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Russell AE, Benham-Clarke S, Ford T, Eke H, Price A, Mitchell S, Newlove-Delgado T, Moore D, Janssens A. Educational experiences of young people with ADHD in the UK: Secondary analysis of qualitative data from the CATCh-uS mixed-methods study. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2023; 93:941-959. [PMID: 37227452 DOI: 10.1111/bjep.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and/or impulsivity. Young people with ADHD have poorer educational and social outcomes than their peers. We aimed to better understand educational experiences of young people with ADHD in the UK, and make actionable recommendations for schools. METHODS In this secondary analysis of qualitative data, we used Thematic Analysis to analyse information relating to experiences of education from 64 young people with ADHD and 28 parents who participated in the Children and adolescents with ADHD in Transition between Children's services and adult Services (CATCh-uS) study. Emerging patterns within and across codes led to organization of the data into themes and subthemes through an iterative process. RESULTS Two main themes were generated. The first described young people's early experiences of education, often within a mainstream setting; we labelled this the problematic provision loop, as this was a negative cycle that was repeated several times for some participants. The second theme described young people's more positive progression through education once they progressed out of the problematic loop. CONCLUSIONS Educational experiences for young people with ADHD are often negative and fraught with complication. Young people with ADHD often found themselves on a more positive trajectory after they were placed in an alternative form of education provision (mainstream or otherwise), or where they were able to study topics that interest them and play to their strengths. We make recommendations that commissioners, local authorities and schools could consider in order to better support those with ADHD.
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Affiliation(s)
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Helen Eke
- University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Anna Price
- University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Siobhan Mitchell
- University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | | | - Darren Moore
- University of Exeter Graduate School of Education, Exeter, UK
| | - Astrid Janssens
- Center for Innovativ Medicinsk Teknologi, University of Southern Denmark, Odense, Denmark
- Center for Research in Partnership with Patients and Relatives, Odense University Hospital, Odense, Denmark
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Batstra L, van Roy AM, Thoutenhoofd ED. Teachers With Special Needs. De-Psychiatrization of Children in Schools. FRONTIERS IN SOCIOLOGY 2021; 6:781057. [PMID: 35224087 PMCID: PMC8867226 DOI: 10.3389/fsoc.2021.781057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
Psychiatrization not only affects adults. Ever more children in Western countries are being diagnosed with a mental disorder of behavior, such as ADHD. Children may often be labelled with the best intentions, for example in order to be able to provide them with suitable care and guidance. However, this labelling can have exclusionary effects and often entails the consequence that important discussion about contextual factors that give rise to (the perception of) unwelcome behavior or academic underperformance rarely, if at all, takes place. In this article we contend that although children are of central concern to schools and the design of pupils' education, it is important not to make pupils the sole owner of problems that arise. It is therefore high time that a far more critical normative stance towards inclusive education is taken, in which the presently widespread biomedical approach is met with a school community response that focuses not on the nature of individual disorders but on the special need for additional capacity that schools and teachers have in meeting (perceived) deviant behaviors and emotions and/or academic underperformance. We argue that teaching should not set out to remedy individual diagnoses, but that teachers should be supported to extend their professional competence to the benefit of all pupils.
