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Price A, Becker K, Ward JH, Ukoumunne OC, Gudka R, Salimi A, Mughal F, Melendez-Torres GJ, Smith JR, Newlove-Delgado T. Support for primary care prescribing for adult ADHD in England: national survey. Br J Gen Pract 2024:BJGP.2023.0595. [PMID: 38621804 PMCID: PMC11388088 DOI: 10.3399/bjgp.2023.0595] [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: 11/14/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, for which there are effective pharmacological treatments that improve symptoms and reduce complications. Guidelines published by the National Institute for Health and Care Excellence recommend that primary care practitioners prescribe medication for adult ADHD under shared-care agreements with Adult Mental Health Services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support. AIM This study aimed to describe elements of support, and their availability/use, in primary care prescribing for adult ADHD medication in England to improve access for this underserved population and inform service improvement. DESIGN AND SETTING Cross-sectional surveys were used to elicit data from commissioners, health professionals (HPs), and people with lived experience of ADHD (LE) across England about elements supporting pharmacological treatment of ADHD in primary care. METHOD Three interlinked cross-sectional surveys were used to ask every integrated care board in England (commissioners), along with convenience samples of HPs and LEs, about prescribing rates, AMHS availability, wait times, and shared-care agreement protocols/policies for the pharmacological treatment of ADHD in primary care. Descriptive analyses, percentages, and confidence intervals were used to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software. RESULTS Data from 782 responders (42 commissioners, 331 HPs, 409 LEs) revealed differences in reported provision by stakeholder group, including for prescribing (95% of HPs versus 64% of LEs). In all, >40% of responders reported extended AMHS wait times of ≥2 years. There was some variability by NHS region - for example, London had the lowest reported extended wait time (25%), while East of England had the highest (55%). CONCLUSION Elements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England. Coordinated approaches are needed to address these gaps.
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Affiliation(s)
- Anna Price
- University of Exeter Medical School, Exeter
| | | | - John H Ward
- University of Exeter Medical School, Exeter, and Department of Psychiatry, University of Oxford, Oxford
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter, Exeter
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Ward J, McBride A, Gudka R, Becker K, Newlove-Delgado T, Price A. Wider health needs in attention deficit hyperactivity disorder from lived and professional experience: a qualitative framework analysis. BMJ Open 2024; 14:e083539. [PMID: 39153774 PMCID: PMC11331868 DOI: 10.1136/bmjopen-2023-083539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 07/26/2024] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVES This study aimed to explore the perspectives of people with attention deficit hyperactivity disorder (ADHD), their supporters and primary care professionals (PCPs), on the wider physical and mental health needs of people with ADHD and the support currently available. DESIGN Qualitative semi-structured interviews, analysed using reflexive thematic analysis. SETTING Five general practice surgeries across England. PARTICIPANTS Participants with lived experience (people with ADHD and their supporters (n=11)) and PCPs (n=9) (eg, general practitioners and practice managers), recruited via clinical academic networks and previous work packages of this study. RESULTS We generated three major themes in relation to ADHD, using reflexive thematic analysis: understanding health, barriers to health and addressing health. Within these, participants reflected on mental and physical health challenges, as well as wider social difficulties and variability in support offered/accessed. CONCLUSIONS This study highlights that health problems in ADHD are complex and rooted both in individual factors (eg, mental health) and social factors (eg, support). This study also highlights the differences in expectations and fulfilment of healthcare.
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Affiliation(s)
- John Ward
- University of Exeter Medical School, Exeter, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | | | | | | | - Anna Price
- University of Exeter Medical School, Exeter, UK
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Adamou M, Arif M, Asherson P, Cubbin S, Leaver L, Sedgwick-Müller J, Müller-Sedgwick U, van Rensburg K, Kustow J. The adult ADHD assessment quality assurance standard. Front Psychiatry 2024; 15:1380410. [PMID: 39156609 PMCID: PMC11327143 DOI: 10.3389/fpsyt.2024.1380410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/08/2024] [Indexed: 08/20/2024] Open
Abstract
Background Attention Deficit Hyperactivity Disorder (ADHD) frequently persists into adulthood. There are practice guidelines that outline the requirements for the assessment and treatment of adults. Nevertheless, guidelines specifying what constitutes a good quality diagnostic assessment and report and the competencies required to be a specialist assessor are lacking. This can lead to variation in the quality and reliability of adult ADHD assessments. Poor quality assessments may not be accepted as valid indicators of the presence of ADHD by other clinicians or services, resulting in wasteful re-assessments and delays in providing treatment. To address this issue the UK Adult ADHD Network (UKAAN) proposes a quality framework for adult ADHD assessments - the Adult ADHD Assessment Quality Assurance Standard (AQAS). Methods The co-authors agreed on five questions or themes that then guided the development of a set of consensus statements. An initial draft was reviewed and amended in an iterative process to reach a final consensus. Results What constitutes a high-quality diagnostic assessment and report was agreed by consensus of the co-authors. The resulting guideline emphasises the need to evaluate impairment, describes core competencies required by the assessor and highlights the importance of linking the diagnosis to an appropriate post-diagnostic discussion. Assessments should be completed in the context of a full psychiatric and neurodevelopmental review, and need good interview skills, using a semi-structured interview with open questioning and probing to elicit real life examples of symptoms and impairments. It is recommended that 2 hours or more is required for an adequate assessment including both the diagnostic assessment and initial post-assessment discussions. Conclusion The AQAS has been developed as a practical resource to support reliable and valid diagnostic assessments of adult ADHD. It is intended to complement formal training. A secondary objective is to empower patients by providing them with evidence-based information on what to expect from an assessment and assessment report.
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Affiliation(s)
- Marios Adamou
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Adult ADHD Clinic, South West Yorkshire Partnership National Health Service (NHS) Foundation Trust, Huddersfield, United Kingdom
| | - Muhammad Arif
- Adult ADHD Clinic, Leicestershire Partnership National Health Service (NHS) Trust, Leicester, United Kingdom
| | - Philip Asherson
- Social Genetic and Developmental Psychiatry, King’s College London, London, United Kingdom
| | - Sally Cubbin
- Adult ADHD Clinic, Manor Hospital, Oxford, United Kingdom
| | | | - Jane Sedgwick-Müller
- Health and Community Services, Government of Jersey, St Helier, Jersey
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Ulrich Müller-Sedgwick
- Health and Community Services, Government of Jersey, St Helier, Jersey
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Adult ADHD Service, Barnet, Enfield and Haringey Mental Health National Health Service (NHS) Trust, London, United Kingdom
| | | | - James Kustow
- Adult ADHD Service, Barnet, Enfield and Haringey Mental Health National Health Service (NHS) Trust, London, United Kingdom
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Ward JH, Becker K, Smith J, Price A, Newlove-Delgado T. Patient, supporter and primary healthcare professional perspectives on health risks in over 16s with attention deficit hyperactivity disorder (ADHD) in England: a national survey study. BMC Health Serv Res 2024; 24:751. [PMID: 38898441 PMCID: PMC11188530 DOI: 10.1186/s12913-024-11188-5] [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: 08/07/2023] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Current research suggests that people with attention deficit hyperactivity disorder (ADHD) are at higher risk of physical and mental health disorders. This study aimed to explore these health risks in ADHD from the perspectives of multiple stakeholders. METHODS This study forms part of the 'Managing young people with ADHD in Primary care (MAP) study'. A survey developed by the study team was distributed to over 16 year olds with ADHD, their supporters, primary healthcare professionals and health commissioners across England, via social media and through patient/clinical networks (September-October 2022). This survey contained two questions on health risks. Question one asked about views on health risks in ADHD (free text). Question two asked about advice given (options list and free text). Descriptive statistics summarised responses to questions one and two, and qualitative analysis (reflexive thematic analysis) was used to explore free text responses from question one. RESULTS 782 participants responded to the MAP survey. Of these, 206 healthcare professionals, 157 people with ADHD and 88 supporters answered question one. The most mentioned perceived risks were substance misuse, sleep disorders, weight management and smoking. More people with ADHD reported disordered eating as a health risk (n = 32) than healthcare professionals (n = 5). Generated themes included perceived health risks, impact of living with ADHD, lack of adequate healthcare, and need for ADHD awareness. In respect to advice given (question two), based on responses from 258 professionals, 162 people with ADHD and 100 supporters, the most common advice discussed in consultation was mental health (n = 149, n = 50 and n = 17 respectively). High numbers of respondents reported not giving/receiving advice on wider health (n = 38, n = 88 and n = 61 respectively). CONCLUSIONS Findings demonstrate that respondents perceived a range of physical and mental health risks posed by ADHD. These related to difficulties with activities of daily living, as well as healthcare interactions and the impact of core features of ADHD (e.g. impulsivity, emotional dysregulation). These risks are not currently explicitly addressed in United Kingdom national guidance on ADHD. More work is needed to examine and address the broader health outcomes of people with ADHD.
