Disruptive behaviour problems (DBPs) during childhood exert a high burden on individuals, families and the community as a whole. Reducing this impact is a major public health priority. Early parenting interventions are recommended as valuable ways to target DBPs; however, low take-up of, and high drop-out rates from, these programmes seriously reduce their effectiveness. We present a review of published qualitative evidence relating to factors that block or facilitate access and engagement of parents with such programmes using a thematic synthesis approach. 12 papers presenting views of both parents and professionals met our inclusion and quality criteria. A large number of barriers were identified highlighting the array of challenges parents can face when considering accessing and engaging with treatment for their child with behavioural problems. Facilitating factors in this area were also identified. A series of recommendations were made with regard to raising awareness of programmes and recruiting parents, providing flexible and individually tailored support, delivering programmes through highly skilled, trained and knowledgeable therapists, and highlighting factors to consider when delivering group-based programmes. Clinical guidelines should address barriers and facilitators of engagement as well as basic efficacy of treatment approaches.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-013-0401-2) contains supplementary material, which is available to authorized users.

5ADHD is a high cost/high burden disorder. Early detection and intervention may prevent 6 or ameliorate the development of the disorder and reduce its long term impact. Here we set out a 7 rationale for an early detection and intervention programme. First, we highlight the costs of the 8 condition. Second, we discuss limitations of the current treatments. We then outline the potential 9 value of an early detection and intervention programme. We review evidence on predictors of 10 poor outcomes for early ADHD signs and discuss how these might allow us to target early 11 intervention more cost-effectively. We then examine potential barriers to engagement with at-risk 12samples. This leads to a discussion of possible intervention approaches and how these could be 13improved. Finally we describe the PEDIA (Programme for Early Detection and Intervention for 14 ADHD) a five year programme of research supported by the National Institute for Health 15Research and conducted at the University of Southampton which aims to develop and evaluate a 16 strategy for early intervention. 17 Peer Review PaperPlease return your comments for the attention of the Assistant Commissioning Editor at l.rishton@expert-reviews.com Many thanks in advance for your kind assistance. ADHD are likely to use medical services [9] and no account is taken of the costs due to family 36 member stress [10]. Furthermore, children with ADHD suffer a wide range of impairments that 37 impinge on social and health care systems at a number of levels (education, criminal justice, 38 mental health, social services etc) [11]. It has been estimated that 45 percent of the young male 39 prison population have ADHD ([12], see also [13] and [14]

BackgroundThe importance of early intervention approaches for the treatment of attention-deficit hyperactivity disorder (ADHD) has been increasingly acknowledged. Parenting programmes (PPs) are recommended for use with preschool children with ADHD. However, low ‘take-up’ and high ‘drop-out’ rates compromise the effectiveness of such programmes within the community.MethodsThis qualitative study examined the views of 25 parents and 18 practitioners regarding currently available PPs for preschool children with ADHD-type problems in the UK. Semi-structured interviews were undertaken to identify both barriers and facilitators associated with programme access, programme effectiveness, and continued engagement.Results and conclusionsMany of the themes mirrored previous accounts relating to generic PPs for disruptive behaviour problems. There were also a number of ADHD-specific themes. Enhancing parental motivation to change parenting practice and providing an intervention that addresses the parents' own needs (e.g. in relation to self-confidence, depression or parental ADHD), in addition to those of the child, were considered of particular importance. Comparisons between the views of parents and practitioners highlighted a need to increase awareness of parental psychological barriers among practitioners and for better programme advertising generally. Clinical implications and specific recommendations drawn from these findings are discussed and presented.

BackgroundPreschool hyperactivity is an early risk factor for adult mental health problems and criminality. Little is known about; (a) the patterns of long‐term service costs associated with this behavioural marker in the general population and (b) the specific factors predicting hyperactivity‐related costs. We undertook a prospective study investigating associations between preschool hyperactivity and average individual annual service costs up to late adolescent and young adulthood.MethodsOne‐hundred and seventy individuals rated as hyperactive by their parents and 88 nonhyperactive controls were identified from a community sample of 4,215 three years olds. Baseline information about behaviour/emotional problems and background characteristics were collected. At follow‐up (when individuals were aged between 14 and 25 years) information was obtained on service use, and associated costs since the age of three. Based on this information we calculated the average cost per annum incurred by each individual.ResultsCompared to controls, preschoolers with hyperactivity had 17.6 times higher average costs per annum across domains (apart from nonmental health costs). These were £562 for each hyperactive individual compared with £30 for controls. Average annual costs decreased as a function of age, with higher costs incurred at younger ages. The effects of hyperactivity remained significant when other baseline factors were added to the model. Effects were fully mediated by later psychiatric morbidity. When the hyperactive group were examined separately, costs were consistently predicted by male gender and, for some cost codes, by conduct problems.ConclusionsPreventative approaches targeting early hyperactivity may be of value. Services should be targeted towards high‐risk individuals with careful consideration given to the cost‐to‐benefit trade‐off of early intervention strategies.

Spatial memory in mammals, including humans, appears highly sexually dimorphic. The present investigation sought to examine if spatial learning and spatial memory in humans is also linked to sexual orientation. This was achieved by using virtual reality versions of two classic paradigms developed in animal models of hippocampal functioning, the Morris Water Maze (MWM) and Radial Arm Maze (RAM). Here, we show that in contrast to heterosexual men, and in congruence with heterosexual women, homosexual men displayed significantly greater search latencies (spatial learning) during a virtual Morris Water Maze. During a virtual 8-arm Radial Arm Maze, heterosexual males had significantly shorter search latency than heterosexual females, and did not differ from homosexual males. Statistical modeling revealed that variations in neurodevelopmental markers previously associated with human sexual orientation (2nd to 4th finger length ratios and older fraternal siblings) differentially predicted MWM probe trial performance and RAM search latencies only. These data may limit the number of possible neurodevelopmental pathways responsible for sexual variation in components of spatial learning and memory.