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Smith MCF, Mukherjee RAS, Müller-Sedgwick U, Hank D, Carpenter P, Adamou M. UK adult ADHD services in crisis. BJPsych Bull 2024; 48:1-5. [PMID: 38058161 PMCID: PMC10801359 DOI: 10.1192/bjb.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/26/2023] [Accepted: 10/12/2023] [Indexed: 12/08/2023] Open
Abstract
The UK's services for adult attention-deficit hyperactivity disorder (ADHD) are in crisis, with demand outstripping capacity and waiting times reaching unprecedented lengths. Recognition of and treatments for ADHD have expanded over the past two decades, increasing clinical demand. This issue has been exacerbated by the COVID-19 pandemic. Despite an increase in specialist services, resource allocation has not kept pace, leading to extended waiting times. Underfunding has encouraged growth in independent providers, leading to fragmentation of service provision. Treatment delays carry a human and financial cost, imposing a burden on health, social care and the criminal justice system. A rethink of service procurement and delivery is needed, with multiple solutions on the table, including increasing funding, improving system efficiency, altering the service provision model and clinical prioritisation. However, the success of these solutions hinges on fiscal capacity and workforce issues.
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Affiliation(s)
| | | | | | - Dietmar Hank
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Peter Carpenter
- University of Bristol, Bristol, UK
- Royal College of Psychiatrists, London, UK
| | - Marios Adamou
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
- University of Huddersfield, Huddersfield, UK
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2
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Papadakis E, Baryannis G, Batsakis S, Adamou M, Huang Z, Antoniou G. ADHD-KG: a knowledge graph of attention deficit hyperactivity disorder. Health Inf Sci Syst 2023; 11:52. [PMID: 38028962 PMCID: PMC10640525 DOI: 10.1007/s13755-023-00253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Attention Deficit Hyperactivity Disorder (ADHD) is a widespread condition that affects human behaviour and can interfere with daily activities and relationships. Medication or medical information about ADHD can be found in several data sources on the Web. Such distribution of knowledge raises notable obstacles since researchers and clinicians must manually combine various sources to deeply explore aspects of ADHD. Knowledge graphs have been widely used in medical applications due to their data integration capabilities, offering rich data stores of information built from heterogeneous sources; however, general purpose knowledge graphs cannot represent knowledge in sufficient detail, thus there is an increasing interest in domain-specific knowledge graphs. Methods In this work we propose a Knowledge Graph of ADHD. In particular, we introduce an automated procedure enabling the construction of a knowledge graph that covers knowledge from a wide range of data sources primarily focusing on adult ADHD. These include relevant literature and clinical trials, prescribed medication and their known side-effects. Data integration between these data sources is accomplished by employing a suite of information linking procedures, which aim to connect resources by relating them to common concepts found in medical thesauri. Results The usability and appropriateness of the developed knowledge graph is evaluated through a series of use cases that illustrate its ability to enhance and accelerate information retrieval. Conclusion The Knowledge Graph of ADHD can provide valuable assistance to researchers and clinicians in the research, training, diagnostic and treatment processes for ADHD.