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Affiliation(s)
- John H Ward
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK.
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Royal Devon University Hospital NHS Foundation Trust, Devon, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Kieran Becker
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Jane Smith
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Anna Price
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Tamsin Newlove-Delgado
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
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Martin J, Langley K, Cooper M, Rouquette OY, John A, Sayal K, Ford T, Thapar A. Sex differences in attention-deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales. J Child Psychol Psychiatry 2024. [PMID: 38864317 DOI: 10.1111/jcpp.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Population-based studies have observed sex biases in the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD). Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnosis and clinical care in young people with ADHD, particularly regarding recognition and treatment of other mental health conditions. METHODS The cohort included individuals diagnosed with ADHD, born between 1989 and 2013 and living in Wales between 2000 and 2019. Routine primary and secondary healthcare record data were used to derive diagnoses of ADHD and other neurodevelopmental and mental health conditions, as well as ADHD and antidepressant medications. Demographic variables included ethnicity, socioeconomic deprivation and contact with social services. RESULTS There were 16,458 individuals diagnosed with ADHD (20.3% females, ages 3-30 years), with a male-to-female ratio of 3.9:1. Higher ratios (4.8:1) were seen in individuals diagnosed younger (<12 years), with the lowest ratio (1.9:1) in those diagnosed as adults (>18). Males were younger at first recorded ADHD diagnosis (mean = 10.9 vs. 12.6 years), more likely to be prescribed ADHD medication and younger at diagnosis of co-occurring neurodevelopmental conditions. In contrast, females were more likely to receive a diagnosis of anxiety, depression or another mental health condition and to be prescribed antidepressant medications, prior to ADHD diagnosis. These sex differences were largely stable across demographic groups. CONCLUSIONS This study adds to the evidence base that females with ADHD are experiencing later recognition and treatment of ADHD. The results indicate that this may be partly because of diagnostic overshadowing from other mental health conditions, such as anxiety and depression, or initial misdiagnosis. Further research and dissemination of findings to the public are needed to improve awareness, timely diagnosis and treatment of ADHD in females.
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Affiliation(s)
- Joanna Martin
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
| | - Miriam Cooper
- Neurodevelopmental Service, Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, UK
| | - Olivier Y Rouquette
- Institute of Suicide Prevention and Mental Health, Swansea University, Swansea, UK
| | - Ann John
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Institute of Suicide Prevention and Mental Health, Swansea University, Swansea, UK
| | - Kapil Sayal
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, UK
- Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anita Thapar
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
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McGrath J. The clinical pathway in ADMiRE, Ireland's first public specialist service for children and adolescents with attention deficit hyperactivity disorder. Ir J Psychol Med 2024:1-8. [PMID: 38825868 DOI: 10.1017/ipm.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder occurring in approximately one in twenty young people in Ireland, and in one-third of those attending Irish Child and Adolescent Mental Health Services (CAMHS). It is important to treat ADHD, as un/poorly treated ADHD is associated with a raft of negative health and socio-economic outcomes. Effective interventions for ADHD are available, and the use of standardised, evidence-based pathways for assessment and management of ADHD optimises outcomes. Despite this, there is no national standardised clinical pathway for assessment and treatment of ADHD in Ireland. ADMiRE, the first public healthcare specialist service for children and adolescents in Ireland, has developed a strongly evidence-based, efficient, effective and safe clinical pathway for assessment and management of ADHD. This paper describes the ADMiRE Clinical Pathway and references ADMiRE resources that are available to other services.
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Affiliation(s)
- Jane McGrath
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
- Linn Dara Child and Adolescent Mental Health Services, Cherry Orchard Hospital, Dublin, Ireland
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Gudka R, Becker K, Ward J, Smith JR, Mughal F, Melendez-Torres GJ, Newlove-Delgado T, Price A. Primary care provision for young people with ADHD: a multi-perspective qualitative study. Br J Gen Pract 2024; 74:e408-e416. [PMID: 38316468 PMCID: PMC11080641 DOI: 10.3399/bjgp.2023.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. UK guidance states that primary care has a vital role in effective ADHD management, including referral, medication prescribing and monitoring, and providing broader mental health and wellbeing support. However, many GPs feel unsupported to provide health care for young people with ADHD. Inadequate health care is associated with rising costs for patients and society. AIM To investigate the experiences of young people with ADHD accessing primary care in England, from the perspectives of people with lived experience of ADHD and healthcare professionals (HCPs). DESIGN AND SETTING A qualitative study. Interviews were conducted with HCPs (GPs, practice managers, and a wellbeing worker) and people with lived experience of ADHD (young people aged 16-25 years and their supporters) located in integrated care systems across England. METHOD Semi-structured interviews were conducted with participants at five purposively selected general practices (varying by deprivation, ethnicity, and setting). Questions focused on experiences of accessing/providing health care for ADHD. Reflexive thematic analysis was undertaken within a critical realist framework to understand how provision works in practice and to explore potential improvements. RESULTS In total, 20 interviews were completed with 11 HCPs and nine people with lived experience. Three themes were generated: a system under stress, incompatibility between ADHD and the healthcare system, and strategies for change in ADHD primary care provision. CONCLUSION Standardisation of ADHD management in primary care, providing better information and support for HCPs, and advising on reasonable adjustments for people with lived experience could help improve access to effective treatments for young people living with ADHD.
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Affiliation(s)
- Rebecca Gudka
- University of Exeter Medical School, University of Exeter, Exeter
| | - Kieran Becker
- University of Exeter Medical School, University of Exeter, Exeter
| | - John Ward
- University of Exeter Medical School, University of Exeter, Exeter; Department of Psychiatry, University of Oxford, Oxford
| | - Jane R Smith
- University of Exeter Medical School, University of Exeter, Exeter
| | | | | | | | - Anna Price
- University of Exeter Medical School, University of Exeter, Exeter
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Bellato A, Hall CL, Groom MJ, Simonoff E, Thapar A, Hollis C, Cortese S. Practitioner Review: Clinical utility of the QbTest for the assessment and diagnosis of attention-deficit/hyperactivity disorder - a systematic review and meta-analysis. J Child Psychol Psychiatry 2024; 65:845-861. [PMID: 37800347 DOI: 10.1111/jcpp.13901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Several computerised cognitive tests (e.g. continuous performance test) have been developed to support the clinical assessment of attention-deficit/hyperactivity disorder (ADHD). Here, we appraised the evidence-base underpinning the use of one of these tests - the QbTest - in clinical practice, by conducting a systematic review and meta-analysis investigating its accuracy and clinical utility. METHODS Based on a preregistered protocol (CRD42022377671), we searched PubMed, Medline, Ovid Embase, APA PsycINFO and Web of Science on 15th August 2022, with no language/type of document restrictions. We included studies reporting accuracy measures (e.g. sensitivity, specificity, or Area under the Receiver Operating Characteristics Curve, AUC) for QbTest in discriminating between people with and without DSM/ICD ADHD diagnosis. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). A generic inverse variance meta-analysis was conducted on AUC scores. Pooled sensitivity and specificity were calculated using a random-effects bivariate model in R. RESULTS We included 15 studies (2,058 participants; 48.6% with ADHD). QbTest Total scores showed acceptable, rather than good, sensitivity (0.78 [95% confidence interval: 0.69; 0.85]) and specificity (0.70 [0.57; 0.81]), while subscales showed low-to-moderate sensitivity (ranging from 0.48 [0.35; 0.61] to 0.65 [0.52; 0.75]) and moderate-to-good specificity (from 0.65 [0.48; 0.78] to 0.83 [0.60; 0.94]). Pooled AUC scores suggested moderate-to-acceptable discriminative ability (Q-Total: 0.72 [0.57; 0.87]; Q-Activity: 0.67 [0.58; 0.77); Q-Inattention: 0.66 [0.59; 0.72]; Q-Impulsivity: 0.59 [0.53; 0.64]). CONCLUSIONS When used on their own, QbTest scores available to clinicians are not sufficiently accurate in discriminating between ADHD and non-ADHD clinical cases. Therefore, the QbTest should not be used as stand-alone screening or diagnostic tool, or as a triage system for accepting individuals on the waiting-list for clinical services. However, when used as an adjunct to support a full clinical assessment, QbTest can produce efficiencies in the assessment pathway and reduce the time to diagnosis.
