Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement

Abstract

Background: Despite evidence-based national guidelines for ADHD in the United Kingdom (UK), ADHD is under-identified, under-diagnosed, and under-treated. Many seeking help for ADHD face prejudice, long waiting lists, and patchy or unavailable services, and are turning to service-user support groups and/or private healthcare for help.Methods: A group of UK experts representing clinical and healthcare providers from public and private healthcare, academia, ADHD patient groups, educational, and occupational specialists, met to discuss shortfalls in ADHD service provision in the UK. Discussions explored causes of under-diagnosis, examined biases operating across referral, diagnosis and treatment, together with recommendations for resolving these matters.Results: Cultural and structural barriers operate at all levels of the healthcare system, resulting in a de-prioritization of ADHD. Services for ADHD are insufficient in many regions, and problems with service provision have intensified as a result of the response to the COVID-19 pandemic. Research has established a range of adverse outcomes of untreated ADHD, and associated long-term personal, social, health and economic costs are high. The consensus group called for training of professionals who come into contact with people with ADHD, increased funding, commissioning and monitoring to improve service provision, and streamlined communication between health services to support better outcomes for people with ADHD.Conclusions: Evidence-based national clinical guidelines for ADHD are not being met. People with ADHD should have access to healthcare free from discrimination, and in line with their legal rights. UK Governments and clinical and regulatory bodies must act urgently on this important public health issue.

What adults with ADHD want to know: A Delphi consensus study on the psychoeducational needs of experts by experience

“…However, participants did not provide evidence of a clinical diagnosis. This was to facilitate participation from adults who self‐identify as having ADHD but who may not yet have a diagnosis or opted not to pursue a formal diagnosis, due to significant waiting lists and barriers to ADHD care 68–70 . Research has indicated that college students who self‐identify as having ADHD but are undiagnosed demonstrate more neuropsychological impairment than non‐ADHD peers, 71 which may possibly support the validity of self‐diagnosis.…”

“…This was to facilitate participation from adults who self‐identify as having ADHD but who may not yet have a diagnosis or opted not to pursue a formal diagnosis, due to significant waiting lists and barriers to ADHD care. 68 , 69 , 70 Research has indicated that college students who self‐identify as having ADHD but are undiagnosed demonstrate more neuropsychological impairment than non‐ADHD peers, 71 which may possibly support the validity of self‐diagnosis. However, we did not collect data on which participants self‐diagnosed and were formally diagnosed and could not analyse any significant differences between these groups or their frequencies.…”

Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy

“…A previous study indicated that the coexistence of a diagnosis of ODD/CD, learning difficulties, anxiety, younger age, family dysfunction, and socioeconomic adversity were all risk factors for predicting poor treatment efficacy for ADHD[ 43 ]. This pathway analysis further focused on children with ADHD with ODD, and aggression led to poor treatment outcomes.…”

Management of ADHD in Prisoners—Evidence Gaps and Reasons for Caution

“…Widely cited studies estimate the prevalence of adult ADHD in the general population to be 3-5% (9)(10)(11), with rates typically being higher for men, though concerns about overdiagnosis should be noted (5,(12)(13)(14). Increasing awareness and discussion about ADHD has led to development of several consensus and guidance documents internationally (15)(16)(17)(18)(19)(20)(21). In incarcerated populations, rates are thought to be disproportionately high (22), but underdiagnosed (23), leading to lobbying for prioritization of ADHD in prisons and calls for effective screening and treatment protocols (20)(21)(22)(23)(24)(25).…”