver he knew had been drinking.
There may be no current suicide risk but there are clearly important risks.
This illustrates a central principle:
Risk assessment should consider how ADHD and the individual's wider circumstances affect their safety rather than simply asking whether they are suicidal.
ADHD Does Not Automatically Mean High Risk
Before considering individual areas of risk, an important distinction needs to be made.
ADHD is associated with increased vulnerability to several adverse outcomes at a population level. However, this does not mean that every individual with ADHD is at high risk.
Many people with ADHD do not self-harm, misuse substances, behave aggressively or engage in dangerous activities.
Risk assessment must therefore remain individualised.
Avoid writing:
"Risk increased due to ADHD."
Instead establish what is actually happening.
For example:
"He reports frequently crossing roads impulsively without checking for traffic and has experienced two previous road traffic accidents."
This tells us something clinically meaningful.
The diagnosis alone does not.
Why ADHD May Influence Risk
Several features associated with ADHD may contribute to risk in some individuals.
Impulsivity
Impulsivity can reduce the time between an urge and an action.
Most people experience impulses that they decide not to act upon. Someone with significant impulsivity may have greater difficulty creating that pause.
This can contribute to:
dangerous driving
impulsive aggression
substance use
unsafe sexual behaviour
impulsive spending
gambling
accidental injury
other poorly considered decisions
The important point is that the individual may understand the risk perfectly well afterwards.
The difficulty occurred at the moment when the decision was made.
Inattention
Inattention can also contribute to safety difficulties.
Someone who becomes easily distracted may:
miss road hazards
forget safety instructions
leave appliances switched on
make errors while completing safety-sensitive tasks
forget medication
lose important items
Again, this does not mean that everyone with inattentive ADHD experiences these problems.
Ask about actual functioning.
Hyperactivity and Sensation Seeking
Some individuals with ADHD describe a strong need for stimulation or excitement.
This may contribute to activities involving greater risk.
In children, this may present as climbing, running into unsafe areas or acting without appreciating danger.
In adolescents and adults, risk may become more sophisticated and could involve driving, substances, sexual behaviour or other high-stimulation activities.
Executive Functioning Difficulties
Risk does not always arise from dramatic impulsive behaviour.
Executive functioning difficulties may contribute in quieter ways.
Someone may understand exactly what they need to do to remain safe but struggle to:
remember appointments
organise medication
follow treatment plans
manage finances
plan journeys
maintain routines
complete important administrative tasks
These difficulties can create significant vulnerability even without deliberate risk-taking.
Self-Harm and Suicide Risk
Self-harm and suicide should form part of a comprehensive psychiatric risk assessment.
Ask directly and sensitively about:
thoughts of death
suicidal thoughts
suicidal intent
plans
previous attempts
self-harm
recent changes in these thoughts or behaviours
Do not assume that asking about suicide will create suicidal thoughts. Direct questioning allows patients to discuss experiences that they may otherwise find difficult to disclose.
Understand the Context
If suicidal thoughts are present, do not stop at:
"Do you have a plan?"
Explore:
frequency
intensity
duration
intent
planning
access to potential means
previous behaviour
triggers
reasons for living
available support
ability and willingness to seek help
The clinical significance of suicidal thoughts depends on the wider context.
Impulsivity and Suicidal Behaviour
Impulsivity deserves particular consideration when assessing suicide risk in ADHD.
A person may experience a rapid escalation from emotional distress to action with relatively little planning.
This means that an absence of a detailed long-term suicide plan should not automatically be interpreted as an absence of meaningful risk.
Consider:
previous impulsive self-harm
rapid changes in emotional state
substance use
access to means
recent interpersonal crises
ability to seek support when distressed
The question is not simply:
"Have they planned suicide?"
It is also:
"What might happen during a period of intense distress?"
ADHD and Emotional Dysregulation
Some people with ADHD experience rapid and intense emotional reactions.
They may become extremely frustrated, angry or distressed before returning towards baseline relatively quickly.
This can be clinically relevant to risk.
Imagine an adolescent who has an argument with their partner.
Within minutes, they feel overwhelmed, send threatening messages and impulsively self-harm.
An hour later, they report regretting what happened and describe the behaviour as something they did without thinking.
A conventional risk assessment focused only on persistent depressive symptoms could miss this pattern.
Explore how the person behaves during periods of intense emotion.
Depression and Other Co-occurring Conditions
ADHD should never be considered in isolation when assessing risk.
Co-occurring conditions may substantially change the risk profile.
Particular attention should be given to:
depression
bipolar disorder
psychosis
substance misuse
severe anxiety
trauma-related difficulties
behavioural disorders
eating disorders where relevant
For example, someone with relatively stable ADHD and no other mental health difficulties may have a very different risk profile from someone with ADHD, severe depression and escalating alcohol misuse.
This is why the previous lesson on comorbidity is directly relevant to risk assessment.
Accidental Injury
Accidental harm is an important but sometimes overlooked aspect of ADHD.
Ask about previous accidents and near misses.
In children, this may include:
running into roads
unsafe climbing
cycling accidents
injuries associated with impulsive play
difficulty following safety instructions
In adults, consider:
workplace accidents
road traffic incidents
unsafe use of equipment
distraction during potentially hazardous activities
Previous incidents can provide useful information about future vulnerability.
Driving Risk
Driving is particularly relevant when assessing adolescents and adults.
ADHD-related inattention and impulsivity may affect:
maintaining attention
noticing hazards
speed regulation
responding impulsively to other drivers
mobile phone use while driving
adherence to road rules
Ask about actual driving behaviour rather than assuming difficulty.
Useful questions include:
"Have you had any accidents or near misses?"
"Do you find yourself becoming distracted while driving?"
"Have you received speeding penalties or other driving offences?"
"Do you ever use your phone while driving?"
