Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions

Abstract

BackgroundAttention Deficit Hyperactivity Disorder is prevalent in adulthood, resulting in serious impairment across multiple domains of living. Despite clinical guidance recommendations, the relative infancy of research on service provision for adults with ADHD, along with the evidence transfer gap, means that there is a lack of specific frameworks for service delivery. Igniting research and developing service delivery frameworks within adult ADHD is an essential step in the provision of effective services for adults with ADHD.MethodFollowing the methodology used in previous related research that utilises a Participatory Action Research approach, we gathered data from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed.ResultsThe resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the ‘ladder of change’, ranging from ‘stuck’ to ‘choice’.ConclusionsThe ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.

Delineating early developmental pathways to ADHD: Setting an international research agenda

“…Involvement of various stakeholders in discussions about these issues through community‐based participatory research approaches will be important to developing a robust understanding of an acceptable clinical research agenda to the ADHD community and will help researchers ensure this work is less likely to be framed in ways that perpetuate stigma. In particular, while there is recognition of the need to involve ADHD community members as stakeholders, there is relatively little work using formally‐defined methods (but see Adamou et al., 2016 ) such as participatory action research methods (Shamrova & Cummings, 2017 ) or cultural consensus modeling (Ulijaszek, 2013 ) that would allow individuals with ADHD and their family members to actively participate in defining research questions, planning and conducting studies, and interpreting and disseminating findings. Ultimately, novel early identification and intervention approaches will only be widely adopted if they are welcomed by individuals with ADHD and their families.…”

Recommendations for occupational therapy interventions for adults with ADHD: a consensus statement from the UK adult ADHD network

“…From previous work, we found that the framework proposed by the ADHD Star can be a useful guide to multidisciplinary interventions based on the ADHD Star domains 'Focus and Attention', 'Friends and Social Life', 'Physical Health', 'How you Feel' "Understanding your ADHD", "Organising yourself", "Thinking and reacting" and "Meaningful use of time" [54]. To this framework, the Occupational Therapy Models of Practice can be deployed using the different frames of reference depending on the needs of the individual.…”

The Adult ADHD Assessment Quality Assurance Standard (AQAS)

“…The relatively recent widespread recognition that ADHD often persists across the lifespan, has left adult service providers working out how best to meet this need, which encompasses up to three generations of undiagnosed adults with ADHD. Various models of care have emerged and are still evolving [9,10], but to date the relatively few established adult ADHD services within the National Health Service (NHS) in the United Kingdom (UK) have generally not been resourced sufficiently to meet the considerable need [11,12]. This problem likely exists in many other regions of the world.…”