Multidisciplinary consensus for the development of ADHD services: the way forward

Ayyash, Hani; Sankar, Sachin; Merriman, Harold L.; Vogt, Carsten; Earl, T.; Shah, Khadija Akbar; Banerjee, Somnath

doi:10.1108/14777271311297939

Cited by 5 publications

(14 citation statements)

References 13 publications

(12 reference statements)

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“…This is consistent with research that highlight selected environmental factors relevant in ADHD [17][18][19], argue for a better understanding of the environment factors that influence functional outcomes in ADHD [50,51], and promote interventions that help individuals with ADHD to more optimally perform in key environmental contexts [52], such as education [53], vocation [54], and community participation [9].…”

Section: Discussionsupporting

confidence: 73%

“…Common in all age-specific brief sets is category e575 General social support services, systems, and policies, which demonstrates the importance of access to support services for the functioning of individuals with ADHD across the lifespan [50]. Principally, support services, systems, and policies, including social security, health, and education, were deemed important, as evidenced …”

Section: Discussionmentioning

confidence: 99%

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Standardised assessment of functioning in ADHD: consensus on the ICF Core Sets for ADHD

Bölte

Mahdi

Coghill

et al. 2018

Eur Child Adolesc Psychiatry

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Attention-deficit/hyperactivity disorder (ADHD) is associated with significant impairments in social, educational, and occupational functioning, as well as specific strengths. Currently, there is no internationally accepted standard to assess the functioning of individuals with ADHD. WHO's International Classification of Functioning, Disability and Health-child and youth version (ICF) can serve as a conceptual basis for such a standard. The objective of this study is to develop a comprehensive, a common brief, and three age-appropriate brief ICF Core Sets for ADHD. Using a standardised methodology, four international preparatory studies generated 132 second-level ICF candidate categories that served as the basis for developing ADHD Core Sets. Using these categories and following an iterative consensus process, 20 ADHD experts from nine professional disciplines and representing all six WHO regions selected the most relevant categories to constitute the ADHD Core Sets. The consensus process resulted in 72 second-level ICF categories forming the comprehensive ICF Core Set-these represented 8 body functions, 35 activities and participation, and 29 environmental categories. A Common Brief Core Set that included 38 categories was also defined. Age-specific brief Core Sets included a 47 category preschool version for 0-5 years old, a 55 category school-age version for 6-16 years old, and a 52 category version for older adolescents and adults 17 years old and above. The ICF Core Sets for ADHD mark a milestone toward an internationally standardised functional assessment of ADHD across the lifespan, and across educational, administrative, clinical, and research settings.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Standardised assessment of functioning in ADHD: consensus on the ICF Core Sets for ADHD

Bölte

Mahdi

Coghill

et al. 2018

Eur Child Adolesc Psychiatry

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“…The main theme highlighted by this review related to the need for education on ADHD. Thirty-seven papers identified issues related to a lack of education on ADHD, representing a wide range of countries, 14 from the US [30–43], 7 from the UK [3, 11, 16, 44–47], 3 from Australia [48–50], 2 from the Netherlands [51, 52], 2 from South Africa [53, 54], 2 from Canada [55, 56] and 1 each from France [57], Singapore [58], Pakistan [59], Finland [60], Brazil [61], Iran [62] and Switzerland [63]. These papers highlighted both a lack of initial training, as well as inadequate training on ADHD.…”

Section: Resultsmentioning

confidence: 99%

“…While a strong need for training on ADHD in general was observed, three studies also highlighted the importance of updated training incorporating new knowledge [37, 39, 42]. This lack of education affected many aspects of the primary care experience of patients from referral and diagnosis [44, 59] to management [50] of ADHD.…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators to understanding of ADHD in primary care: a mixed-method systematic review

French

Sayal

Daley

2018

Eur Child Adolesc Psychiatry

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Attention deficit hyperactivity disorder (ADHD) is a developmental disorder affecting up to 5% of children and adults and is underdiagnosed in many European countries. The process of access to care for this disorder is complex and variable across countries. In general, those affected, or their caregiver, will seek help through their primary care practitioners who are then often responsible for referral to other professionals for diagnosis and provision of treatment. Previous studies have highlighted that many barriers to recognition exist in primary care settings (such as misconceptions, lack of education or lack of resources), preventing access to care for this population and potentially affecting diagnosis rate. This systematic review aims to establish the barriers and facilitators with regard to attitudes, beliefs and experiences of ADHD within primary care. Electronic searches of multiple databases identified 3898 articles of which 48 met our inclusion criteria—primary care professionals from any country, understanding, knowledge, awareness, attitude and recognition of ADHD. Four main themes were identified: (1) need for education, (2) misconceptions and stigma, (3) constraints with recognition, management and treatment, and (4) multidisciplinary approach. The findings suggest many interacting factors are at play in the recognition of ADHD by primary care practitioners with a strong recurring theme of a significant need for better education on ADHD. Implications for research and practice are discussed, suggesting that educational interventions for primary care practitioners could improve the recognition of ADHD in this setting. Electronic supplementary material The online version of this article (10.1007/s00787-018-1256-3) contains supplementary material, which is available to authorized users.