The aim is to understand real-world risk.
Where a patient's condition or treatment may affect their legal fitness to drive, clinicians should also be familiar with the relevant national driving guidance.
Substance and Alcohol Use
Substance use can interact strongly with ADHD-related risk.
Assess:
alcohol
cannabis
stimulants
cocaine
other recreational substances
misuse of prescribed medication
Explore frequency, quantity, context and consequences.
Do not simply ask:
"Do you use drugs?"
Someone may answer no because they do not consider occasional cannabis use or misuse of another person's medication to constitute drug use.
More specific questions often produce more useful information.
Why Substance Use Matters
Substances may increase:
impulsivity
aggression
accidental injury
vulnerability
unsafe sexual behaviour
driving risk
self-harm risk
Substance use may also influence decisions about ADHD medication and the level of monitoring required.
Aggression and Risk to Others
ADHD does not inherently make someone aggressive.
This is important to state clearly.
However, impulsivity, frustration and emotional dysregulation may contribute to reactive aggression in some individuals, particularly when additional behavioural or mental health difficulties are present.
If aggression is reported, explore:
what happened
what triggered it
whether it was impulsive or planned
frequency
severity
injuries
use of weapons
remorse
substance involvement
escalation over time
Distinguish an impulsive shove during an argument from repeated planned violence.
The behaviours may require very different formulations and management.
Risk-Taking Behaviour
Risk-taking may occur in several domains.
Depending on age and circumstances, explore:
dangerous driving
unsafe cycling
substance use
sexual risk-taking
gambling
impulsive spending
dangerous physical activities
online behaviour
Ask about consequences.
Has the individual:
been injured?
accumulated significant debt?
experienced exploitation?
been arrested?
lost employment?
damaged relationships?
Risk assessment becomes more clinically meaningful when connected to actual behaviour and consequences.
Vulnerability and Exploitation
Risk assessment is not only about what the individual might do.
It should also consider what might happen to them.
People with ADHD may sometimes be vulnerable because of:
impulsive decision-making
difficulties anticipating consequences
strong desire for social acceptance
financial impulsivity
substance use
difficulties maintaining boundaries
Children and vulnerable adults may be particularly susceptible to:
bullying
coercion
financial exploitation
sexual exploitation
criminal exploitation
unsafe online relationships
Ask developmentally appropriate questions about relationships, peers, online activity and situations where the individual may have been pressured into doing something they did not want to do.
Safeguarding
Safeguarding should remain separate from diagnosis.
A safeguarding concern requires appropriate action whether or not ADHD is present.
Consider:
abuse
neglect
domestic violence
exploitation
unsafe caregiving environments
significant parental difficulties
risks involving siblings or other children
concerns about vulnerable adults
If information raises a safeguarding concern, follow local safeguarding procedures.
Do not assume that obtaining an ADHD diagnosis resolves the wider environmental problem.
Medication-Related Risk
Risk assessment continues after diagnosis.
Before prescribing ADHD medication, clinicians should consider relevant medical and psychiatric risks.
Depending on the medication and individual circumstances, this may include consideration of:
cardiovascular history
blood pressure and pulse
weight and appetite
substance misuse
risk of medication misuse
risk of diversion
psychiatric symptoms
potential interactions with other medication
Once treatment begins, monitoring should continue.
The purpose is not to make medication appear inherently dangerous but to prescribe safely and proportionately.
Diversion and Misuse
Stimulant medication requires particular consideration because it has the potential for misuse or diversion.
Ask about:
previous stimulant misuse
substance use
whether medication has previously been shared
pressure from peers
concerns about selling medication
In adolescents and university students, consider whether other people may have access to the medication.
Where risk exists, practical measures such as careful dispensing arrangements and secure medication storage may reduce it.
Risk Is Dynamic
One of the most important concepts in psychiatric risk assessment is that risk changes.
Imagine a patient assessed six months ago.
At that time they were functioning well, had supportive relationships and denied self-harm.
Today they have:
lost their job
separated from their partner
begun drinking heavily
stopped taking medication
developed significant depressive symptoms
A risk formulation written six months ago cannot simply be copied into today's assessment.
Always ask:
"What has changed?"
Historical Risk Still Matters
Current risk should not be assessed without understanding the past.
Previous behaviour is often highly informative.
Ask about:
previous self-harm
suicide attempts
serious accidents
aggression
arrests
substance misuse
dangerous driving
previous safeguarding concerns
However, historical risk should not automatically be treated as current risk.
Someone who self-harmed once ten years ago and has remained stable since is different from someone whose self-harm has escalated over the last month.
Context matters.
Protective Factors
Risk assessment should not consist solely of identifying problems.
Protective factors may include:
supportive family
positive relationships
engagement with services
willingness to seek help
future plans
employment or education
responsibilities towards others
effective coping strategies
stable accommodation
insight
reasons for living
Protective factors should be specific.
Writing:
"Family protective."
provides limited information.
Writing:
"He describes a close relationship with his parents, speaks with them daily and states that he would contact them if his mood deteriorated."
is considerably more useful.
Risk Formulation
A good risk assessment should lead to a formulation.
Rather than simply writing:
"Low risk."
explain why.
For example:
"She denies current suicidal thoughts or self-harm and has no history of suicide attempts. She reports occasional impulsive behaviour when distressed but describes good support from her partner and parents and states that she would contact them if she felt unable to keep herself safe. Current suicide risk appears low although impulsivity may increase vulnerability during periods of acute emotional distress."
This communicates much more information than a risk category alone.
Avoid False Precision
Risk cannot be predicted perfectly.
Labels such as:
low risk
medium risk
high risk
may sometimes be required within clinical systems but they should not replace formulation.
A more useful approach is to describe:
what the concern is
what might make it worse
what reduces the risk
what action is required
Risk assessment should support clinical decision-making rather than create an illusion that future behaviour can be predicted with certainty.