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Affiliation(s)
- Emmanuel Papadakis
- School of Computing and Engineering, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH West Yorkshire UK
| | - George Baryannis
- School of Computing and Engineering, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH West Yorkshire UK
| | - Sotiris Batsakis
- School of Computing and Engineering, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH West Yorkshire UK
| | - Marios Adamou
- South West Yorkshire Partnership NHS Foundation Trust, Portobello Road, Wakefield, WF1 5PN West Yorkshire UK
| | - Zhisheng Huang
- Department of Computer Science, Vrije University of Amsterdam, De Boelelaan 1081, Amsterdam, 1081 HV Netherlands
| | - Grigoris Antoniou
- School of Computing and Engineering, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH West Yorkshire UK
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3
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Leaver L, van Rensburg K, Adamou M, Arif M, Asherson P, Cubbin S, Kustow J, Müller-Sedgwick U, Sedgwick-Müller J. Assessments for adult ADHD: what makes them good enough? Br J Gen Pract 2023; 73:473-474. [PMID: 37770223 PMCID: PMC10544520 DOI: 10.3399/bjgp23x735213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/03/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- Laurence Leaver
- Dr Leaver & Partners, Jericho Health Centre, Oxford; Senior Doll Fellow, Green Templeton College, University of Oxford, Oxford
| | - Kobus van Rensburg
- Northamptonshire Healthcare NHS Trust, Adult ADHD, Autism and Tourette's Team, Kettering, Northamptonshire
| | - Marios Adamou
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield
| | | | | | | | - James Kustow
- Barnet Enfield and Haringey Mental Health NHS Trust, London
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4
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Chen T, Tachmazidis I, Batsakis S, Adamou M, Papadakis E, Antoniou G. Diagnosing attention-deficit hyperactivity disorder (ADHD) using artificial intelligence: a clinical study in the UK. Front Psychiatry 2023; 14:1164433. [PMID: 37363182 PMCID: PMC10288489 DOI: 10.3389/fpsyt.2023.1164433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/12/2023] [Indexed: 06/28/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting a large percentage of the adult population. A series of ongoing efforts has led to the development of a hybrid AI algorithm (a combination of a machine learning model and a knowledge-based model) for assisting adult ADHD diagnosis, and its clinical trial currently operating in the largest National Health Service (NHS) for adults with ADHD in the UK. Most recently, more data was made available that has lead to a total collection of 501 anonymized records as of 2022 July. This prompted the ongoing research to carefully examine the model by retraining and optimizing the machine learning algorithm in order to update the model with better generalization capability. Based on the large data collection so far, this paper also pilots a study to examine the effectiveness of variables other than the Diagnostic Interview for ADHD in adults (DIVA) assessment, which adds considerable cost in the screenining process as it relies on specially trained senior clinicians. Results reported in this paper demonstrate that the newly trained machine learning model reaches an accuracy of 75.03% when all features are used; the hybrid model obtains an accuracy of 93.61%. Exceeding what clinical experts expected in the absence of DIVA, achieving an accuracy of 65.27% using a rule-based machine learning model alone encourages the development of a cost effective model in the future.
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Affiliation(s)
- Tianhua Chen
- Department of Computer Science, University of Huddersfield, Huddersfield, United Kingdom
| | - Ilias Tachmazidis
- Department of Computer Science, University of Huddersfield, Huddersfield, United Kingdom
| | - Sotiris Batsakis
- Department of Computer Science, University of Huddersfield, Huddersfield, United Kingdom
- School of Production Engineering and Management, Technical University of Crete, Chania, Greece
| | - Marios Adamou
- South West Yorkshire Partnership National Health Service (NHS) Foundation Trust, Wakefield, United Kingdom
| | - Emmanuel Papadakis
- Department of Computer Science, University of Huddersfield, Huddersfield, United Kingdom
| | - Grigoris Antoniou
- Department of Computer Science, University of Huddersfield, Huddersfield, United Kingdom
- L3S Research Center, Leibniz University Hannover, Hannover, Germany
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5
