Should clinical services for children with possible ADHD, autism or
                        related conditions be delivered in an integrated neurodevelopmental
                        pathway?Should clinical services for children with possible ADHD, autism or
                        related conditions be delivered in an integrated neurodevelopmental
                        pathway?

Male, Ian; Farr, William; Reddy, Venkat

doi:10.1136/ihj-2019-000037

Cited by 10 publications

(22 citation statements)

References 11 publications

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“…Where community paediatrics and mental health services were integrated and collocated in the same organisation this allowed a seamless transition, avoiding duplicated waits and enabling families to see all relevant professionals at once. 18 42 …”

Section: Resultsmentioning

confidence: 99%

“…Few papers clearly delineated the service pathway 18 35 40–42 47 48 and within these were wide variations, including the balance of standardised assessments, observations and clinical judgement. As recommended by NICE, 12 most services were multidisciplinary, and many offered a single point of access, bridging the autism-ADHD diagnostic divide.…”

Section: Resultsmentioning

confidence: 99%

“…As recommended by NICE, 12 most services were multidisciplinary, and many offered a single point of access, bridging the autism-ADHD diagnostic divide. 18 42 For example, Peterborough’s integrated pathway provided assessments for ADHD and autism 18 42 and combined a single point of access with a comprehensive skill mix, including access to therapies. This reduced the number of assessments per individual, saved time and money, and provided a better diagnostic experience.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, RRR is explicitly designed to engage with stakeholders to accelerate the search process and validate findings. 17 Our Expert Stakeholder Group included clinicians (consultant paediatricians, child psychology, SALT), policy-makers and third sector advocacy groups (Council for Disabled Children and Autistica) who were involved in all stages of the process. 19 Ethical approval was not required because stakeholders were acting as research advisers, not participants.…”

Section: Methodsmentioning

confidence: 99%

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Realist evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Findings from a rapid realist review

et al. 2021

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ObjectivesWaiting times in the UK for an autism diagnostic assessment have increased rapidly in the last 5 years. This review explored research (including ‘grey’ literature) to uncover the current evidence base about autism diagnostic pathways and what works best, for whom and in what circumstances, to deliver high quality and timely diagnosis.DesignWe performed a Rapid Realist Review consistent with recognised standards for realist syntheses. We collected 129 grey literature and policy/guidelines and 220 articles from seven databases (January 2011–December 2019). We developed programme theories of how, why and in what contexts an intervention worked, based on cross comparison and synthesis of evidence. The focus was on identifying factors that contributed to a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within specific parameters (Autism diagnostic services in Paediatric and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group, including representatives from local parent forums, national advocacy groups and clinicians, was integral to the process.ResultsBased on 45 relevant articles, we identified 7 programme theories that were integral to the process of diagnostic service delivery. Four were related to the clinical pathway: initial recognition of possible autism; referral and triaging; diagnostic model; and providing feedback to parents. Three programme theories were pertinent to all stages of the referral and diagnostic process: working in partnership with families; interagency working; and training, service evaluation and development.ConclusionsThis theory informed review of childhood autism diagnostic pathways identified important aspects that may contribute to efficient, high quality and family-friendly service delivery. The programme theories will be further tested through a national survey of current practice and in-depth longitudinal case studies of exemplar services.Trial registration numberNCT04422483.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Realist evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Findings from a rapid realist review

et al. 2021

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“…The high level of community paediatricians’ involvement in the assessment and treatment of CYP with neurodevelopmental conditions like ASD and ADHD is consistent with their expertise, workforce recommendations 8 and established practice in the UK. 18 The community paediatricians appeared positive about this area of work. There was no free text comment to suggest that any of the paediatricians had concerns about supporting CYP with neurodevelopmental difficulties.…”

Section: Discussionmentioning

confidence: 99%

Involvement of community paediatricians in the care of children and young people with mental health difficulties in the UK: implications for case ascertainment by child and adolescent psychiatric, and paediatric surveillance systems