Clinical Example
A 19-year-old university student is assessed for ADHD.
The developmental history strongly supports combined ADHD.
He denies current depression and suicidal thoughts and has never self-harmed.
However, further assessment reveals that he drinks heavily several nights each week, occasionally uses recreational substances and frequently drives shortly after drinking. He has accumulated significant debt through impulsive online spending and recently lost £1,000 through online gambling.
If the clinician recorded:
"No suicidal thoughts. Risk low."
the assessment would clearly be incomplete.
The more meaningful formulation recognises significant impulsive risk-taking involving alcohol, driving, gambling and finances despite the absence of current suicide risk.
Management should therefore address these specific behaviours rather than relying on a global risk label.
When Does Risk Require Escalation?
Some findings require action beyond routine ADHD assessment.
Examples may include:
active suicidal intent
recent serious suicide attempt
inability to maintain immediate safety
significant escalating self-harm
severe aggression or credible threats towards others
acute psychosis or mania associated with unsafe behaviour
serious safeguarding concerns
severe substance-related risk
significant exploitation
other situations where immediate safety cannot reasonably be maintained
The exact response will depend on the clinical situation and local pathways.
Possible actions may include:
discussion with a senior clinician
urgent mental health assessment
crisis service involvement
emergency medical assessment
safeguarding referral
involvement of appropriate family or carers
multidisciplinary discussion
Do not continue routinely through an ADHD assessment when an immediate safety issue requires intervention.
A Practical Structure for Risk Assessment
When assessing risk in ADHD, think broadly across several areas.
Risk to Self
Consider:
suicidal thoughts
self-harm
impulsive behaviour
accidental injury
substance use
unsafe driving
significant financial risk
Risk to Others
Consider:
aggression
impulsive violence
threats
dangerous driving
behaviour that may place others at risk
Risk From Others
Consider:
bullying
coercion
exploitation
abuse
unsafe relationships
safeguarding concerns
Factors That May Increase Risk
Consider:
impulsivity
current mental illness
substance use
sleep deprivation
interpersonal conflict
major life events
reduced support
treatment disengagement
Protective Factors
Consider:
relationships
engagement
coping strategies
responsibilities
future plans
willingness to seek help
This provides a clinically useful framework without reducing the assessment to a checklist.
Key Learning Points
Risk assessment is an essential part of ADHD assessment and should extend beyond suicide and self-harm.
ADHD does not automatically make an individual high risk and assessment should remain individualised.
Impulsivity, inattention and executive functioning difficulties may contribute to different forms of risk in some individuals.
Relevant areas may include self-harm, suicide, accidental injury, aggression, substance use, driving, financial behaviour, vulnerability, exploitation and safeguarding.
Co-occurring psychiatric conditions can substantially alter the individual's risk profile.
An absence of a detailed suicide plan does not necessarily mean an absence of meaningful risk, particularly where behaviour can become highly impulsive during periods of acute distress.
Risk assessment should consider risk to the individual, risk to others and risk from others.
Historical behaviour provides important information but should be interpreted alongside the current circumstances.
Protective factors should be identified specifically rather than simply recorded as present.
Risk is dynamic and should be reconsidered when circumstances or mental state change.
Global labels such as low, medium or high risk should not replace an individualised risk formulation.
Significant or immediate safety concerns should take priority over completing a routine ADHD assessment and may require escalation to appropriate services.
The purpose of risk assessment is not to predict the future with certainty. It is to understand foreseeable vulnerabilities and take proportionate steps to reduce harm.
4. Clinical Perspective
Risk assessment in ADHD should be practical, individualised and proportionate. In clinical practice, the most useful risk assessments are rarely those containing the longest list of possible risks. They are the assessments that identify what could realistically go wrong for this particular person, what circumstances make this more likely and what can be done to reduce the risk.
ADHD can influence risk through impulsivity, distractibility, emotional dysregulation and difficulties anticipating consequences. However, clinicians should avoid assuming that ADHD automatically makes someone unsafe. The diagnosis provides context. The individual's actual behaviour, history, circumstances and co-occurring conditions determine the clinical significance.
Clinical Pearls
Ask About Behaviour, Not Just Risk
Patients do not necessarily describe their own behaviour as risky.
If you ask:
"Do you take risks?"
many patients will simply answer no.
More useful questions are often specific:
"Have you had any accidents or near misses?"
"Do you ever make decisions and regret them immediately afterwards?"
"What happens when you become extremely angry or upset?"
"Have you ever driven when you knew you probably shouldn't?"
"Have alcohol or drugs ever led you into situations you later regretted?"
Concrete questions usually produce more clinically meaningful information than broad questions about risk.
Do Not Equate the Absence of Suicidal Thoughts With the Absence of Risk
A patient may have no suicidal thoughts and still have significant risk.
They may:
drive dangerously
misuse substances
become aggressive when overwhelmed
engage in unsafe sexual behaviour
accumulate significant gambling debts
repeatedly experience accidents
place themselves in vulnerable situations
A comprehensive ADHD risk assessment therefore needs to extend beyond suicide and self-harm.
Impulsivity Can Change the Nature of Risk
Some patients describe risk developing extremely quickly.
They may move from feeling relatively settled to acting impulsively during a period of intense distress.
This is particularly important when there is a history of impulsive self-harm, aggression or dangerous behaviour.
Do not rely entirely on questions about long-term planning.
Ask:
"What happens when things become overwhelming very quickly?"
and:
"What have you done impulsively during previous periods of distress?"
Past behaviour during moments of acute distress may provide important information about future vulnerability.
Always Ask What Has Changed
Risk is dynamic.
When someone who was previously stable becomes significantly more vulnerable, there is usually a reason.
