Five Years On: Public Sector Service Use Related to Mental Health in Young People with ADHD or Hyperkinetic Disorder Five Years After Diagnosis

Abstract

Background: Little is known about ongoing service use among young people with ADHD, but this information is important to the development of services to support these young people. Methods: A cohort of young people with ADHD or hyperkinetic disorder (n ¼ 115) was followed up five to seven years after diagnosis. Details are presented of their use of public sector services over the 12 months preceding reassessment, compared to young people with ADHD from a large epidemiological study. Results: Most children remained in contact with CAMHS, with high rates of contact with schools, educational professionals and the criminal justice system. Nearly all had taken medication at some point, while many still were using it. There were low reported rates of psychological and group interventions within the last twelve months, but this does not rule out earlier access to such treatments. Conclusions: Children with ADHD utilise long-term support from public sector services, and cross agency strategies or clinics may help to optimise functioning. Key Practitioner Message:• Many children with ADHD continue to need support from CAMHS into adolescence and early adulthood.• Many children with ADHD need additional support at school on a long-term basis.• Health visitors, general practitioners and teachers were the first professionals approached by parents, so their knowledge and understanding of ADHD is very important.• Girls with ADHD are less likely to be referred to CAMHS.

Prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) symptomatology and psychiatric comorbidity among adolescents diagnosed with ADHD in childhood

“…It would therefore appear that the persistence rates of childhood ADHD into adolescence reported in this study are comparable to those reported in other countries. 5,6 The higher prevalence of primarily inattentive symptoms is in keeping with trends in other studies, as is the general assumption that while hyperactive and impulsive behaviour becomes less prominent as individuals with ADHD age, symptoms of inattention remain prevalent. 6,7 This particular sample of adolescents reported a significant number of psychiatric and adjustment difficulties.…”

“…4 With this in mind, a recent study of 157 individuals who had been diagnosed with ADHD between the ages of 6 and 15 years found that on the basis of parents' reports, 60% of these individuals still met the DSM-IV criteria for ADHD 5 years after diagnosis. 5 There would therefore appear to be convincing evidence of noteworthy persistence rates into adolescence for both full DSM-IV criteria and partial-remission ADHD.…”

“…6 However, both individuals suffering from persistent ADHD and those with partially remitted ADHD have been found to be significantly more likely than controls to be diagnosed with ODD, CD, tics, mood disorders, past and regular use of substances, and sleep disorders. 5 It would therefore appear that while persistent ADHD places adolescents at increased risk for a variety of psychopathologies, reduced ADHD symptoms in adolescents previously diagnosed with the disorder do not necessarily imply reduced risk for psychiatric co-morbidities.…”

Practitioner Review: How can epidemiology help us plan and deliver effective child and adolescent mental health services?

“…In addition, the prevalence of disorder provides little detail about the individual needs of these children, which will be influenced by their family and social circumstances in addition to the presence/absence of psychopathology. However, clinical samples provide very misleading information about the prevalence of childhood psychiatric disorder and its correlates, because only a small and atypical group of children access services (Ford, Fowler, Langley, Whittinger, & Thapar, 2007b). While we should not assume that the presence of impairing psychopathology identifies all need, these estimates provide a firmer foundation for service planning than historical levels of provision or short‐term policy priorities (Flisher et al, 1997; Jenkins, 2001).…”

The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials

“…However, as a result of an often complex assessment and treatment process, inefficient methods of data collection, and difficulties tracking and monitoring long-term treatment, little is known regarding the long-term outcomes of those receiving recommended service intervention(s) 31,33,34…”