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Affiliation(s)
- Alessio Bellato
- School of Psychology, University of Nottingham, Nottingham, Malaysia
- Mind & Neurodevelopment (MiND) Research Cluster, University of Nottingham, Nottingham, Malaysia
| | - Charlotte L Hall
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Cardiff University School of Medicine, Cardiff, UK
| | - Chris Hollis
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Samuele Cortese
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
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Dunn VS, Petty S, Laver‐Fawcett A. Provenance of a "sense-sational" wait: A call for introducing sensory processing differences into diagnostic criteria for attention-deficit/hyperactivity disorder. Brain Behav 2024; 14:e3501. [PMID: 38747736 PMCID: PMC11095298 DOI: 10.1002/brb3.3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/13/2024] [Accepted: 04/05/2024] [Indexed: 05/18/2024] Open
Affiliation(s)
- Victoria Sally Dunn
- Humber Foundation NHS Teaching TrustYork St John University, Lord Mayor's WalkYorkUK
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Martin J. Why are females less likely to be diagnosed with ADHD in childhood than males? Lancet Psychiatry 2024; 11:303-310. [PMID: 38340761 DOI: 10.1016/s2215-0366(24)00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
ADHD is less likely to be diagnosed in females than males, especially in childhood. Females also typically receive the diagnosis later than males and are less likely to be prescribed ADHD medication. Understanding why these sex differences in clinical care and treatment for ADHD occur is key to improving timely diagnosis in people affected by ADHD. This Personal View is a conceptual review synthesising literature on this topic. This publication considers potential biological explanations (eg, genetic factors), influence of diagnostic practices (eg, criteria suitability, diagnostic overshadowing, and sex-specific diagnostic thresholds), and sociocultural explanations (eg, sex differences in presentation and compensatory behaviours), for the observed sex differences in ADHD clinical practice. This Personal View also outlines future research directions for improving understanding of sex differences in recognition and diagnosis of ADHD.
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Affiliation(s)
- Joanna Martin
- Centre for Neuropsychiatric Genetics and Genomics and Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK.
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Kazda L, Bell K, Thomas R, Hardiman L, Heath I, Barratt A. Attention deficit/hyperactivity disorder (ADHD) in children: more focus on care and support, less on diagnosis. BMJ 2024; 384:e073448. [PMID: 38325889 DOI: 10.1136/bmj-2022-073448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Luise Kazda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Wiser Healthcare, Australia
- NHMRC Healthy Environments and Lives (HEAL) National Research Network, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Wiser Healthcare, Australia
| | - Rae Thomas
- Wiser Healthcare, Australia
- Institute for Evidence Based Healthcare, Bond University, QLD, Australia
- Tropical Australian Academic Health Centre, Townsville, QLD, Australia
| | | | | | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Wiser Healthcare, Australia
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Smith MCF, Mukherjee RAS, Müller-Sedgwick U, Hank D, Carpenter P, Adamou M. UK adult ADHD services in crisis. BJPsych Bull 2024; 48:1-5. [PMID: 38058161 PMCID: PMC10801359 DOI: 10.1192/bjb.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/26/2023] [Accepted: 10/12/2023] [Indexed: 12/08/2023] Open
Abstract
The UK's services for adult attention-deficit hyperactivity disorder (ADHD) are in crisis, with demand outstripping capacity and waiting times reaching unprecedented lengths. Recognition of and treatments for ADHD have expanded over the past two decades, increasing clinical demand. This issue has been exacerbated by the COVID-19 pandemic. Despite an increase in specialist services, resource allocation has not kept pace, leading to extended waiting times. Underfunding has encouraged growth in independent providers, leading to fragmentation of service provision. Treatment delays carry a human and financial cost, imposing a burden on health, social care and the criminal justice system. A rethink of service procurement and delivery is needed, with multiple solutions on the table, including increasing funding, improving system efficiency, altering the service provision model and clinical prioritisation. However, the success of these solutions hinges on fiscal capacity and workforce issues.
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Affiliation(s)
| | | | | | - Dietmar Hank
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Peter Carpenter
- University of Bristol, Bristol, UK
- Royal College of Psychiatrists, London, UK
| | - Marios Adamou
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
- University of Huddersfield, Huddersfield, UK
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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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Baggio S, Billieux J, Dirkzwager A, Iglesias K, Moschetti K, Perroud N, Schneider M, Vernaz N, Wolff H, Heller P. Protocol of a monocentric, double-blind, randomized, superiority, controlled trial evaluating the effect of in-prison OROS-methylphenidate vs. placebo treatment in detained people with attention-deficit hyperactivity disorder (BATIR). Trials 2024; 25:23. [PMID: 38178233 PMCID: PMC10765778 DOI: 10.1186/s13063-023-07827-7] [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: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is characterized by difficulty paying attention, poor impulse control, and hyperactive behavior. It is associated with several adverse health and social outcomes and leads to an increased risk of criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prisons. However, ADHD treatment has been neglected in such environments. Stimulant medications such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prisons due to concerns about abuse, even though such claims are not empirically supported. This project aims to compare the efficacy of a 3-month in-prison OROS-MPH vs. placebo treatment on the severity of core ADHD symptoms and relevant in- and post-prison outcomes. METHODS This study is a phase III, double-blinded, randomized, superiority, controlled trial of OROS-MPH vs. placebo. After randomization, the participants will receive 3 months of treatment with OROS-MPH or placebo (1:1 ratio) while incarcerated. Upon release, all participants will be offered the treatment (OROS-MPH) for 1 year but will remain blinded to their initial study group. The study will be conducted at the Division of Prison Health, Geneva, Switzerland, among incarcerated men (n = 150). Measures will include (1) investigator-rated ADHD symptoms, (2) acute events collected by the medical and prison teams, (3) assessment of the risk of recidivism, (4) medication side effects, (5) medication adherence, (6) study retention, (7) health care/prison costs, and (8) 1-year recidivism. Analyses will include bivariable and multivariable modeling (e.g., regression models, mixed-effects models, survival analyses) and an economic evaluation (cost-benefit analysis). DISCUSSION We expect that early identification and treatment of ADHD in prison will be an important public health opportunity and a cost-effective approach that is likely to reduce the vulnerability of incarcerated individuals and promote pathways out of criminal involvement. The study will also promote standards of care for people with ADHD in prison and provide recommendations for continuity of care after release. TRIAL REGISTRATION ClinicalTrials.gov NCT05842330 . Registered on June 5, 2023. Kofam.ch SNCTP000005388. Registered on July 17, 2023.
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Affiliation(s)
- Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
- Laboratory of Population Health (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland.