Look for changes involving:
relationships
employment or education
mental state
substance use
sleep
finances
accommodation
treatment engagement
social support
The question:
"What has changed recently?"
is often one of the most useful questions in risk assessment.
Protective Factors Need to Be Real
Avoid treating protective factors as boxes to tick.
Writing:
"Supportive family."
is not particularly informative.
Ask what that support actually looks like.
Does the patient speak with their family regularly?
Would they disclose suicidal thoughts to them?
Could someone stay with them during a crisis?
Would they contact a particular person if they felt unsafe?
A protective factor is clinically meaningful when you understand how it might actually reduce risk.
Practical Tips for Everyday Practice
Develop a consistent structure for risk assessment but allow the conversation to follow the individual presentation.
A useful mental framework is:
Risk to self
Risk to others
Risk from others
Then consider what increases the risk and what protects against it.
For someone with ADHD, also specifically consider whether impulsivity or inattention creates additional vulnerabilities.
When a risk is identified, obtain examples.
Instead of documenting:
"Risky driving."
establish what this means.
Does the patient speed?
Use their phone?
Become distracted?
Drive after drinking?
Have they had accidents?
Have they received penalties?
Specific information allows you to judge the significance of the concern and develop an appropriate management plan.
Separate Historical Risk From Current Risk
Previous behaviour matters but should not automatically determine the current formulation.
A patient who made a suicide attempt five years ago requires that history to be documented and understood.
However, their current circumstances may be very different.
Equally, someone with no previous self-harm may develop significant acute risk following a major crisis.
Think about risk longitudinally:
What happened previously?
What is happening now?
What could realistically increase risk in the near future?
This produces a more useful formulation than simply categorising someone as low, medium or high risk.
Link the Risk Assessment to a Plan
Identifying risk without deciding what to do about it has limited clinical value.
If someone repeatedly forgets medication, consider how medication can be organised more safely.
If impulsive spending is creating significant debt, consider what practical financial safeguards may help.
If a young person becomes unsafe when emotionally overwhelmed, consider who they can approach and what support is available during these periods.
If significant suicidal risk is identified, an appropriate safety and escalation plan is required.
Every important risk should lead to the question:
"What are we doing about this?"
Common Pitfalls and Misconceptions
Writing "No Risk"
Very few psychiatric assessments justify the statement:
"No risk."
Risk is not binary.
A patient may have no current suicidal thoughts but still have historical vulnerabilities or risks relating to impulsivity, substances or accidental harm.
More precise documentation is preferable.
For example:
"He denies current suicidal thoughts or self-harm. There is no history of suicide attempts. Current suicide risk appears low although impulsivity contributes to occasional risk-taking behaviour."
Using Risk Categories Without Formulation
Labels such as low, medium and high risk can create false reassurance.
Two patients categorised as "medium risk" may have completely different clinical needs.
Where risk categories are required, accompany them with a brief explanation of:
the nature of the concern
relevant historical factors
current circumstances
protective factors
foreseeable triggers
the management plan
The formulation is more useful than the label.
Assuming ADHD Explains Aggression
ADHD does not inherently cause violence.
When aggression occurs, explore it properly.
Consider:
emotional dysregulation
behavioural disorders
substance use
trauma
environmental stress
mood disorder
interpersonal conflict
Do not allow ADHD to become a convenient explanation for behaviour requiring broader assessment.
Overlooking Vulnerability
Clinicians naturally think about what a patient might do to themselves or other people.
Do not forget what other people might do to the patient.
Children, adolescents and vulnerable adults may be particularly susceptible to bullying, coercion, exploitation or manipulation.
Risk assessment should therefore include risk from others.
Treating Risk Assessment as a Form-Filling Exercise
Patients can usually recognise when clinicians are mechanically working through questions.
Risk assessment works best when incorporated naturally into the wider history.
If a patient tells you they frequently act without thinking, this provides an opportunity to ask:
"Has that ever put you in danger?"
If they describe heavy drinking:
"Have there been times when drinking has led you into unsafe situations?"
Risk assessment should develop from the patient's story.
Advice for Newly Qualified Doctors
Ask direct questions.
Newly qualified doctors sometimes worry that asking about suicide, aggression, substances or unsafe behaviour will upset the patient.
Usually, respectful direct questions are easier for patients to answer than vague ones.
If you are concerned about suicide, ask clearly.
If you are concerned about aggression, ask what has happened.
If you suspect substance use, ask specifically about individual substances.
Clarity is safer than ambiguity.
Do Not Be Reassured Too Quickly
A patient saying:
"I'd never do anything."
is useful information but it should not automatically end the assessment if other concerns are present.
If there has been recent self-harm, severe depression or previous suicide attempts, explore further.
Similarly, someone stating that they are a safe driver does not necessarily resolve concerns if they subsequently describe several accidents and repeated speeding offences.
Listen to the patient's interpretation but also examine the evidence.
Ask for Senior Advice Early When You Are Concerned
You are not expected to manage complex risk alone.
Seek senior or specialist advice when:
suicidal intent is unclear
risk appears to be escalating
significant aggression is present
there are safeguarding concerns
substance misuse complicates the assessment
you are uncertain whether the patient can safely leave the assessment
you are unsure what level of intervention is required
Seeking advice is part of safe clinical practice.
Situations Requiring Particular Clinical Judgement
Suicidal Thoughts Without Clear Intent
Not every patient reporting suicidal thoughts requires emergency intervention.
Equally, suicidal thoughts should never simply be dismissed.
Consider:
frequency and intensity
intent
planning
access to means
previous attempts
impulsivity
substance use
current mental state
recent stressors
protective factors
ability to seek help
The decision should be based on the overall formulation rather than one answer.
Impulsive Self-Harm
Someone may repeatedly self-harm during short periods of intense distress without reporting persistent suicidal intent.