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Affiliation(s)
- Laura Batstra
- Department of Child and Family Welfare, The University of Groningen, Groningen, Netherlands
| | - A.C. Marieke van Roy
- Department of Child and Family Welfare, The University of Groningen, Groningen, Netherlands
| | - Ernst D. Thoutenhoofd
- Department of Education and Special Education, The University of Gothenburg, Gothenburg, Sweden
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Ward RJ, Kovshoff H, Kreppner J. School staff perspectives on ADHD and training: understanding the needs and views of UK primary staff. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2021. [DOI: 10.1080/13632752.2021.1965342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rebecca J Ward
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Hanna Kovshoff
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jana Kreppner
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Joy EE, Bartholomew TT. Clients in context: Environment, class, race, and therapists' perceptions of generalized anxiety disorder. J Clin Psychol 2021; 77:2817-2831. [PMID: 34273907 DOI: 10.1002/jclp.23222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/18/2021] [Accepted: 06/30/2021] [Indexed: 11/08/2022]
Abstract
Evidence-based practice necessitates the inclusion of client identity and contextual information when conceptualizing diagnosis. OBJECTIVE To examine how therapists' perceptions of Generalized Anxiety Disorder is influenced by client environmental contextual and identity factors, like class and race. METHOD Therapists (n = 138; 76% women; Mage = 38.3) were randomly assigned three of six client vignettes and asked to provide diagnostic recommendations, confidence in diagnosis, and perception of client's concerns. Vignettes differed in their description of client class, race, and contextual factors. A linear mixed-model was used to test confidence in diagnosis and generalized linear mixed-models were conducted to predict diagnosis and client concerns. RESULTS Therapists altered diagnosis, confidence, and client concerns based on client contextual factors-but not identity factors. CONCLUSIONS Therapists consider contextual factors in making clinical decisions, with overall tendency towards diagnosis regardless of if symptoms met the diagnostic criteria of being "excessive" given the environmental context.
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Affiliation(s)
- Eileen E Joy
- Department of Educational Studies, Purdue University, West Lafayette, Indiana, USA
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Young S, Asherson P, Lloyd T, Absoud M, Arif M, Colley WA, Cortese S, Cubbin S, Doyle N, Morua SD, Ferreira-Lay P, Gudjonsson G, Ivens V, Jarvis C, Lewis A, Mason P, Newlove-Delgado T, Pitts M, Read H, van Rensburg K, Zoritch B, Skirrow C. Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement. Front Psychiatry 2021; 12:649399. [PMID: 33815178 PMCID: PMC8017218 DOI: 10.3389/fpsyt.2021.649399] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Despite evidence-based national guidelines for ADHD in the United Kingdom (UK), ADHD is under-identified, under-diagnosed, and under-treated. Many seeking help for ADHD face prejudice, long waiting lists, and patchy or unavailable services, and are turning to service-user support groups and/or private healthcare for help. Methods: A group of UK experts representing clinical and healthcare providers from public and private healthcare, academia, ADHD patient groups, educational, and occupational specialists, met to discuss shortfalls in ADHD service provision in the UK. Discussions explored causes of under-diagnosis, examined biases operating across referral, diagnosis and treatment, together with recommendations for resolving these matters. Results: Cultural and structural barriers operate at all levels of the healthcare system, resulting in a de-prioritization of ADHD. Services for ADHD are insufficient in many regions, and problems with service provision have intensified as a result of the response to the COVID-19 pandemic. Research has established a range of adverse outcomes of untreated ADHD, and associated long-term personal, social, health and economic costs are high. The consensus group called for training of professionals who come into contact with people with ADHD, increased funding, commissioning and monitoring to improve service provision, and streamlined communication between health services to support better outcomes for people with ADHD. Conclusions: Evidence-based national clinical guidelines for ADHD are not being met. People with ADHD should have access to healthcare free from discrimination, and in line with their legal rights. UK Governments and clinical and regulatory bodies must act urgently on this important public health issue.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, London, United Kingdom.,Department of Psychology, Reykjavik University, Reykjavik, Iceland.,ADHD Foundation, Liverpool, United Kingdom
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Tony Lloyd
- ADHD Foundation, Liverpool, United Kingdom
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,King's Health Partners Academic Health Science Centre, London, United Kingdom.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Muhammad Arif