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
| | - Anja Dirkzwager
- Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Karine Moschetti
- Health Technology Assessment Unit, University Hospital of Lausanne, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marie Schneider
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
- Medication adherence and Interprofessionality lab, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Nathalie Vernaz
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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LoMartire R, Johansson P, Frumento P. Sickness Absence and Disability Pension Among Patients With Chronic Pain in Interdisciplinary Treatment or Unspecified Interventions. THE JOURNAL OF PAIN 2023; 24:2003-2013. [PMID: 37348775 DOI: 10.1016/j.jpain.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
Interdisciplinary treatment is a widely implemented strategy for the rehabilitation of patients with chronic pain. A primary treatment objective is to decrease the load on the social insurance system; however, it is questionable whether interdisciplinary treatment reduces sickness absence and disability pension (SA/DP). This register-based observational study compared SA and DP between patients in interdisciplinary treatment and unspecified interventions. With data from 7,752 Swedish specialist health care patients in their prime working age, we analyzed total net SA/DP days over 3 years from the first visit to a pain rehabilitation center. A zero-one-inflated beta model, adjusted for theoretically substantiated confounders, was used to estimate the mean differences in total days and the proportions of patients with both zero and maximum days. Compared with unspecified interventions, interdisciplinary treatment resulted in a mean (95% confidence interval) absolute increase of 50 (37, 62) total days, a 13.0% (11.3%, 14.6%) decrease in patients with zero days, and a 1.5% (.2%, 2.8%) decrease in patients with the maximum days. These findings support that interdisciplinary treatment increases SA/DP compared to less intensive interventions but reduces the risk of maximum days, implying that it is advantageous for patients with the highest absence. This highlights the need for improved patient selection procedures and the adaptation of interdisciplinary treatment programs to more adequately target SA/DP reduction. PERSPECTIVES: This study provides an accessible overview of SA/DP among working-age patients with chronic pain in Swedish specialist health care. It also shows that interdisciplinary treatment does not decrease SA/DP more than alternative treatments in most patients but is advantageous for the patients with the longest absence.
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Affiliation(s)
- Riccardo LoMartire
- Center for Clinical Research Dalarna, Uppsala University, Falun, Region Dalarna, Sweden
| | - Per Johansson
- Department of Statistics, Uppsala University, Uppsala, Region Uppsala, Sweden; Yau Mathematical Science Center, Tsinghua University, Beijing, China
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Administrative Region of Tuscany, Italy
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Praus P, Proctor T, Rohrmann T, Benedyk A, Tost H, Hennig O, Meyer-Lindenberg A, Wahl AS. Female sex and burden of depressive symptoms predict insufficient response to telemedical treatment in adult attention-deficit/hyperactivity disorder: results from a naturalistic patient cohort during the COVID-19 pandemic. Front Psychiatry 2023; 14:1193898. [PMID: 37867771 PMCID: PMC10585110 DOI: 10.3389/fpsyt.2023.1193898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is a chronic neuropsychiatric disorder, that typically manifests itself during childhood and persists in a majority of the affected individuals into adulthood, negatively affecting physical and mental health. Previous studies have shown detrimental effects of the COVID-19 pandemic on mental health in individuals with ADHD. Thus, telemedicine could be a useful tool for optimizing treatment-outcomes in adult ADHD by improving treatment adherence and persistence. However, data on telemedical treatment outcomes in adult patients with ADHD is scarce. Methods We report here the sub-cohort analysis of a naturalistic cohort of adult patients (N = 254) recruited between April 2020-April 2021, comparing the effects of telemedical treatment on participants either clinically diagnosed with depression (N = 54) or ADHD (N = 67). Participants were asked to fill out the WHO-5 repetitively during >12 weeks of telemedical treatment. Furthermore scores of WHO-5, SCL-90R and BDI-II, psychopathology, psychosocial functioning, sociodemographic data, medical records and a feedback survey were analyzed for both groups and compared. Participants with ADHD were further stratified according to the development of well-being during the study period in order to identify factors associated with a satisfactory treatment outcome. Results Participants with depression reported a significant improvement of well-being during the course of the study, while no such effect could be seen in participants with ADHD on a group level. Despite the good outcome, participants with depression were more severely affected at baseline, with significantly worse psychopathology and a more precarious labor and financial situation. A detailed analysis of ADHD participants without clinical improvement revealed significantly higher BDI-II scores than for ADHD participants with a satisfactory outcome (p = 0.03, Mann-Whitney-U-Test), suggesting successful treatment was hampered by the combination of ADHD and depressive symptoms. Furthermore, female sex among ADHD patients was correlated with an unfavorable treatment outcome during the course of the study (p = 0.001, Spearman correlation) as well as living with children (p = 0.02, Spearman correlation). Conclusion Besides screening for depressive symptoms before telemedical treatment, future research should address the specific needs of female ADHD patients as these patients may be at a particularly high risk of being overburdened with family work.
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Affiliation(s)
- Peter Praus
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Tanja Proctor
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Tobias Rohrmann
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Anastasia Benedyk
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Heike Tost
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Oliver Hennig
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | | | - Anna-Sophia Wahl
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Brain Research Institute, University of Zurich, Zurich, Switzerland
- Department of Neuroanatomy, Institute of Anatomy, Ludwigs-Maximilians-University, Munich, Germany
- Institute for Stroke and Dementia Research, University Hospital of Ludwigs-Maximilians-University, Munich, Germany
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Abstract
OBJECTIVE To identify the level of training of Australian psychiatrists in Attention Deficit Hyperactivity Disorder (ADHD), and to compare the number of psychiatrists specialising in ADHD versus other psychiatric conditions on the basis of the prevalence of conditions, by interrogating the RANZCP 'Find a Psychiatrist' database. CONCLUSION Fewer psychiatrists listed in the RANZCP database specialise in ADHD than in many other psychiatric conditions. Given that 5% of the Australian population suffers from ADHD, the condition can have significant adverse outcomes and is a common comorbidity with other psychiatric conditions, the RANZCP Training Program would be improved by requiring an in-depth knowledge of ADHD. Further training in ADHD would assist many practising psychiatrists.
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Stevanovic D, Nasic S, Doric A, Wentz E, Knez R. The Structure and Diagnostic Accuracy of the QbTest in Pediatric ADHD: A Retrospective Clinical Study. J Atten Disord 2023; 27:1296-1305. [PMID: 37199293 DOI: 10.1177/10870547231174035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The QbTest that combines a continuous performance task (CPT) with a motion-tracking system may help identify attention deficit hyperactivity disorder (ADHD). This study examined the structure and diagnostic ability of the QbTest in children and adolescents. METHOD Retrospective data from 1,274 children and adolescents were analyzed. The study assessed data on a principal component analysis (PCA), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The QbActivity component included the variables micro-events, distance, area, and time active; the QbImpulsivity included normalized commissions and commissions (anticipatory errors were added in a version for 6-12-year-olds only); and the QbInattention included omissions, reaction time, and reaction time variation. Sensitivity ranged between 22% and 50%, specificity 79% and 96%, PPVs 40% and 95%, and NPVs 24% and 66%. CONCLUSION The structure of the QbTest with three cardinal parameters and nine/ten CPT and motion analysis variables was supported. The diagnostic accuracy was found to be poor to moderate. Given that this is a retrospective study, the interpretation of diagnostic accuracy should be considered within this context.