This still requires careful assessment.
Consider how quickly behaviour escalates, what triggers it, whether substances are involved and what support is available during these periods.
The management plan should reflect the pattern of risk rather than relying solely on the patient's mental state during a calm consultation.
Possible Mania or Psychosis
If an ADHD assessment identifies possible mania or psychosis associated with significant behavioural change or impaired judgement, the immediate psychiatric presentation may take priority.
A routine ADHD assessment should not continue unchanged when another condition creates a more urgent clinical need.
Significant Substance Misuse
Substance misuse may affect judgement, increase impulsivity and complicate both diagnosis and prescribing.
Establish the severity of use and associated risks.
Where substance use is significant, additional specialist input or treatment may be required.
Safeguarding Concerns
If a child or vulnerable adult discloses abuse, exploitation or another safeguarding concern, do not wait until the ADHD assessment has been completed before acting.
Follow appropriate safeguarding procedures.
Immediate safety takes priority over completing the diagnostic pathway.
Driving Concerns
Driving can require particular judgement because ADHD symptoms vary substantially between individuals.
Do not assume that every patient with ADHD is unsafe to drive.
Equally, significant distractibility, repeated accidents, dangerous driving or relevant co-occurring conditions should not be ignored.
Where there are concerns about fitness to drive, clinicians should refer to current national driving guidance and advise the patient appropriately.
Documenting Risk Well
A useful risk formulation should answer four questions:
What is the concern?
What makes it more likely?
What reduces the likelihood or severity?
What are we going to do about it?
For example:
"He denies current suicidal thoughts and has no history of suicide attempts. He describes occasional impulsive self-harm during periods of intense interpersonal distress, particularly when drinking alcohol. Risk may therefore increase rapidly during emotional crises. Protective factors include a close relationship with his parents and willingness to seek support. He has agreed to contact his parents and appropriate urgent services if he feels unable to maintain his safety. Alcohol use will require further assessment."
This provides considerably more clinical information than simply writing:
"Risk: medium."
Final Clinical Message
Risk assessment in ADHD should never become a checklist completed because the clinical record requires it.
Think about the individual.
Ask what has actually happened.
Consider what ADHD-related impulsivity, inattention or executive functioning difficulties contribute.
Identify the effect of co-occurring mental health difficulties and substance use.
Consider risk to self, risk to others and risk from others.
Understand previous behaviour but focus on what is happening now and what might change.
Identify meaningful protective factors and translate important concerns into a management plan.
Most importantly, remember that risk assessment is not about predicting exactly what someone will do. It is about recognising foreseeable vulnerabilities and making sensible, proportionate clinical decisions that reduce the likelihood of harm.
5. Summary
Risk assessment is an essential component of ADHD assessment and should extend beyond questions about self-harm and suicide. ADHD may influence safety through impulsivity, inattention, executive functioning difficulties and emotional dysregulation but the presence of ADHD does not automatically mean that an individual is at high risk. Risk should always be assessed according to the person's actual behaviour, circumstances and clinical presentation.
A comprehensive assessment should consider risk to self, risk to others and risk from others. Depending on the individual, relevant areas may include self-harm, suicidal thoughts and behaviour, accidental injury, aggression, substance use, unsafe driving, impulsive financial behaviour, vulnerability, exploitation and safeguarding concerns.
Impulsivity can be particularly important when considering risk in ADHD. Some individuals may move rapidly from an emotional trigger to an unsafe action without extensive planning. An absence of a detailed suicide plan therefore does not necessarily mean that meaningful risk is absent. Previous impulsive self-harm, substance use, access to means and behaviour during periods of acute distress should all be considered when clinically relevant.
Co-occurring conditions can substantially alter the risk profile. Depression, bipolar disorder, psychosis, substance misuse, behavioural disorders and other mental health difficulties may introduce risks that cannot be explained by ADHD alone. Clinicians should therefore integrate risk assessment with the wider psychiatric formulation rather than considering ADHD in isolation.
Risk is dynamic rather than fixed. Mental state, relationships, employment, education, substance use, sleep, finances and social support may all change over time. A previous risk assessment should therefore not simply be carried forward without considering what has changed since the individual was last reviewed.
Historical information remains valuable. Previous self-harm, suicide attempts, aggression, serious accidents, substance misuse and other unsafe behaviours can help clinicians understand patterns of vulnerability. However, historical risk should always be interpreted alongside the individual's current circumstances rather than automatically being treated as evidence of current high risk.
Protective factors are equally important. Supportive relationships, engagement with treatment, future plans, responsibilities, coping strategies and willingness to seek help may all reduce risk. These factors should be described specifically so that it is clear how they contribute to the individual's safety.
The purpose of risk assessment is ultimately to produce a meaningful risk formulation and management plan. Rather than relying solely on labels such as low, medium or high risk, clinicians should identify the nature of the concern, factors that may increase it, factors that reduce it and the actions required to manage it.
Where immediate concerns arise, safety takes priority over completing the routine ADHD assessment. Active suicidal intent, serious escalating self-harm, significant aggression, acute mania or psychosis, severe substance-related risk, exploitation or safeguarding concerns may require urgent assessment, senior clinical advice or involvement of appropriate specialist services.
The central questions throughout risk assessment should therefore be:
What could realistically go wrong for this individual?
What factors make this more or less likely?
What might cause the risk to change?
What action is required to reduce the likelihood of harm?
Answering these questions produces a risk assessment that is individualised, clinically meaningful and directly connected to safe patient care.
6. Further Reading
Risk assessment in ADHD requires an understanding of both general psychiatric risk assessment and the specific vulnerabilities that may be associated with ADHD. The literature highlights associations between ADHD and outcomes including self-harm, suicidal behaviour, substance misuse and road traffic accidents. These associations should be understood at a population level and should never be used to assume that a particular individual with ADHD is necessarily at high risk.
