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McKenna K, Wanni Arachchige Dona S, Gold L, Dew A, Le HND. Barriers and Enablers of Service Access and Utilization for Children and Adolescents With Attention Deficit Hyperactivity Disorder: A Systematic Review. J Atten Disord 2024; 28:259-278. [PMID: 38084035 PMCID: PMC10838487 DOI: 10.1177/10870547231214002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To update a systematic review of the literature on the barriers and enablers of service access and utilization for children and adolescents with a diagnosis, or symptoms of attention deficit/hyperactivity disorder (ADHD), from the perspective of caregivers, clinicians, and teachers. METHODS Five databases were searched for peer-reviewed literature published from May 2012 to March 2023. Two independent reviewers completed a two-stage screening process and quality assessment. RESULTS Of 4,523 search results, 30 studies were included. Five main themes were generated: 1) Awareness of ADHD, 2) Stigma, 3) Parental choice and partnerships, 4) Education services as an integral component, 5) Referrals, waiting times, and logistics. More than half of the studies reported poor acknowledgement, expertise of ADHD, and stigma. CONCLUSION Findings highlight the need for ongoing ADHD education for all involved and policy changes to service delivery systems to increase the availability of health providers with specialist ADHD expertise.
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Affiliation(s)
| | | | - Lisa Gold
- Deakin University, Burwood, Australia
| | | | - Ha N D Le
- Deakin University, Burwood, Australia
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Fridman M, Banaschewski T, Sikirica V, Quintero J, Chen KS. Access to diagnosis, treatment, and supportive services among pharmacotherapy-treated children/adolescents with ADHD in Europe: data from the Caregiver Perspective on Pediatric ADHD survey. Neuropsychiatr Dis Treat 2017; 13:947-958. [PMID: 28408828 PMCID: PMC5384740 DOI: 10.2147/ndt.s128752] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and negatively impacts caregivers' lives. Factors including barriers to accessing care, dissatisfaction with support services, and lack of caregiver resources may contribute to this. OBJECTIVES To report caregivers' experiences of ADHD diagnosis, behavioral therapy (BT), and supportive care for children/adolescents with ADHD. METHODS The Caregiver Perspective on Pediatric ADHD (CAPPA) survey included caregivers of children/adolescents (6-17 years) from ten European countries who were currently receiving/had received ADHD pharmacotherapy in the previous 6 months. Caregivers reported experiences of obtaining an ADHD diagnosis, access to BT, availability of caregiver resources, and level of health care/school support. Pan-EU and country-specific descriptive statistics are reported; responses were compared across countries. RESULTS Of 3,616 caregivers, 66% were female. Mean age of children/adolescents was 11.5 years; 80% were male. Mean time from the first doctor visit to diagnosis was 10.8 (95% confidence interval 10.2, 11.3) months; 31% of caregivers reported the greatest degrees of difficulty in obtaining an ADHD diagnosis; 44% of children/adolescents did not receive BT. Forty-seven percent of caregivers reported that sufficient resources were available, 44% were "very satisfied"/"satisfied" with medical care, and 50% found health care providers "very supportive"/"somewhat supportive". Mainstream schools were attended by 82% of children/adolescents. Of those, 67% of caregivers thought schools could help more with the child/adolescent's ADHD and 48% received extra help/special arrangement. Results varied significantly between countries (P<0.001, all parameters). CONCLUSION Almost a third of caregivers reported a high degree of difficulty in obtaining an ADHD diagnosis for their child/adolescent, less than half felt that sufficient resources were available, and gaps in support from health care providers/schools were identified. Findings underscore the need to improve access to diagnosis and provision of supportive services to enable better standards of care, and potentially reduce the impact of child/adolescent ADHD on caregivers' lives.
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Affiliation(s)
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Vanja Sikirica
- Global Health Economics Outcomes Research and Epidemiology, Shire, Wayne, PA, USA
| | - Javier Quintero
- Psychiatry Department, Hospital Universitario Infanta Leonor, Complutense University, Madrid, Spain
| | - Kristina S Chen
- Global Health Economics Outcomes Research and Epidemiology, Shire, Lexington, MA, USA
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Adamou M, Graham K, MacKeith J, Burns S, Emerson LM. Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions. BMC Health Serv Res 2016; 16:632. [PMID: 27821125 PMCID: PMC5100092 DOI: 10.1186/s12913-016-1894-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder is prevalent in adulthood, resulting in serious impairment across multiple domains of living. Despite clinical guidance recommendations, the relative infancy of research on service provision for adults with ADHD, along with the evidence transfer gap, means that there is a lack of specific frameworks for service delivery. Igniting research and developing service delivery frameworks within adult ADHD is an essential step in the provision of effective services for adults with ADHD. METHOD Following the methodology used in previous related research that utilises a Participatory Action Research approach, we gathered data from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed. RESULTS The resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the 'ladder of change', ranging from 'stuck' to 'choice'. CONCLUSIONS The ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.
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Affiliation(s)
- Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK.
