Tamsin V Newlove-Delgado

Mental health related contact with education professionals in the British Child and Adolescent Mental Health Survey 2004

Purpose – The purpose of this paper is to describe mental health-related contact with educational professionals amongst children in the British Child and Adolescent Mental Health Survey (BCAMHS) 2004. Design/methodology/approach – BCAMHS 2004 was a community-based survey of 5,325 children aged 5-16, with follow-up in 2007. This paper reports the percentage of children with a psychiatric disorder that had mental health-related contact with education professionals (categorised as teachers or specialist education services) and the percentage with specific types of psychiatric disorders amongst those contacting services. Findings – Two-thirds (66.1 per cent, 95 per cent CI: 62.4-69.8 per cent) of children with a psychiatric disorder had contact with a teacher regarding their mental health and 31.1 per cent (95 per cent CI: 27.5-34.7 per cent) had contact with special education either in 2004 or 2007, or both. Over half of children reporting special education contact (55.1 per cent, 95 per cent CI: 50.0-60.2 p...

Trajectories of Psychopathology in Relation to Mental Health Related Service Contacts over Three Years in the British Child and Adolescent Mental Health Survey 2004

Introduction Previously, a number of observational studies have found no association between contact with services and improved outcomes in children with psychopathology, despite the existence of effective interventions. The British Child and Adolescent Mental Health Survey (BCAMHS) 2004 is a study of 5,325 children aged 5-16, with data on parent-reported mental health-related public sector service contacts and psychopathology over three years, allowing exploration of the association in a large community-based dataset. Aims • Describe the trajectories of children in contact and not in contact with services over three years from 2004-2007 • Explore the association between mental health-related service contact over the study period and outcomes in terms of parent-rated psychopathology Methods This study is a secondary analysis of childrens trajectories by service contact status (no contact, contact 2004 only, contact 2007 only, contact 2004 & 2007). The main measure of psychopathology over time was the well-validated Strengths and Difficulties Questionnaire. Multivariable linear regression was used to examine the association between contact and outcomes in children with a psychiatric disorder at baseline in 2004. Results Children in contact with services demonstrated the highest levels of psychopathology over time, and the 2007-only contact group displayed a trajectory of increasing difficulties. Overall, contact with services was not associated with improvement in outcomes, following adjustment for measured confounders. Conclusions The effectiveness of contact alone with services was not demonstrated in our findings. Despite methodological limitations, this underlines the need for continuing development and consistent implementation of effective interventions, alongside initiatives evaluating outcomes within services.

Adult Attention Deficit Hyperactivity Disorder (ADHD): Public Health Implications