The following resources provide useful guidance and evidence for clinicians wishing to explore this area in greater depth.
Relevant NICE Guidance
National Institute for Health and Care Excellence (NICE)
Attention Deficit Hyperactivity Disorder: Diagnosis and Management (NG87).
This is the principal UK guideline for ADHD assessment and management. NICE highlights several issues relevant to risk including impulsive behaviour, substance misuse, self-medication and the potential effect of ADHD symptoms on driving. Before starting medication, NICE also recommends assessment of coexisting mental health and neurodevelopmental conditions alongside the risk of substance misuse and drug diversion.
NICE NG87: Attention deficit hyperactivity disorder: diagnosis and management
National Institute for Health and Care Excellence (NICE)
Self-harm: Assessment, Management and Preventing Recurrence (NG225).
This guideline provides an important framework for clinicians assessing individuals who have self-harmed. It emphasises comprehensive psychosocial assessment and individualised formulation rather than relying solely on numerical risk prediction or simple categories such as low, medium or high risk.
NICE NG225: Self-harm: assessment, management and preventing recurrence
National Institute for Health and Care Excellence (NICE)
Depression in Children and Young People: Identification and Management (NG134) and Depression in Adults: Treatment and Management (NG222).
These guidelines are particularly relevant when ADHD coexists with depression. They provide guidance on assessing suicidal thoughts, self-harm and other aspects of risk within the wider assessment and management of depressive illness.
NICE NG134: Depression in children and young people
NICE NG222: Depression in adults
National Driving Guidance
Driver and Vehicle Licensing Agency (DVLA)
Assessing Fitness to Drive: A Guide for Medical Professionals.
Clinicians assessing adolescents and adults with ADHD should understand the relevant UK driving requirements. ADHD does not automatically prevent someone from driving. NICE notes that people with ADHD must inform the DVLA if their symptoms or medication affect their ability to drive safely.
DVLA guidance for medical professionals on assessing fitness to drive
International Clinical Guidance
Canadian ADHD Resource Alliance (CADDRA)
Canadian ADHD Practice Guidelines.
The CADDRA guidelines provide a practical lifespan approach to ADHD assessment and management. They are particularly useful for understanding the relationship between ADHD, psychiatric comorbidity, substance use, functional impairment and treatment planning.
American Academy of Pediatrics
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
This guideline provides a useful framework for comprehensive ADHD assessment in children and adolescents including consideration of co-occurring emotional, behavioural and developmental conditions that may substantially influence risk.
Important Research on ADHD and Suicide Risk
Septier M, Stordeur C, Zhang J, Delorme R and Cortese S.
Association Between Suicidal Spectrum Behaviors and Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. Neuroscience & Biobehavioral Reviews. 2019.
This systematic review and meta-analysis examined the relationship between ADHD and suicidal ideation, suicide plans, suicide attempts and suicide. It found significant associations between ADHD and suicidal-spectrum behaviours while also highlighting the complexity of the relationship and the importance of potential confounding factors.
Balazs J and Kereszteny A.
Attention-Deficit/Hyperactivity Disorder and Suicide: A Systematic Review. World Journal of Psychiatry. 2017.
This systematic review provides a useful overview of the relationship between ADHD and suicidality. Importantly, it highlights the role of co-occurring psychiatric disorders in understanding this association.
Garas P, Takacs ZK and Balázs J.
Longitudinal Suicide Risk in Children and Adolescents With Attention Deficit and Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Brain and Behavior. 2025.
This more recent review examined longitudinal studies of children and adolescents with ADHD. It found an increased subsequent risk of suicidal ideation, suicide attempts and other suicidal outcomes while also emphasising substantial heterogeneity between individuals and the importance of factors including comorbidity and social circumstances.
ADHD and Self-Harm
Smaniotto L, Tolentino A, Barros FMR, et al.
Non-suicidal Self-injury in Individuals With Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis With Age- and Sex-stratified Findings. Psychiatry Research. 2026.
This recent systematic review and meta-analysis examined non-suicidal self-injury in people with ADHD. It provides useful evidence that self-harm should be considered during comprehensive assessment while reinforcing the need for individualised evaluation rather than assuming risk on the basis of ADHD diagnosis alone.
ADHD and Driving Risk
Vaa T.
ADHD and Relative Risk of Accidents in Road Traffic: A Meta-analysis. Accident Analysis & Prevention. 2014.
This meta-analysis provides useful context for understanding driving risk in ADHD. Importantly, it challenges older claims that ADHD necessarily produces extremely large increases in accident risk and demonstrates the importance of factors such as exposure and co-occurring behavioural difficulties when interpreting the evidence.
This paper is particularly useful clinically because it reinforces the principle that population-level associations should not be translated directly into assumptions about an individual patient's driving ability.
ADHD Treatment and Adverse Outcomes
Zhang L, Zhu N, Sjölander A, et al.
ADHD Drug Treatment and Risk of Suicidal Behaviours, Substance Misuse, Accidental Injuries, Transport Accidents, and Criminality: Emulation of Target Trials. BMJ. 2025.
This large Swedish register study examined several clinically important outcomes following initiation of ADHD medication. Treatment was associated with lower rates of first suicidal behaviours, substance misuse, transport accidents and criminality. As an observational study it should not be interpreted as proving that medication prevents these outcomes in every individual but it provides important contemporary evidence regarding the relationship between ADHD treatment and wider safety outcomes.
Liu WJ, Mao HJ, Hu LL, et al.
Attention-Deficit/Hyperactivity Disorder Medication and Risk of Suicide Attempt: A Meta-analysis of Observational Studies. Pharmacoepidemiology and Drug Safety. 2020.