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Tolia M, Symvoulakis EK, Matalliotakis E, Kamekis A, Adamou M, Kountourakis P, Mauri D, Dakanalis A, Alexidis P, Varveris A, Antoniadis C, Matthaios D, Paraskeva M, Giaginis C, Kamposioras K. COVID-19 Emotional and Mental Impact on Cancer Patients Receiving Radiotherapy: An Interpretation of Potential Explaining Descriptors. Curr Oncol 2023; 30:586-597. [PMID: 36661695 PMCID: PMC9857784 DOI: 10.3390/curroncol30010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Significant changes in the accessibility and viability of health services have been observed during the COVID-19 period, particularly in vulnerable groups such as cancer patients. In this study, we described the impact of radical practice and perceived changes on cancer patients’ mental well-being and investigated potential outcome descriptors. Methods: Generalized anxiety disorder assessment (GAD-7), patient health (PHQ-9), and World Health Organization-five well-being index (WHO-5) questionnaires were used to assess anxiety, depression, and mental well-being. Information on participants, disease baseline information, and COVID-19-related questions were collected, and related explanatory variables were included for statistical analysis. Results: The mean score values for anxiety, depression, and mental well-being were 4.7 ± 5.53, 4.9 ± 6.42, and 72.2 ± 18.53, respectively. GAD-7 and PHQ-9 scores were statistically associated (p < 0.001), while high values of GAD-7 and PHQ-9 questionnaires were related to low values of WHO-5 (p < 0.001).Using the GAD-7 scale, 16.2% of participants were classified as having mild anxiety (GAD-7 score: 5−9).Mild to more severe anxiety was significantly associated with a history of mental health conditions (p = 0.01, OR = 3.74, 95% CI [1.372−10.21]), and stage category (stage III/IV vs. I/II, p = 0.01, OR = 3.83, 95% CI [1.38−10.64]. From the participants, 36.2% were considered to have depression (PHQ-9 score ≥ 5). Depression was related with older patients (p = 0.05, OR = 1.63, 95% CI [1.16−2.3]), those with previous mental health conditions (p = 0.03, OR = 14.24, 95% CI [2.47−81.84]), those concerned about the COVID-19 impact on their cancer treatment (p = 0.027, OR = 0.19, 95% CI [0.045−0.82]) or those who felt that COVID-19 pandemic has affected mental health (p = 0.013, OR = 3.56, 95% CI [1.30−9.72]). Additionally, most participants (86.7%) had a good well-being score (WHO-5 score ≥ 50). Mental well-being seemed more reduced among stage I−III patients than stage IV patients (p = 0.014, OR = 0.12, 95% CI [0.023−0.65]). Conclusion: There is a necessity for comprehensive cancer care improvement. These patients’ main concern related to cancer therapy, yet the group of patients who were mentally affected by the pandemic should be identified and supported.
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Affiliation(s)
- Maria Tolia
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Emmanouil K. Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Emmanouil Matalliotakis
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | | | - Marios Adamou
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | | | - Davide Mauri
- Medical Oncology, University of Ioannina, 45500 Ioannina, Greece
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Petros Alexidis
- Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Antonios Varveris
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Chrysostomos Antoniadis
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | | | - Maria Paraskeva
- Oncology Department, General Hospital of Rhodes, 85133 Rhodes, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
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6
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Champ RE, Adamou M, Tolchard B. Seeking connection, autonomy, and emotional feedback: A self-determination theory of self-regulation in attention-deficit hyperactivity disorder. Psychol Rev 2022; 130:569-603. [PMID: 36548057 DOI: 10.1037/rev0000398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent and highly debated diagnosis for mental disorder in practice today. Two decades of research have substantially contributed to evolving conceptualizations and understanding of the condition. However, this evolution has not been extended to theoretical research. Current cognitive behavioral-based theories aim to identify the etiology of ADHD and experience challenges in accommodating the full spectrum of both neurobiological and behavioral research evidence. Characterizations historically associated with mental illness have generated public stigma, influencing low self-esteem, negative self-concept, and identity development in ADHD individuals. Neurodiversity research and activism recognize a diversity of nonnormative development and highlight the need for alternatives to deficit models of functioning. Recent research in psychology recommends developing approaches beyond symptom control and seeking to develop positive psychological factors and well-being. We propose that the perspective presented by self-determination theory (SDT) on human motivation, self-regulation, and self-determination offers a new understanding of ADHD research evidence and symptomology. According to this theory, humans have a natural tendency toward growth and self-actualization. We propose a framework grounded in SDT that provides an alternative understanding of ADHD neural processing, motivation and engagement, self-regulation, and a potential foundation for treatment approaches with self-determination and positive identity outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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7
