'ADHD assessment and brief intervention service for teenagers in CAMHS to provide a multi-disciplinary perspective' Professor Kapil Sayal, Dr Kate Arron, and Joe Kilgariff

Professor Kapil Sayal, Professor of Child and Adolescent Psychiatry, University of Nottingham, spoke with Dr. Kate Arron, Clinical Psychologist, and Joe Kilgariff, Advanced Nurse, on 'ADHD assessment and brief intervention service for teenagers in CAMHS to provide a multi-disciplinary perspective'. Recorded on 10 March 2017 at the Emanuel Miller memorial lecture and conference on 'Controversies in ADHD'. ACAMH members can now receive a CPD certificate for watching this recorded lecture.

Parental ADHD Knowledge in Latinx Families: Gender Differences and Treatment Effects

Objective The current study aimed to extend findings of a study comparing two psychosocial treatments for ADHD in Latinx youth by examining if parental ADHD knowledge improves following treatment and if parental gender differences in ADHD knowledge exist. Method Following a comprehensive ADHD assessment, 58 Latinx families of school-aged children (mean age of 8 years) were randomly assigned to either culturally-adapted treatment (CAT) or standard evidence-based treatment (EBT). Parents completed an ADHD Knowledge measure both pre- and post-treatment. Results/Conclusion Latinx mothers demonstrated greater knowledge of ADHD symptomatology than fathers at pre-treatment. CAT resulted in improvements in parental knowledge of ADHD for both mothers and fathers, whereas standard EBT resulted in no change in maternal knowledge and reduced paternal knowledge of ADHD symptomatology. Clinical implications will be discussed.

Awareness of ADHD in primary care: stakeholder perspectives

Background: Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs’ ADHD awareness, this qualitative study aims to further explore individual stakeholders’ experiences. Methods: Semi-structured interviews explored the views of multiple stakeholders- GPs (n=5), healthcare specialists (n=5), patients (adults with ADHD n=5) and parents (n=5) with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. Results: Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. Conclusion: This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.

Demand and capacity in an ADHD team: reducing the wait times for an ADHD assessment to 12 weeks

Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder characterised by the core symptoms of hyperactivity, impulsivity and inattention. ADHD is thought to affect about 3%–9% of school-age children and young people in the UK. With increased awareness and early identification of ADHD, and the long-term impact of the condition, there is a growing demand for ADHD services for both assessment and treatment of children and young people with the condition. Demand and capacity modelling carried out in October 2017 identified the ADHD pathway team in City and Hackney Child and Adolescent Mental Health Service (CAMHS) were working at 127% utilisation, indicating a mismatch between capacity and demand. A quality improvement (QI) project was implemented to improve efficiency and effectiveness of processes within the team and to support the increasing demand within the limited capacity and resource. The aim of the project was to reduce the average length of time from initial referral to CAMHS to ‘ADHD assessment feedback’ to 12 weeks by September 2018, which is in line with trust-level targets. The team followed the model for improvement and guidance from East London Foundation Trust (ELFT) QI Microsite to structure the project. They used a variety of tools to develop a theory of change, and used Plan-Do-Study-Act cycles to test change ideas. Overall wait times have reduced from 28 weeks to below our target of 12 weeks. Data examining the entry point to the ADHD pathway to completion of the ADHD assessment and feedback reduced from an average of 87 days, to an average of 18 days.The diagnostic rate has increased from 62% to 78% (due to more appropriate screening and referrals). The QI approach was systematic and supported the development of more efficient systems; reducing wait times and increasing capacity to manage the demand. Team engagement in ‘change’, by embedding QI into fortnightly team meetings, has resulted in collective ownership and responsibility across team members. A monitoring system is supporting the sustainability and maintenance of improvement.

Awareness of ADHD in primary care: stakeholder perspectives

Background Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs’ ADHD awareness, this qualitative study aims to further explore individual stakeholders’ experiences. Methods Semi-structured interviews explored the views of multiple stakeholders- GPs (n=5), healthcare specialists (n=5) and patients (adults with ADHD n=5), (parents n=5) and with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. Results Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. Conclusion This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.

C-06 Differential and Dual Diagnosis of Alzheimer’s Disease and Personality Disorders: Performance on WAIS-IV Subtests

Objective Certain personality disorder (PD) diagnoses are related to the development of dementing disorders. There is a higher rate of comorbidity of PD in samples of patients with dementing disorders compared to healthy controls, which can lead to difficulties during the diagnostic process. The present study seeks to identify the neurocognitive correlates of those diagnosed with Alzheimer’s dementia (AD) compared to PD, potentially aiding in differential diagnosis. Method Data was collected as part of a large assessment outpatient clinical practice. The data contained 580 participants who came to the clinic with a variety of referral questions (e.g., neurological diagnosis, personality functioning, ADHD assessment). To measure cognitive functioning, participants were administered the WAIS-IV. Participants included 43 people diagnosed with AD and 18 with PD. Results Subtest scores for participants diagnosed with AD were lower than participants with PD. We adjusted the mean level difference using vocabulary. Using regression, we pulled out the variance associated with vocabulary as it is not susceptible to cognitive decline. Block design was significantly different for the two groups even after controlling for vocabulary (r-square = .06; p = .017). Matrix reasoning was significantly different for the two groups even after controlling for vocabulary (r-square = .09; p = .005). Conclusions The differential diagnosis of PD and dementing disorders is important, and thus these findings are important in beginning to understand the cognitive patterns in those with AD and PD. Past research has not controlled for intellectual functioning. However, additional research utilizing larger sample sizes and an extensive test battery is necessary.