This meta-analysis is useful when considering concerns about ADHD medication and suicidal behaviour. The observational evidence did not indicate an increased risk of suicide attempts associated with ADHD medication overall and stimulant treatment was associated with lower observed risk in the included studies.
Recommended Broader Reading
Faraone SV, Banaschewski T, Coghill D, et al.
The World Federation of ADHD International Consensus Statement: 208 Evidence-based Conclusions About the Disorder. Neuroscience & Biobehavioral Reviews. 2021.
This international consensus statement provides a broad evidence-based overview of ADHD including its functional consequences, associated conditions and longer-term outcomes.
Barkley RA.
Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment.
This remains a valuable clinical reference for understanding ADHD assessment, functional impairment, comorbidity and the behavioural consequences of impulsivity and executive functioning difficulties.
Suggested Reading for This Lesson
For clinicians with limited time, the most useful starting points are:
NICE NG87: Attention Deficit Hyperactivity Disorder: Diagnosis and Management.
NICE NG225: Self-harm: Assessment, Management and Preventing Recurrence.
DVLA: Assessing Fitness to Drive: A Guide for Medical Professionals.
Septier M, Stordeur C, Zhang J, et al. Association Between Suicidal Spectrum Behaviors and Attention-Deficit/Hyperactivity Disorder.
Garas P, Takacs ZK and Balázs J. Longitudinal Suicide Risk in Children and Adolescents With Attention Deficit and Hyperactivity Disorder.
Vaa T. ADHD and Relative Risk of Accidents in Road Traffic.
Zhang L, Zhu N, Sjölander A, et al. ADHD Drug Treatment and Risk of Suicidal Behaviours, Substance Misuse, Accidental Injuries, Transport Accidents, and Criminality.
Together, these resources reinforce the central principle of this lesson: risk should not be inferred simply from an ADHD diagnosis. ADHD is associated at a population level with several important adverse outcomes but the clinician's task is to assess the individual patient, including their current mental state, previous behaviour, impulsivity, co-occurring conditions, substance use, circumstances, protective factors and current support.
The purpose of risk assessment is not to predict future behaviour with certainty. It is to identify foreseeable vulnerabilities and use this information to develop proportionate plans that reduce the likelihood of harm.
7. Knowledge Check
The following questions are designed to consolidate the key principles covered in this lesson. The focus is on applying risk assessment to realistic ADHD presentations rather than simply identifying individual risk factors.
Question 1
Which statement best describes risk assessment in ADHD?
A. It should focus primarily on suicide and self-harm.
B. Everyone diagnosed with ADHD should be considered high risk.
C. It should consider a range of individual risks including self-harm, accidental harm, impulsive behaviour, substance use, aggression, vulnerability and safeguarding concerns where relevant.
D. Risk assessment is only required when a patient reports suicidal thoughts.
Correct answer: C
Explanation
A. Incorrect. Suicide and self-harm are important but represent only part of a comprehensive risk assessment.
B. Incorrect. ADHD may be associated with increased vulnerability to certain adverse outcomes at a population level but this does not mean that every individual with ADHD is at high risk.
C. Correct. Risk assessment should be individualised and consider the areas relevant to the person's actual presentation and circumstances.
D. Incorrect. Clinically important risks may exist even when suicidal thoughts are completely absent.
Question 2
A 17-year-old with ADHD denies suicidal thoughts and has never self-harmed. However, he frequently cycles into roads without checking for traffic, drinks heavily with friends and has experienced several accidental injuries. What is the most appropriate conclusion?
A. There is no significant risk because he is not suicidal.
B. His risk assessment should identify significant accidental and impulsive risk-taking despite the absence of current suicide risk.
C. These behaviours should automatically be considered normal adolescent behaviour.
D. ADHD alone means that he should be categorised as high risk.
Correct answer: B
Explanation
A. Incorrect. An absence of suicidal thoughts does not mean that other clinically important risks are absent.
B. Correct. His impulsive behaviour, alcohol use and history of accidents represent meaningful areas of risk requiring further assessment and appropriate management.
C. Incorrect. Some risk-taking occurs during adolescence but repeated behaviour associated with significant potential harm should not simply be dismissed.
D. Incorrect. Risk should be based on the individual's behaviour and circumstances rather than the diagnostic label alone.
Question 3
Why may impulsivity be particularly important when assessing self-harm or suicide risk in ADHD?
A. People with ADHD always have suicidal thoughts.
B. Impulsivity may contribute to rapid movement from intense distress to unsafe behaviour without extensive planning.
C. Impulsivity means that protective factors are irrelevant.
D. Anyone with impulsive ADHD requires emergency psychiatric assessment.
Correct answer: B
Explanation
A. Incorrect. Most individuals with ADHD do not necessarily experience suicidal thoughts and ADHD should not be equated with suicidality.
B. Correct. For some individuals, impulsivity may reduce the time between an intense emotional reaction and an action. Previous impulsive self-harm, substance use, access to means and behaviour during periods of acute distress may therefore be particularly relevant.
C. Incorrect. Protective factors remain an important part of the overall formulation.
D. Incorrect. Impulsivity alone does not indicate a psychiatric emergency. The wider clinical picture determines the appropriate response.
Question 4
Which of the following is the best example of a clinically meaningful protective factor?
A. "Family protective."
B. "Has friends."
C. "He describes a close relationship with his parents, speaks with them regularly and states that he would contact them if he felt unable to maintain his safety."
D. "Lives with other people."
Correct answer: C
Explanation
A. Incorrect. This does not explain how the family actually reduces risk.
B. Incorrect. Having friends may be protective but the nature and availability of that support need to be understood.
C. Correct. This identifies a specific source of support and explains how it could be used if risk increased.
D. Incorrect. Simply living with other people does not necessarily mean that meaningful support or supervision is available.