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Asherson P, Leaver L, Adamou M, Arif M, Askey G, Butler M, Cubbin S, Newlove-Delgado T, Kustow J, Lanham-Cook J, Findlay J, Maxwell J, Mason P, Read H, van Rensburg K, Müller-Sedgwick U, Sedgwick-Müller J, Skirrow C. Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations. BMC Psychiatry 2022; 22:640. [PMID: 36221085 PMCID: PMC9553294 DOI: 10.1186/s12888-022-04290-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 09/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND ADHD in adults is a common and debilitating neurodevelopmental mental health condition. Yet, diagnosis, clinical management and monitoring are frequently constrained by scarce resources, low capacity in specialist services and limited awareness or training in both primary and secondary care. As a result, many people with ADHD experience serious barriers in accessing the care they need. METHODS Professionals across primary, secondary, and tertiary care met to discuss adult ADHD clinical care in the United Kingdom. Discussions identified constraints in service provision, and service delivery models with potential to improve healthcare access and delivery. The group aimed to provide a roadmap for improving access to ADHD treatment, identifying avenues for improving provision under current constraints, and innovating provision in the longer-term. National Institute for Health and Care Excellence (NICE) guidelines were used as a benchmark in discussions. RESULTS The group identified three interrelated constraints. First, inconsistent interpretation of what constitutes a 'specialist' in the context of delivering ADHD care. Second, restriction of service delivery to limited capacity secondary or tertiary care services. Third, financial limitations or conflicts which reduce capacity and render transfer of care between healthcare sectors difficult. The group recommended the development of ADHD specialism within primary care, along with the transfer of routine and straightforward treatment monitoring to primary care services. Longer term, ADHD care pathways should be brought into line with those for other common mental health disorders, including treatment initiation by appropriately qualified clinicians in primary care, and referral to secondary mental health or tertiary services for more complex cases. Long-term plans in the NHS for more joined up and flexible provision, using a primary care network approach, could invest in developing shared ADHD specialist resources. CONCLUSIONS The relegation of adult ADHD diagnosis, treatment and monitoring to specialist tertiary and secondary services is at odds with its high prevalence and chronic course. To enable the cost-effective and at-scale access to ADHD treatment that is needed, general adult mental health and primary care must be empowered to play a key role in the delivery of quality services for adults with ADHD.
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Affiliation(s)
- Philip Asherson
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK.
| | | | | | | | - Gemma Askey
- NHS Warrington Clinical Commissioning Group, Warrington, UK
| | - Margi Butler
- NHS Warrington Clinical Commissioning Group, Warrington, UK
| | | | | | - James Kustow
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | | | - James Findlay
- NHS Northamptonshire Clinical Commissioning Group, Northampton, UK
| | | | - Peter Mason
- ADHD And Psychiatry Services Limited, Liverpool, UK
| | | | | | | | - Jane Sedgwick-Müller
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
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8
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Abstract
OBJECTIVE Continuous performance tests are widely used to aid diagnostic decision making and measure symptom reduction in adult ADHD clinical populations. The diagnostic accuracy of the Quantified Behavior Test plus (QbTest+), developed to identify ADHD populations as an objective measure of ADHD symptoms, was explored. METHODS The utility of the QbTest+ was investigated in a clinical cohort of 69 adult patients referred to a specialist ADHD clinic in the UK. RESULTS Scores from the QbTest+ failed to differentiate between patients diagnosed with ADHD and those who did not receive a diagnosis after full clinical assessment. CONCLUSIONS Based on our findings, we recommend clinicians are cautious when interpreting results of the QbTest+ in clinical populations. This study highlights the need for investigation into the lack of validation of commonly used objective measures in ADHD populations.