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Affiliation(s)
- Dejan Stevanovic
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
- University of Gothenburg, Sweden
| | - Salmir Nasic
- University of Gothenburg, Sweden
- Skaraborgs Hospital, Skövde, Sweden
| | - Ana Doric
- University of Rijeka, Croatia
- IntechOpen Limited, Rijeka, Croatia
| | | | - Rajna Knez
- University of Gothenburg, Sweden
- Skaraborgs Hospital, Skövde, Sweden
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19
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Price A, Smith JR, Mughal F, Salimi A, Melendez-Torres GJ, Newlove-Delgado T. Protocol for the mixed methods, Managing young people (aged 16-25) with Attention deficit hyperactivity disorder in Primary care (MAP) study: mapping current practice and co-producing guidance to improve healthcare in an underserved population. BMJ Open 2023; 13:e068184. [PMID: 37429692 DOI: 10.1136/bmjopen-2022-068184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents, with an average worldwide prevalence of 5%. Up to 40% of young people continue to experience symptoms into adulthood. Young people with ADHD experience poorer outcomes than their peers across multiple domains, with treatment shown to reduce these risks. Primary care practitioners play an important role in healthcare provision for this group in the UK. However, many feel unsure about how best to provide support, reporting prescribing concerns and need for more evidence-based guidance. A lack of national data on primary care provision hinders efforts to improve access to care and optimise outcomes. This mixed-methods study aims to provide evidence that may be used to improve primary care services for young people aged 16-25 years with ADHD. METHODS AND ANALYSIS There are three interlinked work packages: (a) a mapping study including a survey of stakeholders (healthcare professionals, people with ADHD and commissioners) will map ADHD prescribing practice, shared-care arrangements, available support and practitioner roles by geographic locations across England for different respondent groups; (b) a qualitative study involving semi-structured interviews with stakeholders (10-15 healthcare professionals and 10-15 people with ADHD) will explore experiences of 'what works' and 'what is needed' in terms of service provision and synthesise findings; (c) workshops will integrate findings from (a) and (b) and work with stakeholders to use this evidence to codevelop key messages and guidance to improve care. ETHICS AND DISSEMINATION The protocol has been approved by Yorkshire and the Humber-Bradford Leeds Research Ethics Committee. Recruitment commenced in September 2022. Findings will be disseminated via research articles in peer-reviewed journals, conference presentations, public involvement events, patient groups and media releases. A summary of study findings will be shared with participants at the end of the study. TRIAL REGISTRATION NUMBER NCT05518435.
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Affiliation(s)
- Anna Price
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Jane R Smith
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Faraz Mughal
- Keele University School of Medicine, Keele, UK
- Keele University, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Anita Salimi
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
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Young S, Cocallis K. A Systematic Review of the Relationship Between Neurodiversity and Psychosexual Functioning in Individuals with Autism Spectrum Disorder (ASD) or Attention-Deficit/Hyperactivity Disorder (ADHD). Neuropsychiatr Dis Treat 2023; 19:1379-1395. [PMID: 37287894 PMCID: PMC10243356 DOI: 10.2147/ndt.s319980] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
The scientific literature on psychosexual functioning shows a range of outcomes for individuals with neurodiversity. The aim of this article was to synthesize and critically evaluate evidence regarding psychosexual selfhood (orientation), behaviors and experiences in individuals with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) to prioritize further research and identify interventions to reduce risk. A systematic review of the literature that compared sexual orientation, behavior and experiences of individuals with ASD or ADHD with those of neurotypical peers was performed in AMED, CINAHL, MEDLINE, PsycARTICLES and PsycINFO, Psychology and Behavioural Sciences Collection, Child Development and Adolescent Studies databases (supplemented by hand-searching of reference lists). Seventeen ASD and nineteen ADHD studies met inclusion criteria. Overall, the studies reviewed suggest poorer psychosexual functioning for individuals with ASD or ADHD compared to neurotypical peers, including a lack of satisfaction in their sexual relationships, sexual dysfunction, risky sexual behaviors, and victimization. This appears to be more marked for females. Individuals with ASD were more likely to identify with a non-heterosexual orientation compared with neurotypical peers. The study identifies gaps in our knowledge relating to risky sexual behaviors (in particular, those relating to sexual health and vulnerability to sexual victimization and perpetration). The public health implications of the findings are discussed. Future research is needed to clarify the mechanisms by which individuals with neurodevelopmental disorders may be at increased risk of adverse psychosexual outcomes and identify interventions that may mediate outcomes.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, London, UK
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Kelly Cocallis
- Health Psychology, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
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21
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Bisset M, Brown LE, Bhide S, Patel P, Zendarski N, Coghill D, Payne L, Bellgrove MA, Middeldorp CM, Sciberras E. Practitioner Review: It's time to bridge the gap - understanding the unmet needs of consumers with attention-deficit/hyperactivity disorder - a systematic review and recommendations. J Child Psychol Psychiatry 2023; 64:848-858. [PMID: 36651107 PMCID: PMC10952204 DOI: 10.1111/jcpp.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Understanding the unmet needs of healthcare consumers with attention-deficit/hyperactivity disorder (ADHD) (individuals with ADHD and their caregivers) provides critical insight into gaps in services, education and research that require focus and funding to improve outcomes. This review examines the unmet needs of ADHD consumers from a consumer perspective. METHODS A standardised search protocol identified peer-reviewed studies published between December 2011 and December 2021 focusing on consumer-identified needs relating to ADHD clinical care or research priorities. RESULTS 1,624 articles were screened with 23 studies that reviewed examining the needs of ADHD consumers from Europe, the U.K., Hong Kong, Iran, Australia, the U.S.A. and Canada. Consumer-identified needs related to: treatment that goes beyond medication (12 studies); improved ADHD-related education/training (17 studies); improved access to clinical services, carer support and financial assistance (14 studies); school accommodations/support (6 studies); and ongoing treatment efficacy research (1 study). CONCLUSION ADHD consumers have substantial unmet needs in clinical, psychosocial and research contexts. Recommendations to address these needs include: improving access to and quality of multimodal care provision; incorporating recovery principles into care provision; fostering ADHD health literacy; and increasing consumer participation in research, service development and ADHD-related training/education.
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Affiliation(s)
- Matthew Bisset
- School of PsychologyDeakin UniversityMelbourneVICAustralia
- The Royal Children's HospitalParkvilleVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
| | | | - Sampada Bhide
- School of PsychologyDeakin UniversityMelbourneVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
- The Royal Melbourne HospitalParkvilleVICAustralia
| | - Pooja Patel
- School of PsychologyDeakin UniversityMelbourneVICAustralia
| | - Nardia Zendarski
- Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
| | - David Coghill
- The Royal Children's HospitalParkvilleVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
| | - Leanne Payne
- Child Health Research CentreUniversity of QueenslandBrisbaneQLDAustralia
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
| | - Mark A. Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological SciencesMonash UniversityMelbourneVICAustralia
| | - Christel M. Middeldorp
- Child Health Research CentreUniversity of QueenslandBrisbaneQLDAustralia
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
| | - Emma Sciberras
- School of PsychologyDeakin UniversityMelbourneVICAustralia
- Murdoch Children's Research InsitituteMelbourneVICAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
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Young S, Abbasian C, Al-Attar Z, Branney P, Colley B, Cortese S, Cubbin S, Deeley Q, Gudjonsson GH, Hill P, Hollingdale J, Jenden S, Johnson J, Judge D, Lewis A, Mason P, Mukherjee R, Nutt D, Roberts J, Robinson F, Woodhouse E, Cocallis K. Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement. World J Psychiatry 2023; 13:84-112. [PMID: 37033892 PMCID: PMC10075023 DOI: 10.5498/wjp.v13.i3.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/19/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.