Question 5
A patient was assessed six months ago and had no significant current safety concerns. They now report relationship breakdown, job loss, heavy alcohol use and worsening depression. What is the most appropriate approach?
A. Continue using the previous risk assessment because risk has already been documented.
B. Reassess risk because important dynamic factors have changed.
C. Reassess only if the patient reports a suicide plan.
D. Assume the increased distress is caused entirely by ADHD.
Correct answer: B
Explanation
A. Incorrect. Risk assessments should not simply be carried forward when circumstances have changed.
B. Correct. Risk is dynamic. Changes in mental state, relationships, employment, substance use and support can substantially alter an individual's risk profile.
C. Incorrect. A detailed suicide plan is not required before risk becomes clinically significant.
D. Incorrect. Worsening depression and alcohol use require assessment in their own right.
Question 6
Which statement best describes the relationship between ADHD and aggression?
A. ADHD inherently causes violent behaviour.
B. Aggression should always be considered part of hyperactivity.
C. Impulsivity and emotional dysregulation may contribute to reactive aggression in some individuals but aggression requires broader assessment.
D. Aggression is unrelated to ADHD and does not need to be considered during assessment.
Correct answer: C
Explanation
A. Incorrect. ADHD should not be equated with aggression or violence.
B. Incorrect. Hyperactivity and aggression are different phenomena.
C. Correct. Where aggression occurs, clinicians should explore triggers, severity, intention, consequences, substance involvement and possible co-occurring conditions rather than simply attributing it to ADHD.
D. Incorrect. Aggression may be clinically relevant and should be assessed when indicated by the history.
Question 7
Which aspect of risk is most likely to be missed if the clinician considers only risk to self and risk to others?
A. Medication adherence.
B. Vulnerability to exploitation, coercion or abuse.
C. Previous ADHD treatment.
D. Educational attainment.
Correct answer: B
Explanation
A. Incorrect. Medication adherence may be relevant to safety but is not the main concept missing from this framework.
B. Correct. Risk assessment should also consider risk from others. Depending on age and circumstances, this may include bullying, coercion, abuse, financial exploitation, sexual exploitation or criminal exploitation.
C. Incorrect. Previous treatment forms part of the clinical history rather than representing the missing category of risk.
D. Incorrect. Educational functioning is important in ADHD assessment but does not represent the third major direction of risk considered here.
Question 8
A university student with ADHD is being considered for stimulant treatment. He reports recreational drug use and says that friends have previously asked whether he could give them ADHD medication. What should the clinician do?
A. Ignore this because diversion is not part of clinical risk assessment.
B. Automatically refuse all ADHD medication permanently.
C. Assess substance use and the risk of medication misuse or diversion and incorporate this into prescribing and monitoring decisions.
D. Prescribe additional medication so that he does not run out if some tablets are lost.
Correct answer: C
Explanation
A. Incorrect. Misuse and diversion are relevant considerations when prescribing stimulant medication.
B. Incorrect. The presence of a potential risk does not automatically determine the treatment decision. The clinician should assess its nature and severity and consider proportionate management.
C. Correct. Substance use, previous misuse, peer pressure and potential diversion should be explored. The findings can then inform safe prescribing, dispensing arrangements, storage advice and monitoring.
D. Incorrect. Providing additional medication would not appropriately manage the identified concern and could increase the potential for misuse or diversion.
Question 9
Which statement best reflects good documentation of risk?
A. "Risk: low."
B. "No risk."
C. "Patient safe."
D. "She denies current suicidal thoughts and has no history of suicide attempts. Risk may increase during periods of acute emotional distress because of impulsivity. She identifies her partner and parents as sources of support and states that she would seek help if unable to maintain her safety."
Correct answer: D
Explanation
A. Incorrect. A category alone provides little information about the nature of the risk or the reasoning behind the judgement.
B. Incorrect. Risk is rarely appropriately described as completely absent and this wording provides no formulation.
C. Incorrect. This is overly broad and does not explain how the conclusion was reached.
D. Correct. This formulation describes current findings, an important potential vulnerability and relevant protective factors. It provides useful information for subsequent clinicians and supports management planning.
Question 10
During a routine ADHD assessment, a patient reports current suicidal intent and states that they do not believe they can maintain their safety after leaving the appointment. What is the most appropriate response?
A. Complete the ADHD assessment before addressing the risk.
B. Arrange a routine ADHD follow-up appointment.
C. Prioritise immediate safety assessment and appropriate escalation rather than continuing the routine ADHD assessment unchanged.
D. Continue the assessment because suicidal thoughts are common in psychiatric practice.
Correct answer: C
Explanation
A. Incorrect. Immediate safety concerns take priority over completion of a routine diagnostic assessment.
B. Incorrect. Routine follow-up alone would not adequately address an immediate concern about the patient's ability to maintain their safety.
C. Correct. The clinician should undertake an appropriate immediate risk assessment and follow relevant local pathways. Depending on the circumstances, this may involve senior clinical advice, crisis services, emergency assessment or other appropriate intervention.
D. Incorrect. The fact that suicidal thoughts are encountered in psychiatric practice does not reduce their clinical significance. Current intent and an inability to maintain safety require appropriate action.
Reflection
Before progressing to the next lesson, consider the following questions:
How would you ensure that your ADHD risk assessment extends beyond self-harm and suicide?
How might impulsivity change the way you assess someone who experiences sudden periods of intense emotional distress?
What is the difference between risk to self, risk to others and risk from others?
Which changes in a patient's circumstances would prompt you to reconsider a previous risk formulation?
How would you distinguish a genuinely useful protective factor from a simple statement that someone has support?
When should immediate safety concerns take priority over completing the ADHD diagnostic pathway?
The central principle is that risk assessment should lead to action. A useful assessment identifies what the concern is, what may increase it, what may reduce it and what needs to be done about it.