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Affiliation(s)
| | - Sarah L Jones
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Laura Marks
- University College London Hospitals NHS Foundation Trust, UK
| | - Deborah Lowe
- Greater Manchester Mental Health NHS Foundation Trust, Bolton, UK
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9
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Sedgwick-Müller JA, Müller-Sedgwick U, Adamou M, Catani M, Champ R, Gudjónsson G, Hank D, Pitts M, Young S, Asherson P. University students with attention deficit hyperactivity disorder (ADHD): a consensus statement from the UK Adult ADHD Network (UKAAN). BMC Psychiatry 2022; 22:292. [PMID: 35459116 PMCID: PMC9027028 DOI: 10.1186/s12888-022-03898-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is associated with poor educational outcomes that can have long-term negative effects on the mental health, wellbeing, and socio-economic outcomes of university students. Mental health provision for university students with ADHD is often inadequate due to long waiting times for access to diagnosis and treatment in specialist National Health Service (NHS) clinics. ADHD is a hidden and marginalised disability, and within higher education in the UK, the categorisation of ADHD as a specific learning difference (or difficulty) may be contributing to this. AIMS This consensus aims to provide an informed understanding of the impact of ADHD on the educational (or academic) outcomes of university students and highlight an urgent need for timely access to treatment and management. METHODS The UK Adult ADHD Network (UKAAN) convened a meeting of practitioners and experts from England, Wales, and Scotland, to discuss issues that university students with ADHD can experience or present with during their programme of studies and how best to address them. A report on the collective analysis, evaluation, and opinions of the expert panel and published literature about the impact of ADHD on the educational outcomes of university students is presented. RESULTS A consensus was reached that offers expert advice, practical guidance, and recommendations to support the medical, education, and disability practitioners working with university students with ADHD. CONCLUSIONS Practical advice, guidance, and recommendations based on expert consensus can inform the identification of ADHD in university students, personalised interventions, and educational support, as well as contribute to existing research in this topic area. There is a need to move away from prevailing notions within higher education about ADHD being a specific learning difference (or difficulty) and attend to the urgent need for university students with ADHD to have timely access to treatment and support. A multimodal approach can be adapted to support university students with ADHD. This approach would view timely access to treatment, including reasonable adjustments and educational support, as having a positive impact on the academic performance and achievement of university students with ADHD.
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Affiliation(s)
- Jane A. Sedgwick-Müller
- grid.13097.3c0000 0001 2322 6764Health and Community Services, Government of Jersey, St Helier, Jersey. Social, Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience (IoPPN) & Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care (FNFNM), King’s College London, London, UK
| | - Ulrich Müller-Sedgwick
- grid.5335.00000000121885934Adult Neurodevelopmental Service, Health and Community Services, Government of Jersey, St Helier, Jersey. Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marios Adamou
- grid.15751.370000 0001 0719 6059School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Marco Catani
- grid.13097.3c0000 0001 2322 6764Natbrainlab, Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
| | - Rebecca Champ
- grid.15751.370000 0001 0719 6059School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Gísli Gudjónsson
- grid.13097.3c0000 0001 2322 6764Psychology Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
| | - Dietmar Hank
- grid.439418.3Adult ADHD Service, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Mark Pitts
- grid.37640.360000 0000 9439 0839Adult ADHD and Autism Outpatient Service, South London & Maudsley NHS Foundation Trust, London, UK
| | - Susan Young
- grid.9580.40000 0004 0643 5232Psychology Services Limited, Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Philip Asherson
- grid.13097.3c0000 0001 2322 6764Social, Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
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10
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Champ RE, Adamou M, Tolchard B. The impact of psychological theory on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults: A scoping review. PLoS One 2021; 16:e0261247. [PMID: 34932573 PMCID: PMC8691636 DOI: 10.1371/journal.pone.0261247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022] Open
Abstract
Psychological theory and interpretation of research are key elements influencing clinical treatment development and design in Attention Deficit Hyperactivity Disorder (ADHD). Research-based treatment recommendations primarily support Cognitive Behavioural Therapy (CBT), an extension of the cognitive behavioural theory, which promotes a deficit-focused characterisation of ADHD and prioritises symptom reduction and cognitive control of self-regulation as treatment outcomes. A wide variety of approaches have developed to improve ADHD outcomes in adults, and this review aimed to map the theoretical foundations of treatment design to understand their impact. A scoping review and analysis were performed on 221 documents to compare the theoretical influences in research, treatment approach, and theoretical citations. Results showed that despite variation in the application, current treatments characterise ADHD from a single paradigm of cognitive behavioural theory. A single theoretical perspective is limiting research for effective treatments for ADHD to address ongoing issues such as accommodating context variability and heterogeneity. Research into alternative theoretical characterisations of ADHD is recommended to provide treatment design opportunities to better understand and address symptoms.