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Affiliation(s)
- Susan Young
- Department of Psychology, Psychology Services Limited, Croydon CR9 7AE, United Kingdom
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Cyrus Abbasian
- Psychiatry-UK Limited, Cornwall PL33 9ET, United Kingdom
| | | | - Polly Branney
- ADHD and Autism, Oxford ADHD & Autism Centre, Headington OX3 7BX, United Kingdom
| | - Bill Colley
- CLC Consultancy, Dunkeld PH8 0AY, United Kingdom
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Sally Cubbin
- Adult ADHD, Adult ADHD Clinic Ltd, Oxford OX3 7RP, United Kingdom
| | - Quinton Deeley
- Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London Institute of Psychiatry, London SE5 8AF, United Kingdom
| | - Gisli Hannes Gudjonsson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Peter Hill
- Department of Psychiatry, University of London, London WC1E 7HU, United Kingdom
| | - Jack Hollingdale
- Department of Psychology, Compass Psychology Services Ltd, London BR1 9DX, United Kingdom
| | | | - Joe Johnson
- Halton and Knowsley Adult ADHD Team, Merseycare NHS Foundation Trust, Winwick WA2 9WA, United Kingdom
| | | | - Alexandra Lewis
- Department of Psychiatry, Fulbourn Hospital, Cambridge CB21 5EF, United Kingdom
| | - Peter Mason
- Department of Psychiatry, Dr Peter Mason ADHD & Psychiatry Services Limited, Liverpool L1 9AR, United Kingdom
| | - Raja Mukherjee
- Adult Neurodevelopmental Service, Horizon House, Epsom KT17 4QJ, United Kingdom
| | - David Nutt
- Department of Psychiatry, Imperial College London, London WS12 0NN, United Kingdom
| | - Jane Roberts
- Service User Representative, Gloucestershire GL1 3NN, United Kingdom
| | - Fiona Robinson
- Drug & Alcohol Services, Surrey & Borders Partnership Trust, Leatherhead KT22 7AD, United Kingdom
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Kelly Cocallis
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington NE63 9JJ, United Kingdom
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Park JI, Lee IH, Lee SJ, Kwon RW, Choo EA, Nam HW, Lee JB. Effects of music therapy as an alternative treatment on depression in children and adolescents with ADHD by activating serotonin and improving stress coping ability. BMC Complement Med Ther 2023; 23:73. [PMID: 36879223 PMCID: PMC9987133 DOI: 10.1186/s12906-022-03832-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/30/2022] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the effect of music therapy as an alternative treatment on depression in children and adolescents with attention-deficit hyperactivity disorder (ADHD) by activating serotonin (5-HT) and improving stress coping ability. METHODS This study is designed based on randomization method. A total of 36 subjects participated in the experiment, consisting of an ADHD control group (n = 18) and ADHD music therapy group (n = 18). The ADHD control group received standard care, while the ADHD music therapy group received music therapy and standard care. The ADHD music therapy group received both active music therapy (improvisation) and receptive music therapy (music listening) for 50 minutes, twice a week, for 3 months: a total of 24 times. From a neurophysiological perspective, changes in depression and stress were tracked by measuring 5-HT secretion, cortisol expression, blood pressure (BP), heart rate (HR), and CDI and DHQ psychological scales. RESULTS The ADHD music therapy group's 5-HT secretion increased (p < 0.001), whereas cortisol expression (p < 0.001), BP (p < 0.001) and HR (p < 0.001) decreased. The CDI and DHQ psychological scales also showed positive changes (p < 0.01 and p < 0.001, respectively). However, the ADHD Con G's (who did not receive music therapy) 5-HT secretion did not increase, whereas cortisol expression, BP, and HR did not decrease. In addition, the CDI and DHQ psychological scales did not display positive changes. CONCLUSIONS In conclusion, the application of music therapy as an alternative treatment for ADHD children and adolescents showed positive neurophysiological and psychological effects. Therefore, this study would like to propose a new alternative to medicine for preventing and treating depression through various uses of music therapy.
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Affiliation(s)
- Jong-In Park
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, 31151, Republic of Korea.,Department of Medical Sciences, Graduate School, Soonchunhyang University, Asan, 31538, Republic of Korea
| | - In-Ho Lee
- Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, 31151, Republic of Korea
| | - Seung-Jea Lee
- Department of Medical Sciences, Graduate School, Soonchunhyang University, Asan, 31538, Republic of Korea
| | - Ryeo-Won Kwon
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, 31151, Republic of Korea
| | - Eon-Ah Choo
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, 31151, Republic of Korea
| | - Hyun-Woo Nam
- Department of Medical Sciences, Graduate School, Soonchunhyang University, Asan, 31538, Republic of Korea
| | - Jeong-Beom Lee
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, 31151, Republic of Korea. .,Department of Medical Sciences, Graduate School, Soonchunhyang University, Asan, 31538, Republic of Korea.
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Maciver D, Rutherford M, Johnston L, Curnow E, Boilson M, Murray M. An interdisciplinary nationwide complex intervention for lifespan neurodevelopmental service development: Underpinning principles and realist programme theory. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:1060596. [PMID: 36794269 PMCID: PMC9922833 DOI: 10.3389/fresc.2022.1060596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/28/2022] [Indexed: 01/31/2023]
Abstract
Background People seeking support for neurodevelopmental differences often report waiting too long for assessment and diagnosis, as well as receiving inadequate support in educational and health settings. The National Autism Implementation Team (NAIT) developed a new national improvement programme in Scotland, focusing on assessment, diagnosis, educational inclusion, and professional learning. The NAIT programme was conducted within health and education services across the lifespan for a range of neurodevelopmental differences, including autism, developmental coordination disorder, developmental language disorder, and attention deficit hyperactivity disorder. NAIT included a multidisciplinary team, with the involvement of an expert stakeholder group, clinicians, teachers, and people with lived experience. This study explores how the NAIT programme was planned, delivered, and received over three years. Design We performed a retrospective evaluation. We collected data from review of programme documents, consultation with programme leads and consultation with professional stakeholders. A theory-based analysis was completed, drawing on the Medical Research Council Framework for developing and evaluating complex interventions, and realist analysis methods. We developed a programme theory of the contexts (C), mechanisms (M), and outcomes (O) influencing the NAIT programme, based on comparison and synthesis of evidence. A key focus was on identifying the factors that contributed to the successful implementation of NAIT activities across different domains, including practitioner, institutional and macro levels. Results On synthesis of the data, we identified the key principles underlying the NAIT programme, the activities and resources utilised by the NAIT team, 16 aspects of context, 13 mechanisms, and 17 outcome areas. Mechanisms and outcomes were grouped at practitioner level, service level and macro level. The programme theory is pertinent to observed practice changes across all stages of referral, diagnosis and support processes within health and education services for neurodivergent children and adults. Conclusions This theory-informed evaluation has resulted in a clearer and more replicable programme theory that can be used by others with similar aims. This paper illustrates the value of NAIT, as well as realist and complex interventions methodologies as tools for policymakers, practitioners, and researchers.
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Affiliation(s)
- Donald Maciver
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Marion Rutherford
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Lorna Johnston
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- Additional Support for Learning Service, Communities and Families, City of Edinburgh Council, Edinburgh, UK
| | - Eleanor Curnow
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Marie Boilson
- Fife Health and Social Care Partnership, Whytemans Brae Hospital, Kirkcaldy, United Kingdom
| | - Mairéad Murray
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
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Hargitai LD, Livingston LA, Waldren LH, Robinson R, Jarrold C, Shah P. Attention-deficit hyperactivity disorder traits are a more important predictor of internalising problems than autistic traits. Sci Rep 2023; 13:31. [PMID: 36646771 PMCID: PMC9842645 DOI: 10.1038/s41598-022-26350-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023] Open
Abstract
Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) are both linked to internalising problems like anxiety and depression. ASD and ADHD also often co-occur, making their individual statistical contributions to internalising disorders difficult to investigate. To address this issue, we explored the unique associations of self-reported ASD traits and ADHD traits with internalising problems using a large general population sample of adults from the United Kingdom (N = 504, 49% male). Classical regression analyses indicated that both ASD traits and ADHD traits were uniquely associated with internalising problems. Dominance and Bayesian analyses confirmed that ADHD traits were a stronger, more important predictor of internalising problems. However, brief depression and anxiety measures may not provide a comprehensive index of internalising problems. Additionally, we focused on recruiting a sample that was representative of the UK population according to age and sex, but not ethnicity, a variable that may be linked to internalising disorders. Nevertheless, our findings indicate that while ASD and ADHD uniquely predict internalising problems, ADHD traits are a more important statistical predictor than ASD traits. We discuss potential mechanisms underlying this pattern of results and the implications for research and clinical practice concerning neurodevelopmental conditions.
