Specialist adult ADHD clinics in East Anglia: service evaluation and audit of NICE guideline compliance

Magon, Rakesh; Latheesh, Beena; Müller, Ulrich

doi:10.1192/pb.bp.113.043257

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…This is the first audit of a community CAMHS ADHD diagnostic pathway in SLaM, to our knowledge. Several audits have been published elsewhere in the UK, which have reported adherence to NICE guidelines for diagnosing ADHD in adults (Magon et al , 2015) and children (Bellenis et al , 2007; Coghill and Seth, 2015) referred to clinical services. The present study found that NICE (2008) recommendations for diagnosing ADHD in young people were generally consistent with existing clinical practice in most areas, with the audit identifying evidence that the four recommended guidance points were used least 90 per cent of cases eventually diagnosed with ADHD.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a diagnostic ADHD pathway in a community child mental health service in South London

Barnes¹,

Wretham

Sedgwick

et al. 2020

MHRJ

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Purpose Clinicians working in UK child mental health services are faced with several challenges in providing accurate assessment and diagnosis of attention deficit hyperactivity disorder (ADHD). Within the South London & Maudsley (SLaM) NHS Trust, community Child & Adolescent Mental Health Services (CAMHS) are developing structured pathways for assessing and diagnosing ADHD in young people. To date, these pathways have not been formally evaluated. The main aims of this evaluation are to evaluate all ADHD referrals made to the service in an 18-month period, including the number of completed assessments and proportion of children diagnosed with ADHD; and investigate adherence to the National Institute for Clinical Excellence (NICE) guideline for diagnosing ADHD in children and young people. Design/methodology/approach Retrospective data analysis was performed using service databases and electronic patient records. Adherence to the clinical guideline was measured using the NICE data collection tool for diagnosing ADHD in children and young people. All completed ADHD assessments were compared to four key recommendation points in the guideline. Findings Within the time frame, 146 children aged 4-17 years were referred and accepted for an ADHD assessment. Of these, 92 families opted in and were seen for an initial appointment. In total, 36 ADHD assessments were completed, of which 19 children received a diagnosis of ADHD and 17 did not. Aside from structured recording of ADHD symptoms based on ICD-10 criteria (69%) and reporting of functional impairment (75%), adherence to all guidance points was above 90%. The study also found that although a greater proportion of children referred to the service were male and identified as White, these differences narrowed upon receipt of ADHD diagnosis. Research limitations/implications Relationship to the existing literature is discussed in relation to the assessment process, demographic characteristics and rates of co-occurrence. Practical implications The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families. Originality/value This article is unique in that it is, to the best of the authors’ knowledge, the first to describe and report clinician-adherence to a structured pathway for diagnosing ADHD in young people within a community CAMHS service in South London.

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Section: Discussionmentioning

confidence: 99%

Evaluation of a diagnostic ADHD pathway in a community child mental health service in South London

Barnes¹,

Wretham

Sedgwick

et al. 2020

MHRJ

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“…Furthermore, prescribing is only one part of the approach to managing young people with persisting ADHD symptoms. There are various models of delivering care for older adolescents and adults with ADHD including extension of child mental health services, youth services and specific adult ADHD services, and recent recommendations on transition have been made by the UK Adult ADHD Network (UKAAN) [ 26 – 28 ]. However, the evidence regarding the effectiveness of different service models in improving outcomes needs to be strengthened—a systematic review in 2015 by Paul and colleagues concluded that there was currently no ‘high quality’ evidence to support the use of any particular transition care models [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Prescribing of medication for attention deficit hyperactivity disorder among young people in the Clinical Practice Research Datalink 2005–2013: analysis of time to cessation