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Affiliation(s)
- Rebecca E. Champ
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Marios Adamou
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Barry Tolchard
- School of Health and Life Sciences, Teeside University, Middlesbrough, United Kingdom
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11
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Abstract
Purpose
Since the 1990s, the National Health Service (NHS)advisory officers have developed considerable expertise in managing the process of specifying, procuring, contracting and running public–private partnership (PPP) projects. However, there has been a relatively consistent trajectory in the findings of studies and evaluation of PPP from its initial introduction in the health sector in 1992 to the present time. Therefore, the purpose of this study is to critically evaluate the PPP experience in the UK context using a case study in the NHS.
Design/methodology/approach
The partnership literature is primarily focussed on process issues, and the impact of partnerships on improving outcomes cannot be assumed. By conducting a critical review on most updated research studies and innovative approaches in this area, the literature as to the place of PPPs in health in the context of the UK is critically explored and whether they have a role in system resilience is examined. A case study has be used as well to describing the processes of a PPP arrangement.
Findings
Health-care PPP is one of the options relating to health system resilience. However, their contribution in the NHS has been mixed, with success noted in short-term clinical and services contracts while in the long-term the value for money argument has not been proven. In theory, the role of PPPs in bringing together ingredients supporting system resilience such as finance, management and innovation in the UK has not always been successful, and NHS providers have taken the approach to exit such arrangements.
Research limitations/implications
More research work is needed to capture the 21st-century challenges and critical success factors during its implementation.
Practical implications
The creation of strong partnerships is moving service delivery away from a project-by-project approach to one that includes strategic and policy developments for long-term results.
Originality/value
This is a fresh discussion in the role of PPP in system resilience in the UK perspective through a case study describing an exit from a PPP arrangement.
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12
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Jones SL, Johnson M, Alty B, Adamou M. The Effectiveness of RAADS-R as a Screening Tool for Adult ASD Populations. Autism Res Treat 2021; 2021:9974791. [PMID: 34552768 PMCID: PMC8452438 DOI: 10.1155/2021/9974791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Adult referrals to specialist autism spectrum disorder diagnostic services have increased in recent years, placing strain on existing services. It was proposed that the Ritvo Autism Asperger's Diagnostic Scale could be used as a screening tool, in order to identify and prioritise patients most likely to receive an ASD diagnosis. This study evaluates the validity of the RAADS-R as a screening tool for ASD in an adult population. Retrospective case note analysis was used to evaluate the efficacy of the RAADS-R as a screening tool to predict ASD diagnostic outcomes in 50 service users of a NHS specialist autism service. Results indicate no association between RAADS-R scores and clinical diagnostic outcome, suggesting the RAADS-R is not an effective screening tool for identifying service users most likely to receive an ASD diagnosis. In conclusion, used as a self-report measure pre-full diagnostic assessment, the RAADS-R lacks predictive validity and is not a suitable screening tool for adults awaiting autism assessments. Future research should aim to identify reliable screening tools for this purpose.