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Affiliation(s)
- Luca D. Hargitai
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Lucy A. Livingston
- grid.5600.30000 0001 0807 5670Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK ,grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lucy H. Waldren
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Ross Robinson
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Christopher Jarrold
- grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, BS8 1TU UK
| | - Punit Shah
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, BA2 7AY UK
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Butt DA, Stephenson E, Kalia S, Moineddin R, Tu K. Patient visits and prescriptions for attention-deficit/hyperactivity disorder from 2017-2021: Impacts of COVID-19 pandemic in primary care. PLoS One 2023; 18:e0281307. [PMID: 36913355 PMCID: PMC10010552 DOI: 10.1371/journal.pone.0281307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/20/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To determine whether more patients presented with Attention-deficit/hyperactivity disorder (ADHD)-related visits and/or sought care from family physicians more frequently during the COVID-19 pandemic. METHODS Electronic medical records from the University of Toronto Practice-Based Research Network were used to characterize changes in family physician visits and prescriptions for ADHD medications. Annual patient prevalence and visit rates pre-pandemic (2017-2019) were used to calculate the expected rates in 2020 and 2021. The expected and observed rates were compared to identify any pandemic-related changes. RESULTS The number of patients presenting for ADHD-related visits during the pandemic was consistent with pre-pandemic trends. However, observed ADHD-related visits in 2021 were 1.32 times higher than expected (95% CI: 1.05-1.75), suggesting that patients visited family physicians more frequently than before the pandemic. CONCLUSION Demand for primary care services related to ADHD has continued to increase during the pandemic, with increased health service use among those accessing care.
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Affiliation(s)
- Debra A. Butt
- Department of Family and Community Medicine, Scarborough General Hospital, Scarborough Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Ellen Stephenson
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sumeet Kalia
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Research and Innovation, Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
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Janssens A, Blake S, Eke H, Price A, Ford T. Parenting roles for young people with attention-deficit/hyperactivity disorder transitioning to adult services. Dev Med Child Neurol 2023; 65:136-144. [PMID: 35723621 PMCID: PMC10083944 DOI: 10.1111/dmcn.15320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
AIM To inform transitions from child to adult health services, we explored the work and roles parents take in the care of young people with attention-deficit/hyperactivity disorder (ADHD) aged 14 to 25 years old. METHOD Using framework thematic analysis, we analysed data collected from 28 semi-structured interviews with parents of young people with ADHD to generate a typology and triangulated it against findings from 64 interviews with young people with ADHD. The interviews were carried out as part of a three-strand, interactive mixed-method study. RESULTS An entourage typology of three parent roles was identified. Parents moved between 'manager' and 'roadie' roles as their child gradually matured. A 'superfan' role was identified which supported young people's positive self-image but may impede withdrawal from the 'manager' role. Continued parental involvement into adulthood reflected a need to maintain the balance of resources required to maintain quality of life for the whole family. INTERPRETATION This is the first study to explore parental roles in the health care of young people with ADHD. Parents will vary in their capacity to fulfil the identified roles and step back their care as their children reach adulthood. The findings can inform intervention development to support families and transition between services. WHAT THIS PAPER ADDS Parents move from a 'manager' to 'roadie' role as young people mature. A 'superfan' role supports positive self-image and directed health care work. Continued involvement reflects parental responsibility to juggle wider family needs and resources. Parents differ in capacity to fulfil and move between these roles.
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Affiliation(s)
- Astrid Janssens
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Center for Forskning Sammen med Patienter og Pårørende, Odense University Hospital, Denmark.,University of Exeter Medical School, Exeter
| | - Sharon Blake
- University of Exeter Medical School, Exeter.,Law School, University of Exeter, Exeter
| | - Helen Eke
- University of Exeter Medical School, Exeter
| | - Anna Price
- University of Exeter Medical School, Exeter
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Chitsabesan P, Hall CL, Carter LA, Reeves M, Mohammed V, Beresford B, Young S, Kraam A, Trowse S, Wilkinson-Cunningham L, Lennox C. Using an objective computer task (QbTest) to aid the identification of attention deficit hyperactivity disorder (ADHD) in the Children and Young People Secure Estate (CYPSE): a feasibility randomised controlled trial. BMJ Open 2022; 12:e064951. [PMID: 36526320 PMCID: PMC9764651 DOI: 10.1136/bmjopen-2022-064951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES QbTest has been shown to improve time to decision/diagnosis for young people with attention deficit hyperactivity disorder (ADHD). The aim was to assess the feasibility of QbTest for young people in prison. DESIGN Single-centre feasibility randomised controlled trial (RCT), with 1:1 allocation. Concealed random allocation using an online pseudorandom list with random permuted blocks of varying sizes. SETTING One Young Offenders Institution in England. PARTICIPANTS 355 young people aged 15-18 years displaying possible symptoms of ADHD were assessed for eligibility, 69 were eligible to take part and 60 were randomised. INTERVENTION QbTest-a computer task measuring attention, activity and impulsivity. MAIN OUTCOME MEASURES Eligibility, recruitment and retention rates and acceptability of randomisation and trial participation. RESULTS Of the 355 young people assessed for eligibility, 69 were eligible and 60 were randomised (n=30 QbTest plus usual care; n=30 usual care alone). The study achieved the specified recruitment target. Trial participation and randomisation were deemed acceptable by the majority of participants. 78% of young people were followed up at 3 months, but only 32% at 6 months, although this was also affected by COVID-19 restrictions. Secondary outcomes were mixed. Participants including clinical staff were mostly supportive of the study and QbTest; however, some young people found QbTest hard and there were issues with implementation of the ADHD care pathway. There were no serious adverse events secondary to the study or intervention and no one was withdrawn from the study due to an adverse event. CONCLUSIONS With adaptations, a fully powered RCT may be achievable to evaluate the effectiveness of QbTest in the assessment of ADHD in the Children and Young People Secure Estate, with time to decision (days) as the primary outcome measure. However, further programme developmental work is required to address some of the challenges highlighted prior to a larger trial. TRIAL REGISTRATION NUMBER ISRCTN17402196.
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Affiliation(s)
- Prathiba Chitsabesan
- Children and Young People's Research Unit, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Charlotte Lucy Hall
- Psychiatry, Institute of Mental Health, NIHR CLAHRC-East Midlands, Nottingham, UK
| | - Lesley-Anne Carter
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Mindy Reeves
- Medical School, The University of Manchester, Manchester, UK
| | - Vaseem Mohammed
- Medical School, The University of Manchester, Manchester, UK
| | | | - Susan Young
- Department of Clinical and Forensic Psychology, Psychology ServicesLimited, London, UK
- Department of Psychology, University of Reykjavik, Reykjavik, Iceland
| | - Abdullah Kraam
- Children and Adolescent Mental Health, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
| | - Sally Trowse
- Child and Adolescent Mental Health Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | - Charlotte Lennox
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Mindfulness Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis. PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint3040031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition impacting children and adults. Current treatments are limited and there is increasing interest in the use of mindfulness, which is growing in popularity. Previous systematic reviews have typically focused on specific ages, outcome measures or interventions. The current review aimed to take a more comprehensive approach. Title and abstract searches were performed in five databases for randomized and non-randomized controlled trials or pre-post studies with participants with an ADHD diagnosis or a score above a clinically relevant cut-off on a validated ADHD measure. Studies had to measure symptoms of ADHD, global or social functioning. Extraction of key information including participant status (i.e., diagnosis, scale scores, comorbidities, medication use), study design, and outcome measures was conducted. Effect sizes (Hedge’s g) were calculated and where a measure had been used in at least three studies with the same population, meta-analyses were considered. Twenty-nine studies were initially identified, with seven deemed poor quality and removed from further analysis leaving, 22 studies containing data from 1237 children and adults with ADHD along with data from 525 family members. The data indicate possible benefits of mindfulness on self-compassion, quality of life, wellbeing, depression, and anxiety. The findings also suggest that mindfulness may also improve ADHD symptoms, executive function, problematic behaviours, and emotional dysregulation, although results vary by age of patient and measures used. Parent stress and parenting style have received limited attention, highlighting the need for more studies in these areas. Whilst the data presented suggest that mindfulness may be beneficial, the evidence base is not as strong as the popularity of the approach. Many of the studies lacked blind assessment, adequate randomization, or suitable control conditions. As such high-quality controlled studies considering medication, other psychosocial interventions, use of active and in active controls and comorbidity as well as longer follow-up periods, are needed to confirm this.
