Practitioner Review: Pathways to care for ADHD – a systematic review of barriers and facilitators

Abstract

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.

What do general practitioners know about ADHD? Attitudes and knowledge among first-contact gatekeepers: systematic narrative review

“…Furthermore, to address the question of urgency, research suggests that it would be necessary to train teachers, as well as to educate parents and other relevant family members. This is because studies of pathways to care [6, 13] and major reviews [64] indicate that service access is affected by parents’ and teachers’ knowledge about ADHD and their interpretation of child behaviour, as well as referral requests by parents. An exploration of such approaches would seem warranted for ADHD, i.e., combining training, guideline implementation, checklists, and collaborative care, with wider education for relevant professionals and society.…”

Access to diagnosis, treatment, and supportive services among pharmacotherapy-treated children/adolescents with ADHD in Europe: data from the Caregiver Perspective on Pediatric ADHD survey

“…Recent findings from a systematic review showed that barriers to accessing care for children with ADHD can operate at the individual, organizational, or societal level 7. In a longitudinal study (N=162), the majority of parents of children who used specialist services reported barriers to accessing services, with the most common barrier being the lack of information about who could help 8.…”

Does methylphenidate improve academic performance? A systematic review and meta-analysis

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