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Affiliation(s)
- Sarah L Jones
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Maria Johnson
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Bronwen Alty
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
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13
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Abstract
Purpose
The Adult Asperger Assessment (AAA), comprising the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire is a commonly used screening tool designed to identify adults who may benefit from a further clinical assessment for autism spectrum disorder. The purpose of this paper is to investigate the usefulness of this screening measure in a clinical setting.
Design/methodology/approach
This retrospective cohort study comprised of 192 service users referred for diagnostic assessment of Autism by a specialist service of the National Health Service. The authors evaluated the diagnostic accuracy of the AAA by investigating if the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire were able to predict the diagnostic outcome of Autism in a clinical setting.
Findings
Scores from the Relatives Questionnaire can accurately predict diagnostic outcome. No evidence of accuracy for the Autism Questionnaire or the Empathy Quotient was apparent. Based on the findings, the authors recommend clinicians are cautious when interpreting results of the AAA.
Research limitations/implications
It should be acknowledged that the results may not be generalisable to whole populations. Also, the authors used the full item versions of the scales; therefore, the findings are most applicable to studies which did similar.
Originality/value
This study highlights the need for investigation into the lack of validation of commonly used screening measures in autistic populations.
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Adamou M, Kamposioras K. The COVID-19 survey pandemic: a critical approach. J BUON 2021; 26:654-655. [PMID: 34268916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
COVID-19 pandemic has obviously affected patients' behavior towards seeking medical help as well as physicians' decision in the management of emergencies. Our recent experience as surgeons at a COVID-19 referral hospital revealed cases which share an alerting characteristic: the delay in appropriate management. Unfortunately for COVID-19 negative patients a "coronacentric" health system has been adopted. In view of measures applied to avoid spread of the disease, a significant delay in patients' presentation as well as in their in-hospital management is observed. We present cases where delay in appropriate management affected the patients' outcome and underline the fact that balancing between COVID-19 safety measures and a patient who needs urgent treatment can be very challenging and stressful.
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Affiliation(s)
- Marios Adamou
- School of Human and Health Sciences. University of Huddersfield, HD1 3DH, UK
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15
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Adamou M, Jones SL, Fullen T, Galab N, Abbott K, Yasmeen S. Remote assessment in adults with Autism or ADHD: A service user satisfaction survey. PLoS One 2021; 16:e0249237. [PMID: 33765076 PMCID: PMC7993762 DOI: 10.1371/journal.pone.0249237] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/13/2021] [Indexed: 01/15/2023] Open
Abstract
Advances in digital health have enabled clinicians to move away from a reliance on face to face consultation methods towards making use of modern video and web-based conferencing technology. In the context of the COVID-19 pandemic, remote telecommunication methods have become much more common place in mental health settings. The current study sought to investigate whether remote telecommunication methods are preferable to face to face consultations for adults referred to an Autism and ADHD Service during the COVID-19 pandemic. Also, whether there are any differences in preferred consultation methods between adults who were referred for an assessment of Autism as opposed to ADHD. 117 service users who undertook assessment by the ADHD and Autism Service at South West Yorkshire NHS Partnership Foundation Trust from April to September 2020 completed an adapted version of the Telehealth Usability Questionnaire (TUQ). Results demonstrated that service users found remote telecommunication to be useful, effective, reliable and satisfactory. Despite this, almost half of service users stated a general preference for face to face consultations. There was no difference in the choice of methods of contact between Autism and ADHD pathways. Remote telecommunication methods were found to be an acceptable medium of contact for adults who undertook an assessment of Autism and ADHD at an NHS Service during the COVID-19 pandemic.
