PurposeAttention deficit hyperactivity disorder (ADHD) is the most commonly studied and diagnosed psychiatric disorder in children. There is a need to engage service development, commissioning and service managers to address primary care involvement and define service models that will enable effective management of people with ADHD. The purpose of this project is to define recommendations through consensus that can be implemented to improve ADHD management in the UK.Design/methodology/approachA set of 40 consensus statements has been developed by a multidisciplinary group of ADHD professionals in the UK. These statements cover ten topics, ranging from commissioning of ADHD services to optimisation of the care pathway. The aim of the project was to define a set of standards that could be tested across a wider clinical population.FindingsA total of 122 respondents scored each statement on a questionnaire and levels of agreement were summated and analysed. Of 40 statements, only four scored less than 90 per cent agreement, with all statements achieving greater than 74.9 per cent agreement.Originality/valueRecommendations support the wider integration of ADHD services and the closer involvement of commissioners within the new GP consortia to ensure that the potentially negative societal and personal impacts of ADHD are managed effectively and with appropriate use of resources.
Aim/objectives: To define a set of standards and validate them as a road map for future development of ADHD services in the UK. Methods:A multidisciplinary group of clinicians involved in the treatment of patients with ADHD met to define a set of appropriate consensus statements that would define the ideal structure and direction of improving service development in the UK. Forty statements were agreed, covering 10 topics, ranging from commissioning of ADHD services to optimisation of the care pathway. The statements were collated into a questionnaire and passed to other professionals at multidisciplinary meetings around the UK. The questionnaire data was analysed and scores produced for levels of agreement with each statement. Respondents were grouped into child & adolescent psychiatrists, paediatricians , nurses , trainees and other staff .Results: 122 respondents scored each statement on a questionnaire and levels of agreement were summated and analysed. Of 40 statements, only 4 scored less than 90% agreement (Table 1A), with all statements achieving greater than 74.9% agreement. All other 36 statements achieved greater than 90% agreement while six out these statements achieved greater than 99.1% agreement ( Table 1B) [ Table 1 and 2]Conclusions: All 40 statements therefore have broad support across the ADHD clinical and professional community and reflect strong agreement about what constitutes best practice in the management of ADHD and the direction for future development of services.
GORDON BATES:Welcome to what I hope will be an interesting discussion. Let's begin with diagnosis, how much time do you have available for the initial assessment for ADHD? VALERIE HARPIN: At the first appointment we start taking the history and decide whether or not to take things further; this takes perhaps 45 minutes. Then we collect information by contacting the school, including a direct observation by one of our nurses, follow up of any comorbid issues and then carry out a review, so the whole assessment takes about eight weeks. Often parents go away with written information to consider. Although we like to think we take as long as is needed, in reality we do not have the opportunity to. SACHIN SANKAR:In our department, once we get a referral, the patient has an initial screening meeting that lasts 45 minutes, during which there is discussion between the family and the clinician to look at the best way forward and to establish what the family is asking for. If it becomes clear that ADHD is a possibility then a slot would be booked at the ADHD clinic. We book about three cases in one four-hour session, giving us about an hour with each child, where we again go through the history and see whether we can make a diagnosis. In other cases there may be a period of school or home observation during which information is collated and discussed at another appointment. GORDON BATES:Clearly making the diagnosis correctly is the first step and that requires a lot a time. Do you think we spend enough time discussing the range of management options with parents and children, once the diagnosis has been made? SACHIN SANKAR: Diagnosis does take a lot of time, which is why I book the child into a follow up ADHD clinic. After the initial appointment at which time we try to give the family a diagnosis, we provide them with a lot of information, which includes treatment options so they can read through this before they attend the ADHD clinic. We generally find that by the time the patient meets the criteria for being referred by the GP, they are asking for immediate treatment. Most of our referrals are moderate to severe cases and at that stage parents and patients are looking for medical options. Increasingly over the past year we have had parents who are very keen to know about non-pharmacological treatments, and this usually takes more time as they are interested in studies of treatment versus non-treatment. We are under a lot of pressure and there is always a wish that you have more time to spend with the family. GORDON BATES:Quite a lot of my time has been involved in second opinion work, and that gives an opportunity to review the current management plan. There should be a difference between the initial plan and later versions as the child becomes a teenager. In the teenage years, there is a change of emphasis from the parents' views of treatment to a much stronger lead from the young person. You often have to work much harder with teenagers, in terms of their engagement. With regard to treatment, how do you decide with t...
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