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Cabrera Lagunes A, Díaz-Anzaldúa A, Rojas Andrade G, Peschard VG, Arias Caballero A, Gaspar-Barba CE, Yunes Jimenez A, De la Peña Olvera FR, Cruz Fuentes CS, Feria-Aranda M, Sosa Mora L, Pérez Molina A, Guizar Sanchez D, Palacios-Cruz L. Association between CLOCK gene polymorphisms and ADHD in Mexican teenagers: A comprehensive assessment. Psychiatry Res 2022; 317:114835. [PMID: 36166946 PMCID: PMC10824139 DOI: 10.1016/j.psychres.2022.114835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/20/2022] [Accepted: 09/04/2022] [Indexed: 01/04/2023]
Abstract
This study aimed to evaluate markers of the CLOCK gene rs1801260 and rs4864548 in Mexican adolescents, addressing clinical and biological aspects previously associated with ADHD. 347 Mexican adolescents were assessed for mental disorders, metabolic disruption and related conditions, circadian preference, as well as genotyping for the CLOCK. We found a significant association between ADHD and the AA and AG genotypes of rs1801260. Also, we identified in the ADHD group that the total Triiodothyronine and total Thyroxine values were respectively 10 ng/dl units and 0.58 ug/dl units lower in females than in males. Previously reported common variations of the CLOCK gene have been associated with ADHD like the Rs1801260 polymorphism hereby we could consider it as risk factor, but genetic, biochemical and clinical studies in the Mexican population are entailed.
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Affiliation(s)
- Alfonso Cabrera Lagunes
- Comprehensive Wellbeing Program, Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Adriana Díaz-Anzaldúa
- Department of Genetics, Sub-division of Clinical Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Gustavo Rojas Andrade
- Department of Genetics, Sub-division of Clinical Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Vanessa-Giselle Peschard
- Department of Medicine, Division of Nephrology, University of California, San Francisco 941130, United States
| | - Adriana Arias Caballero
- Comprehensive Wellbeing Program, Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - César Enrique Gaspar-Barba
- Comprehensive Wellbeing Program, Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Arlette Yunes Jimenez
- Comprehensive Wellbeing Program, Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico; Eating Disorders Clinic, Instituto Prado S.C., Mexico City 11000, Mexico
| | - Francisco Rafael De la Peña Olvera
- Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico; Unit of Research Promotion, Direction of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Carlos Sabas Cruz Fuentes
- Department of Genetics, Sub-division of Clinical Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Miriam Feria-Aranda
- Comprehensive Wellbeing Program, Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico; Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Liz Sosa Mora
- Comprehensive Wellbeing Program, Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico; Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Armando Pérez Molina
- Department of Genetics, Sub-division of Clinical Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Diana Guizar Sanchez
- Department of Physiology, Laboratory of Learning Sciences, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Lino Palacios-Cruz
- Comprehensive Wellbeing Program, Adolescent Clinic, Division of Clinical Services, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico; Department of Clinical Epidemiology, Sub-division of Clinical Research, Division of Neurosciences, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico.
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Seery C, Wrigley M, O'Riordan F, Kilbride K, Bramham J. What adults with ADHD want to know: A Delphi consensus study on the psychoeducational needs of experts by experience. Health Expect 2022; 25:2593-2602. [PMID: 35999687 PMCID: PMC9615057 DOI: 10.1111/hex.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION A lack of knowledge about attention-deficit/hyperactivity disorder (ADHD) can contribute to feelings of distress and difficulty in seeking and accepting an ADHD diagnosis. The present study uses a Delphi consensus design to investigate the psychoeducational needs of adults with ADHD and the information about ADHD they would like included in digital health interventions for adults with ADHD. Inclusion of perspectives of service users in developing such interventions ensures that they are evidence based and addresses the risks of engagement barriers. METHODS The expert panel consisted of 43 adults with ADHD (age range: 23-67 years). Panel members were asked to rate the importance of the proposed topics and provide additional suggestions. Suggested topics and topics that did not achieve consensus were included for ranking in the second round. RESULTS Interquartile ratings were used to determine consensus. A high consensus was achieved in both rounds, with an agreement on 94% of topics in the first round and 98% in the second round. Most topics were rated as important or essential. CONCLUSIONS The findings highlighted that adults with ADHD want to learn about many different aspects of ADHD and the importance of considering their perspectives when developing psychosocial interventions. Findings can be applied when creating psychoeducational content for adult ADHD. PATIENT OR PUBLIC CONTRIBUTION Adults with ADHD were recruited to the Delphi panel to use an experts-by-experience approach. In doing so, we are engaging service users in the development of a psychoeducational smartphone app. The evaluation of the app will involve interviews with app users. Additionally, the present study was developed and conducted with ADHD Ireland, a charity based in Ireland that advocates for people with ADHD.
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Affiliation(s)
- Christina Seery
- UCD School of PsychologyUniversity College DublinDublinIreland
| | - Margo Wrigley
- National Clinical Programme for ADHD in AdultsHealth Service ExecutiveDublinIreland
| | - Fiona O'Riordan
- National Clinical Programme for ADHD in AdultsHealth Service ExecutiveDublinIreland
| | | | - Jessica Bramham
- UCD School of PsychologyUniversity College DublinDublinIreland
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Tzang RF, Chang YC. Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy. World J Psychiatry 2022; 12:787-800. [PMID: 35978969 PMCID: PMC9258275 DOI: 10.5498/wjp.v12.i6.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/15/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder (ADHD) is reported to be poor, possibly due to heterogeneity of ADHD symptoms. Little is known about poor treatment efficacy owing to ADHD heterogeneity.
AIM To use generalized structural equation modeling (GSEM) to show how the heterogeneous nature of hyperactivity/impulsivity (H/I) symptoms in ADHD, irritable oppositional defiant disorder (ODD), and the presentation of aggression in children interferes with treatment responses in ADHD.
METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests. ODD scores from the Swanson, Nolan, and Pelham, version IV scale were obtained. The child behavior checklist (CBCL) and parent’s satisfaction questionnaire were completed. The relationships were analyzed by GSEM.
RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD, ODD symptoms, and childhood aggressive behavior. ODD directly mediated ADHD symptom severity. The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494% [= exp (2.602)] in children with comorbid ADHD and ODD [odds ratio (OR) = 2.602, 95% confidence interval (CI): 1.832-3.373, P = 0.000] after adjusting for the effects of other factors. Childhood aggression mediated ODD symptom severity. The chance of reaching remission based on ODD symptoms was lowered by 11.000% [= 1 - exp (-0.117)] in children with more severe baseline symptoms of aggression based on the CBCL score at study entry [OR = -0.117, 95%CI: (-0.190)-(-0.044), P = 0.002].
CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity. More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment, e.g., symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.
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Affiliation(s)
- Ruu-Fen Tzang
- Department of Child and Adolescent Psychiatry, Mackay Memorial Hospital, Taipei 104, Taiwan
- Department of Childhood Care and Education, Mackay Junior College of Medicine, Nursing, and Management, New Taipei City 112, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City 251, Taiwan
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Tully J. Management of ADHD in Prisoners-Evidence Gaps and Reasons for Caution. Front Psychiatry 2022; 13:771525. [PMID: 35370827 PMCID: PMC8973692 DOI: 10.3389/fpsyt.2022.771525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- John Tully
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
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