Ayyash

Ogundele

Lynn

et al. 2021

bmjpo

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ObjectiveTo ascertain the extent to which community paediatricians are involved in the care of children with mental health conditions in order to determine which difficulties are appropriate for single or joint surveillance by the British Paediatric Surveillance Unit (BPSU) and Child and Adolescent Psychiatry Surveillance System (CAPSS).DesignAn online survey of the 1120 members of the British Association of Community Child Health (BACCH) working in 169 Community Child Health (CCH) services in the UK.ResultsA total of 245 community paediatricians responded to the survey. This represents 22% of members of BACCH but likely to have covered many of the 169 CCH units because participants could respond on behalf of other members in their unit. The survey showed that children and young people (CYP) with neurodevelopmental conditions presented more frequently to paediatrics than to Child and Adolescent Mental Health Services (CAMHS). In addition, a sizeable proportion of CYP with emotional difficulties presented to paediatricians (eg, 29.5% for anxiety/obsessive compulsive disorder (OCD), and 12.8% for depression)—mainly due to difficulty with accessing CAMHS. More than half of the community paediatricians are involved in the care of CYP with anxiety and OCD, while 32.3% are involved in the care of those with depression.ConclusionThere is significant involvement of community paediatricians in the care of CYP with mental health conditions. Involvement is highest for neurodevelopmental conditions, but also significant for CYP with emotional difficulties. The implication of the findings for surveillance case ascertainment is that joint BPSU and CAPSS is recommended for surveillance studies of neurodevelopmental conditions. However, for emotional disorders, single or joint surveillance should be made based on the specific research question and the relative trade-offs between case ascertainment, and the additional cost and reporting burden of joint surveillance. Single CAPSS studies remain appropriate for psychosis and bipolar disorder.

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Prevalence of neurodevelopmental differences and autism in Scottish primary schools 2018–2022

Maciver,

Rutherford,

Johnston

et al. 2023

Autism Research

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This study investigated the prevalence of neurodevelopmental needs among children in primary schools in Scotland. Two groups were identified: autistic learners and a larger group of learners who had neurodevelopmental differences. These differences encompassed any need for additional support in various domains, including communication, interaction, emotional regulation, coordination, movement, and cognition. A two‐phase process was employed, drawing on data from a cross‐sectional study followed by a secondary analysis of a population census. In the first phase, a random sample of 688 children with additional support needs from 22 schools participated. Demographics, support characteristics, and neurodevelopmental needs were identified. Results revealed that 76.89% of children with additional support needs exhibited a need type consistent with a neurodevelopmental difference. In the second phase, data from the Scottish Government Annual Pupil Census, covering all state‐provided primary school children between 2018 and 2022, were analyzed. Modeling was conducted using data from the first phase to estimate prevalence of neurodevelopmental differences. Data on autism were directly extracted from the census. Analysis revealed an increase in the prevalence of neurodevelopmental differences and autism. The prevalence of autism rose by 31.98%, with 2.60% of primary school children identified as autistic in 2022. Similarly, the prevalence of neurodevelopmental differences increased by 10.57%, with 16.22% of primary school children exhibiting such differences in 2022. Across 32 localities, regional variations in prevalence were observed. These findings show the substantial number of neurodivergent children within Scottish primary schools and emphasize the need for a neurodevelopmentally informed approach to inclusive education.

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Should clinical services for children with possible ADHD, autism or related conditions be delivered in an integrated neurodevelopmental pathway?Should clinical services for children with possible ADHD, autism or related conditions be delivered in an integrated neurodevelopmental pathway?

Cited by 10 publications

References 11 publications

Realist evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Findings from a rapid realist review

Realist evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Findings from a rapid realist review

Involvement of community paediatricians in the care of children and young people with mental health difficulties in the UK: implications for case ascertainment by child and adolescent psychiatric, and paediatric surveillance systems

Prevalence of neurodevelopmental differences and autism in Scottish primary schools 2018–2022

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