Background Routine outcome measurement (ROM) in CAMHS is supported by U.K. Government policy. However, little is known about how measures are used in practice. Method Data describing use of ROM, knowledge and attitudes regarding implementation were collected using a regional case‐note audit, online survey and stakeholder workshop. Results While the principle of ROM was supported by stakeholders, baseline and follow‐up outcome measurement occurred in less than a fifth of cases. Barriers to implementation included lack of training and resources, clinicians' perceptions of the limitations of existing measures and lack of regular feedback of outcome data. Conclusions Implementation of ROM may be facilitated by session‐by‐session measures with immediate feedback to clinicians and patients.

BackgroundAttention‐Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder starting in childhood that may persist into adulthood. It can be managed through carefully monitored medication and nonpharmacological interventions. Access to care for children at risk of ADHD varies both within and between countries. A systematic literature review was conducted to investigate the research evidence related to factors which influence children accessing services for ADHD.MethodStudies investigating access to care for children at risk of ADHD were identified through electronic searches of the international peer‐reviewed and grey literature. Databases were searched from inception till 30th April 2012. This identified 23,156 articles which were subjected to three levels of screening (title, abstract and full text) by a minimum of two independent reviewers. Due to the heterogeneity in the study designs, a narrative approach was used to present the findings.ResultsTwenty‐seven papers met the inclusion criteria; these were grouped into four main themes, with some papers being included in more than one. These were wider determinants (10 papers); identification of need (9 papers); entry and continuity of care (13 papers) and interventions to improve access (4 papers). Barriers and facilitators to access were found to operate at the individual, organisational and societal level. Limited evidence of effective interventions to improve access was identified.ConclusionThis review explored the multilayered obstacles in the pathway to care for children at risk of ADHD and the lack of evidence‐based interventions designed to address these issues, thereby indicating areas for service development and further evaluative research.

Attention-deficit/hyperactivity disorder (ADHD) is a common neuro-developmental disorder that causes controversy; this may have a negative effect on the ability of families, teachers and healthcare professionals to achieve shared understanding and goals. This article reviews recent research of the knowledge and attitudes of children, adolescents, parents, teachers, healthcare professionals and the public about ADHD. Findings suggest that misconceptions about ADHD persist, and children with ADHD and their parents report stigmatizing experiences. Educational interventions to improve the knowledge of teachers about ADHD appeared to be effective in the short term. Parents and professionals working together in the diagnosis and treatment of children with ADHD may have different views about their roles in the shared decision-making process. Studies have reported both similarities and differences in parents' and professionals' views about the effectiveness of treatments for ADHD, but all stakeholders supported the principles of information-sharing and working in partnership.

Background: Diagnosis of attention deficit hyperactivity disorder (ADHD) relies on subjective methods which can lead to diagnostic uncertainty and delay. This trial evaluated the impact of providing a computerised test of attention and activity (QbTest) report on the speed and accuracy of diagnostic decision-making in children with suspected ADHD. Methods: Randomised, parallel, single-blind controlled trial in mental health and community paediatric clinics in England. Participants were 6-17 years-old and referred for ADHD diagnostic assessment; all underwent assessment-as-usual, plus QbTest. Participants and their clinician were randomised to either receive the QbTest report immediately (QbOpen group) or the report was withheld (QbBlind group). The primary outcome was number of consultations until a diagnostic decision confirming/excluding ADHD within 6-months from baseline. Health economic cost-effectiveness and cost utility analysis was conducted. Assessing QbTest Utility in ADHD: A Randomised Controlled Trial was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/ NCT02209116). Results: One hundred and thirty-two participants were randomised to QbOpen group (123 analysed) and 135 to QbBlind group (127 analysed). Clinicians with access to the QbTest report (QbOpen) were more likely to reach a diagnostic decision about ADHD (hazard ratio 1.44, 95% CI 1.04-2.01). At 6-months, 76% of those with a QbTest report had received a diagnostic decision, compared with 50% without. QbTest reduced appointment length by 15% (time ratio 0.85, 95% CI 0.77-0.93), increased clinicians' confidence in their diagnostic decisions (odds ratio 1.77, 95% CI 1.09-2.89) and doubled the likelihood of excluding ADHD. There was no difference in diagnostic accuracy. Health economic analysis showed a position of strict dominance; however, cost savings were small suggesting that the impact of providing the QbTest report within this trial can best be viewed as 'cost neutral'. Conclusions: QbTest may increase the efficiency of ADHD assessment pathway allowing greater patient throughput with clinicians reaching diagnostic decisions faster without compromising diagnostic accuracy.