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“…This is in line with a consensus of ADHD professionals in the UK, who considered that a care co-ordination role for adult patients with complex health and social needs would facilitate multiagency service input. 192 In most community and inpatient AMHS, there is a specific role of care coordinator under the CPA, but some clinicians in this sample described CPA processes as administratively burdensome. A care co-ordination function for young people with ADHD could present a valuable focus for development and research to help facilitate transition for ADHD patients with comorbidities and those with complex needs, as well as access to non-pharmacological support.…”

Section: Architecture Of Servicesmentioning

confidence: 94%

The transition from children’s services to adult services for young people with attention deficit hyperactivity disorder: the CATCh-uS mixed-methods study

Janssens

Eke

Price

et al. 2020

Health Serv Deliv Res

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Background Attention deficit hyperactivity disorder was previously seen as a childhood developmental disorder, so adult mental health services were not set up to support attention deficit hyperactivity disorder patients who became too old for child services. To our knowledge, this is the first in-depth study of the transition of attention deficit hyperactivity disorder patients from child to adult health services in the UK. Objectives Our objectives were to explore how many young people with attention deficit hyperactivity disorder are in need of services as an adult, what adult attention deficit hyperactivity disorder services are available and how attention deficit hyperactivity disorder stakeholders experience transition from child to adult services. Design An interactive mixed-method design was adopted with three study streams: (1) a 12-month surveillance study with 9-month follow-up to find out how many young people required ongoing medication when they were too old for child services (929 surveys completed by children’s clinicians); (2) a mapping study to identify and describe services for young adults with attention deficit hyperactivity disorder (2686 respondents to online surveys for patients and health workers and freedom of information requests to service providers and commissioners); and (3) a qualitative study to explore key stakeholders’ experiences of transition from child to adult services (144 interviews with 64 attention deficit hyperactivity disorder patients, 28 parents and 52 health clinicians; 38 working in child or adult secondary health services and 14 general practitioners). Members of the public advised at each stage of the study. Results When corrected for non-response and case ascertainment, the annual number of young people with an ongoing need for medication for attention deficit hyperactivity disorder lies between 270 and 599 per 100,000 people aged 17–19 years. Among 315 individuals eligible for transition, 64% were accepted, but only 22% attended their first adult services appointment. Our interactive map describes 294 unique services for adults with attention deficit hyperactivity disorder across the UK, of which 44 are ‘dedicated’ attention deficit hyperactivity disorder services. Few services provide the full range of recommended provision; most focus on diagnosis and medication. Services are unevenly distributed across the UK, with nearly all ‘dedicated’ services being in England. Exploring stakeholders’ experiences revealed how invested the stakeholders are in continuing attention deficit hyperactivity disorder treatment and how the architecture of services affects transition. An association between attention deficit hyperactivity disorder, education and continuance of medication into young adulthood, plus parent involvement and feeling prepared for transition and adult life with attention deficit hyperactivity disorder, influenced investment. However, even with investment, how accessible adult services are, how patient needs fit with the remit of the adult service and the level of patient information available affect transition outcomes. The results also highlight how general practitioners can end up as care co-ordinators during transition by default. Limitations Transition estimates were based on those who want medication, so these indicate a minimum level of need. Conclusions Few of those who need ongoing support for attention deficit hyperactivity disorder successfully transfer to adult services, and a small proportion of those who transfer experience optimal transitional care. Adult attention deficit hyperactivity disorder service provision is patchy. Even among ‘dedicated’ services, few provide the whole range of National Institute for Health and Care Excellence-recommended treatments. Future work We need to evaluate various models of transitional care and adult attention deficit hyperactivity disorder provision, as well as develop and evaluate psychosocial interventions for young people and adults with attention deficit hyperactivity disorder. Trial registration Current Controlled Trials ISRCTN12492022. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 42. See the NIHR Journals Library website for further project information.

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Multidisciplinary consensus for the development of ADHD services: the way forward

Cited by 5 publications

References 13 publications

Standardised assessment of functioning in ADHD: consensus on the ICF Core Sets for ADHD

Standardised assessment of functioning in ADHD: consensus on the ICF Core Sets for ADHD

Barriers and facilitators to understanding of ADHD in primary care: a mixed-method systematic review

The transition from children’s services to adult services for young people with attention deficit hyperactivity disorder: the CATCh-uS mixed-methods study

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