- University of Huddersfield, School of Human Health Sciences, Queensgate, HD13DH, UK.
| | - Katharine Graham
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Joy MacKeith
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Sara Burns
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Lisa-Marie Emerson
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
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Hall CL, Taylor JA, Newell K, Baldwin L, Sayal K, Hollis C. The challenges of implementing ADHD clinical guidelines and research best evidence in routine clinical care settings: Delphi survey and mixed-methods study. BJPsych Open 2016; 2:25-31. [PMID: 27703750 PMCID: PMC4995556 DOI: 10.1192/bjpo.bp.115.002386] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/13/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The landmark US Multimodal Treatment of ADHD (MTA) study established the benefits of individualised medication titration and optimisation strategies to improve short- to medium-term outcomes in attention-deficit hyperactivity disorder (ADHD). This individualised medication management approach was subsequently incorporated into the National Institute for Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78). However, little is known about clinicians' attitudes towards implementing these medication management strategies for ADHD in routine care. AIMS To examine National Health Service (NHS) healthcare professionals' consensus on ADHD medication management strategies. METHOD Using the Delphi method, we examined perceptions on the importance and feasibility of implementing 103 ADHD treatment statements from sources including the UK NICE ADHD guidelines and US medication management algorithms. RESULTS Certain recommendations for ADHD medication management were judged as important and feasible to implement, including a stepwise titration of stimulant medication. Other recommendations were perceived as important but not feasible to implement in routine practice, such as weekly clinic follow-up with the family during titration and collection of follow-up symptom questionnaires. CONCLUSIONS Many of the key guideline recommendations for ADHD medication management are viewed by clinicians as important and feasible to implement. However, some recommendations present significant implementation challenges within the context of routine NHS clinical care in England. DECLARATION OF INTEREST C.H. and K.S. were members of the Guideline Development Group for the NICE ADHD Clinical Guideline (NICE CG78). COPYRIGHT AND USAGE © 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
| | | | - Karen Newell
- , BSc, MSc, CLAHRC, University of Nottingham, Nottingham, UK
| | - Laurence Baldwin
- , BSc, MA, PhD, RN, RNT, CAMHS, Derbyshire Healthcare NHS Foundation Trust, Derbyshire, UK
| | | | - Chris Hollis
- , PhD, FRCPsych, Developmental Psychiatry, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Russell L, Forbes F, Forsyth K, Maciver D, Mulvanny A, Whitehead J. The value of an inter-agency pathway for Attention Deficit Hyperactivity Disorder (ADHD). INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.7.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lucy Russell
- Child and Adolescent Psychiatry, South East Scotland Deanery
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Abstract
OBJECTIVES We wanted to investigate how one element of the transitional process of adolescents to an adult ADHD service, namely the use of medication, fared when compared to the recommendations of national guidelines. METHODS We did a chart review of the dose of stimulants in a cohort of transitional patients after they were transferred to an adult ADHD service, whilst investigating if other variables such as severity of ADHD, age, gender and comorbidity played any role in determining the dose of stimulants at transition. RESULTS The dose of stimulants when calculated in mg/kg was almost half the recommended whist the patients were also severely symptomatic. Reported comorbidity with Autistic Spectrum Disorders was also very high. CONCLUSIONS A handover approach of adolescents with ADHD to an adult service, may hide gaps at least as far as prescribing is concerned. This gap may need considerable resources to address successfully. We suggest that establishing transitional processes may help minimise this problem.
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Affiliation(s)
| | - Sara Bowers
- Leeds Partnerships NHS Foundation Trust, Leeds, UK
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Prasad S, Arellano J, Steer C, Libretto SE. Assessing the value of atomoxetine in treating children and adolescents with ADHD in the UK. Int J Clin Pract 2009; 63:1031-40. [PMID: 19570121 DOI: 10.1111/j.1742-1241.2009.02090.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Economic evaluation of healthcare technologies is becoming increasingly relevant, enabling decision makers to assess and compare treatments within the context of costs and outcomes. Moreover, it is increasingly important for clinicians and prescribers to have some understanding of economic evaluation. For attention-deficit/hyperactivity disorder (ADHD), economic evaluations have largely focused on pharmacotherapy, and results indicate that such treatments are cost-effective compared with other interventions. AIMS This review provides an overview of ADHD, its consequences and pharmacotherapy; describes the principles of health economic analysis, health-related quality of life (HRQL) and a cost-effectiveness model of atomoxetine for ADHD treatment; and outlines guidance from the National Institute for Health and Clinical Excellence on ADHD pharmacotherapy. METHODS The cost-effectiveness of atomoxetine for children with ADHD in the UK was compared with treatment alternatives using an economic model with Markov processes. The model evaluated atomoxetine in five patient subgroups according to treatment history and comorbidities precluding stimulants. Incremental cost per quality-adjusted life-year (QALY) was calculated and compared between treatment algorithms. The Markov process incorporated 18 health states, representing a range of outcomes across the treatments. Utility values were derived from a survey of 83 parents of children with ADHD, and treatment efficacy and safety were based on a review of controlled clinical trials and literature, and validated by international experts. Costs and outcomes were estimated using Monte Carlo simulation over 1-year. RESULTS Atomoxetine was a cost-effective treatment across the whole ADHD population, with incremental cost-effectiveness ratios ranging from pound 11,500 to pound 15,900 per QALY, compared with alternative pharmacotherapies, which are within UK and rest of Europe acceptability limits. Higher utility values achieved treating ADHD with atomoxetine, compensate for the relatively higher acquisition cost compared with stimulants. CONCLUSIONS Atomoxetine is cost-effective and may have advantages over stimulants, including benefits to HRQL and no abuse liability and is the only treatment in the UK licensed for continued treatment into adulthood in adolescents who have shown a response from treatment.
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Affiliation(s)
- S Prasad
- Department Paediatrics, Cromwell Hospital, London, UK.
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