In 2008 NICE guidance recommended the identification and treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults. Previously, diagnosis and treatment of this condition had mainly been confined to children and young people. Dr Tamsin Newlove-Delgado and Professor Ken Stein from University of Exeter explain why adult ADHD is important and what the implications are for health improvement, commissioning and providing evidence based services Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, with symptoms of inattention, hyperactivity and impulsivity causing significant impairment in functioning. The diagnostic criteria for ADHD currently require that symptoms must have been present before the age of seven years, and be apparent in more than one setting. There is no single cause; instead the condition appears to result from a complex interaction of genetic and environmental factors.1 ADHD is estimated to affect 3-5% of children of school age in the UK.1,2 Does ADHD exist in adults? Few studies have followed up young people with ADHD beyond the age of 25. A meta-analysis of data from follow-up studies suggested that although the rate of persistence of ADHD meeting the full diagnostic criteria at age 25 was only 15%, the persistence of symptoms was much higher at around 40-60%.3 Therefore, although the prevalence of ADHD certainly declines with age, a significant proportion of adults have still been found to be affected. ADHD in adults remains the subject of some debate, given the high rate of co-morbidities and the difficulty in distinguishing normal symptoms from pathological ones. However, in 2008 the National Institute for Health and Clinical Excellence (NICE) reviewed the evidence on adult ADHD, recommending recognition of the condition and establishment of services for assessment and management, with stimulant medication as the first-line treatment for adults with either moderate or severe levels of impairment.2 How many adults might suffer with ADHD? A meta-analysis of world literature produced a pooled prevalence estimate of 2.5%.4 The UK 2007 Adult Psychiatric Morbidity Survey5 used the six item Adult ADHD Self Report Scale (ASRS) to screen the sample for ADHD symptoms. Using this scale 8.2% of adults scored four or more, which was considered to warrant clinical assessment, and 0.6% scored all six, indicating a high likelihood of a positive diagnosis. NICE have estimated the number of men with ADHD at over 300,000 in England, and the number of women at over 80,000,6 indicating that there is a considerable population likely to be affected. Impact of adult ADHD Higher risk of other psychiatric disorders Adults with ADHD are at increased risk for other psychiatric disorders. Over a lifetime, it is estimated that over threequarters of those with ADHD will have a psychiatric co-morbidity;7 with depression and anxiety being most common. Substance misuse and smoking Substance misuse affects up to half of adults with ADHD.7 A significant proportion of those in contact with substance misuse services also have ADHD symptoms. High rates of smoking (up to 40%) in ADHD8 may be explained by genetic influences or self-medication with nicotine: the condition is also linked with earlier initiation of smoking and difficulty in quitting.9 Accidents Studies have reported that adolescents and adults with ADHD are more likely to be involved in road traffic collisions, to be stopped for speeding, and to report losses of concentration and control whilst driving.10 Similarly, both children and adults with ADHD appear to have more accidents and injuries in general, possibly due to impulsivity and risktaking behaviours.11 Educational and occupational underachievement Adults with ADHD experience higher job turnover and more periods of unemployment. A recent European study found they were twice as likely to be unemployed. …

Recurrent Abdominal Pain in Children: Summary Evidence From 3 Systematic Reviews of Treatment Effectiveness.

Objectives: Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities. Methods: We carried out a systematic review of randomised controlled trials (RCTs) in eleven databases and 2 trials registries from inception to June 2016. An update search was run in November 2017. All screening was performed by 2 independent reviewers. Included studies were appraised using the Cochrane risk of bias tool and the evidence assessed using GRADE. We included any dietary, pharmacological or psychosocial intervention for RAP, defined by Apley or an abdominal pain-related functional gastrointestinal disorder, as defined by the Rome III criteria, in children and adolescents. Results: We included 55 RCTs, involving 3572 children with RAP (21 dietary, 15 pharmacological, 19 psychosocial, and 1 multiarm). We found probiotic diets, cognitive-behavioural therapy (CBT) and hypnotherapy were reported to reduce pain in the short-term and there is some evidence of medium term effectiveness. There was insufficient evidence of effectiveness for all other dietary interventions and psychosocial therapies. There was no robust evidence of effectiveness for pharmacological interventions. Conclusions: Overall the evidence base for treatment decisions is poor. These data suggest that probiotics, CBT, and hypnotherapy could be considered as part of holistic management of children with RAP. The evidence regarding relative effectiveness of different strains of probiotics is currently insufficient to guide clinical practice. The lack of evidence of effectiveness for any drug suggests that there is little justification for their use outside of well-conducted clinical trials. There is an urgent need for high-quality RCTs to provide evidence to guide management of this common condition.

‘You’re 18 now, goodbye’: the experiences of young people with attention deficit hyperactivity disorder of the transition from child to adult services

ABSTRACT The term ‘transition’ is used to refer to the process of moving from child to adult services. Among child and adolescent mental health services attenders, young people with Attention Deficit Hyperactivity Disorder (ADHD) are less likely to transition successfully, but there is a gap in understanding their views and why they might disengage from services. The aim of this study was to explore the experiences of transition of young people with ADHD in Southwest England using semi-structured interviews and thematic analysis. Seven young people aged 17–19 years participated. Four key themes were identified: professionals’ roles and relationships with young people; the role of ADHD medication, uncertainties around transition and medication management, and identified needs and increasing independence. Although this study presents the experiences of a small number of people, their stories suggest that best practice around transition is not always being followed. There is consequently a need to better understand the facilitators and barriers to best practice implementation.