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | | | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences & Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent NHS Trust, Southampton, United Kingdom.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States
| | - Sally Cubbin
- The ADHD Clinic, Manor Hospital, Oxford, United Kingdom
| | - Nancy Doyle
- Genius Within, Plumpton Green, United Kingdom.,Department of Organizational Psychology, Birkbeck College, University of London, London, United Kingdom
| | - Susan Dunn Morua
- AADD-United Kingdom, Bristol, United Kingdom.,Bristol Adult ADHD Support Group, Bristol, United Kingdom
| | - Philip Ferreira-Lay
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Gisli Gudjonsson
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | - Alexandra Lewis
- Cambridge & Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Peter Mason
- ADHD Foundation, Liverpool, United Kingdom.,ADHD and Psychiatry Services Limited, Liverpool, United Kingdom.,Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
| | | | - Mark Pitts
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Helen Read
- ADHD Consultancy Limited, London, United Kingdom
| | - Kobus van Rensburg
- Adult ADHD and Asperger's Team & Children and Young People's ADHD and ASD Service, Northamptonshire Healthcare NHS Foundation Trust, Kettering, United Kingdom
| | - Bozhena Zoritch
- ADDmire Clinic, West Byfleet, United Kingdom.,Epsom and St. Helier University Hospital, Epsom, United Kingdom
| | - Caroline Skirrow
- Cambridge Cognition, Cambridge, United Kingdom.,Psychological Sciences, University of Bristol, Bristol, United Kingdom
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Buadze A, Friedl N, Schleifer R, Young S, Schneeberger A, Liebrenz M. Perceptions and Attitudes of Correctional Staff Toward ADHD-A Challenging Disorder in Everyday Prison Life. Front Psychiatry 2020; 11:600005. [PMID: 33633596 PMCID: PMC7901975 DOI: 10.3389/fpsyt.2020.600005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/30/2020] [Indexed: 01/13/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is associated with risk-taking behaviors, poor self-control, and interpersonal difficulties. Affected individuals have an increased probability of involvement with the criminal justice system, contributing to a higher rate of arrest, and imprisonment compared with the general population; they are also inadequately treated once sentenced. Because prison staff play a central role in the identification of inmates with mental disorders, they could well be key to improving provision of care. There is however little knowledge of the conceptions, perceptions, and attitudes of prison staff toward ADHD. Such information could help to identify starting points for awareness training and further implementation of specific ADHD treatment. To bridge this gap, we undertook a study based on a qualitatively-driven mixed methods design, combining qualitative data collection in the form of narrative interviews with 19 prison staff from a Swiss correctional facility with quantitative data collection in the form of a survey that included the Attitudes toward Prisoners scale. The interviews were analyzed with QSR NVIVO 11 and a qualitative content analysis approach was used to evaluate findings. Prison staff were generally aware of ADHD and its symptomology, believing it to a be "real," but "fashionable" disorder and favoring hereditary-genetic or biological explanatory models for its development. They viewed inmates with ADHD rather negatively, as complicating correctional efforts, and perceived them as sticking out, as tying up more resources and as frequently being involved in confrontations. Our findings suggest that difficulties in pragmatic aspects of communication and language comprehension may be perceived "as not listening or following instructions," creating additional tensions. Consequently, inmates with ADHD are more often exposed to disciplinary sanctions, such as solitary confinement-an intervention deemed "necessary" by staff. Therefore, staff training on ADHD might need to cover evidence on adverse effects. Non-pharmacological interventions for treatment were preferred and considered to be highly efficacious. Skepticism toward pharmacological treatment prevailed, even when benefits from stimulant medication were described. Interestingly, this skepticism was not the result of negative experiences with the misuse and diversion of stimulants. Acceptance of multimodal treatment among prison staff may require customized strategies.
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Affiliation(s)
- Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Nadine Friedl
- Hospital of Psychiatry Münsingen, Münsingen, Switzerland
| | - Roman Schleifer
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Susan Young
- Psychology Services Limited, London, United Kingdom.,Department of Psychology, Reykjavik University, Reykjavík, Iceland
| | - Andres Schneeberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Psychiatrische Dienste Graubuenden, Chur, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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