Newlove‐Delgado

Ford

Hamilton

et al. 2017

Eur Child Adolesc Psychiatry

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The aim of this study was to examine the time to cessation of ADHD medication amongst young people with ADHD aged 16 in the period 2005–2013. Previous studies of prescribing in primary care reported high rates of medication cessation amongst 16 and 17 year olds with ADHD. The examination of trends since the introduction of new NICE guidance in 2008 will support service planning and improvement of outcomes over the vulnerable transition period from child to adult services. We used primary care records from the Clinical Practice Research Datalink and identified cases prescribed ADHD medication at the time of their 16th birthday during the study period. The outcome was time to medication cessation from the age of 16. Cessation of medication was defined as occurring at the beginning of a gap of over 6 months in prescriptions. 1620 cases were included. The median time to cessation was 1.51 years (95% CI 1.42–1.67).The estimated probability of remaining on medication was 0.63 (95% CI 0.61–0.65) at age 17 (i.e., at 1 year) and 0.41 (95% CI 0.39–0.43) at age 18. Young people with ADHD remain at high risk of cessation of medication during the transition from child to adult services. Despite the restriction that only primary care prescribing data were available, the results suggest continuing disparity between expected levels of symptom persistence and continuation of medication.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-017-1011-1) contains supplementary material, which is available to authorized users.

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“…Data extraction – Neurodevelopmental disorders). Three studies included young people with ASD (Laxman, Taylor, DaWalt, Greenberg, & Mailick, 2019; Merrick et al., 2020; Tunesi, Bosio, & Russo, 2019), four included young people with any neurodevelopmental condition (Asl, 2014; Maslow, 2016; Patwardhan, Singh, & Kanster, 2019; Singh et al., 2021), one focused on learning disabilities (Sharif, 2021), one on hyperkinetic disorder (Blasco‐Fontecilla et al., 2012) and the remainder focussed on ADHD (Ayyash et al., 2018; Eke et al., 2019; Eke et al., 2018; Heron et al., 2020; Janssens et al., 2020; Magon, Latheesh, & Muller, 2015; McCarthy et al., 2009; McNicholas & Singh, 2015; Moosa & Sandhu, 2015; Ogundele, 2013; Ogundele & Omenaka, 2012; Price, Newlove‐Delgado, et al., 2019; Reale et al., 2018; Reale, Frassica, Gollner, & Bonati, 2015; Tatlow‐Golden et al., 2018). However, most studies included young people with comorbidity, including those with comorbid ADHD/ASD.…”

Section: Transition For Those With Neurodevelopmental Disordersmentioning

confidence: 99%

Annual Research Review: A systematic review of mental health services for emerging adults – moulding a precipice into a smooth passage

Anderson

Newlove‐Delgado

Ford

2021

Child Psychology Psychiatry

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Background: The transition between child and adult services should aim to support young people into the next stage of their life in a way that optimises their function. Yet financial, organisational and procedural barriers to continuity of care often hamper smooth transition between child and adult services. Aim and method: We reviewed studies of transition from child to adult mental health services, focusing on: (a) rates of referrals and referral acceptance; (b) barriers and facilitators of successful transition; (c) continuity of care during and post-transition and (d) service users' experience of transition. Studies were identified through systematic searches of electronic databases: PsycINFO, Medline, Embase and Child Development and Adolescent Studies. Findings: Forty-seven papers describing 43 unique studies met inclusion criteria. Service provision is influenced by previous history and funding processes, and the presence or absence of strong primary care, specialist centres of excellence and coordination between specialist and primary care. Provision varies between and within countries, particularly whether services are restricted to 'core' mental health or broader needs. Unsupportive organisational culture, fragmentation of resources, skills and knowledge base undermine the collaborative working essential to optimise transition. Stigma and young people's concerns about peers' evaluation often prompt disengagement and discontinuation of care during transition, leading to worsening of symptoms and later, to service re-entry. Qualitative studies reveal that young people and families find the transition process frustrating and difficult, mainly because of lack of advanced planning and inadequate preparation. Conclusions: Despite increasing research interest over the last decade, transition remains 'poorly planned, executed and experienced'. Closer collaboration between child and adult services is needed to improve the quality of provision for this vulnerable group at this sensitive period of development.

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Specialist adult ADHD clinics in East Anglia: service evaluation and audit of NICE guideline compliance

Cited by 7 publications

References 12 publications

Evaluation of a diagnostic ADHD pathway in a community child mental health service in South London

Evaluation of a diagnostic ADHD pathway in a community child mental health service in South London

Prescribing of medication for attention deficit hyperactivity disorder among young people in the Clinical Practice Research Datalink 2005–2013: analysis of time to cessation

Annual Research Review: A systematic review of mental health services for emerging adults – moulding a precipice into a smooth passage

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