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Affiliation(s)
- Marios Adamou
- University of Huddersfield, Huddersfield, United Kingdom
| | - Sarah L. Jones
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Tim Fullen
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Nazmeen Galab
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Karl Abbott
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Salma Yasmeen
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
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16
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Adamou M, Asherson P, Arif M, Buckenham L, Cubbin S, Dancza K, Gorman K, Gudjonsson G, Gutman S, Kustow J, Mabbott K, May-Benson T, Muller-Sedgwick U, Pell E, Pitts M, Rastrick S, Sedgwick J, Smith K, Taylor C, Thompson L, van Rensburg K, Young S. Recommendations for occupational therapy interventions for adults with ADHD: a consensus statement from the UK adult ADHD network. BMC Psychiatry 2021; 21:72. [PMID: 33541313 PMCID: PMC7863422 DOI: 10.1186/s12888-021-03070-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/25/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND ADHD is neurodevelopmental disorder which persists into adulthood. Presently, therapeutic approaches are mainly pharmacological and psychological whilst the role, scope and approaches of occupational therapists have not been adequately described. RESULTS In this consensus statement we propose that by assessing specific aspects of a person's occupation, occupational therapists can deploy their unique skills in providing specialist interventions for adults with ADHD. We also propose a framework with areas where occupational therapists can focus their assessments and give practice examples of specific interventions. CONCLUSIONS Occupational therapists have much to offer in providing interventions for adults with ADHD. A unified and flexible approach when working with adults with ADHD is most appropriate and further research on occupational therapy interventions is needed.
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Affiliation(s)
- Marios Adamou
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK.
| | - Philip Asherson
- grid.14105.310000000122478951MRC Social Genetic and Developmental Psychiatry Research Centre, London, UK
| | - Muhammad Arif
- grid.420868.00000 0001 2287 5201Leicestershire Partnership NHS Trust, Leicestershire, UK
| | - Louise Buckenham
- grid.500653.50000000404894769Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK ,The Royal College of Occupational Therapy and Heath Care Professionals Council, London, UK
| | | | - Karina Dancza
- grid.486188.b0000 0004 1790 4399Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Kirstie Gorman
- grid.439737.d0000 0004 0382 8292Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - Gísli Gudjonsson
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Sharon Gutman
- grid.21729.3f0000000419368729Columbia University, New York, USA
| | - James Kustow
- grid.451052.70000 0004 0581 2008Barnet,Enfield and Haringey NHS Trust, London, UK
| | - Kerry Mabbott
- grid.500653.50000000404894769Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK ,The Royal College of Occupational Therapy and Heath Care Professionals Council, London, UK
| | | | | | - Emma Pell
- grid.499523.00000 0000 8880 3342South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Mark Pitts
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Jane Sedgwick
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | | | - Clare Taylor
- grid.439450.f0000 0001 0507 6811South West London and St George’s Mental Health NHS Trust, London, UK
| | - Lucy Thompson
- grid.499523.00000 0000 8880 3342South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Kobus van Rensburg
- grid.500653.50000000404894769Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK
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Adamou M, Jones SL, Wetherhill S. Predicting diagnostic outcome in adult autism spectrum disorder using the autism diagnostic observation schedule, second edition. BMC Psychiatry 2021; 21:24. [PMID: 33423664 PMCID: PMC7798323 DOI: 10.1186/s12888-020-03028-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) module four assessment for diagnosing autism spectrum disorder in adults has shown good sensitivity and specificity in research settings. METHOD This study aimed to evaluate the predictive accuracy of the ADOS-2 module four by investigating the components of the assessment, in relation to diagnostic outcome in a clinical setting. Data from 88 service users referred to a Specialist Adult Autism Service was explored. RESULTS ADOS-2 scores failed to predict the diagnostic outcome (overall sensitivity = 92%, specificity = 57%). Interestingly, scores from the 'restricted interests' component of the ADOS-2 have the potential to predict diagnostic outcome, despite this domain not been included in the scoring algorithm. CONCLUSIONS Based on our findings, we recommend clinicians are cautious when interpreting results of the ADOS-2 assessment.
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Affiliation(s)
| | - Sarah L. Jones
- grid.499523.00000 0000 8880 3342South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK ,Manygates Clinic, Belle Isle Health Park, Portobello Road, Wakefield, WF1 5PN UK
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18
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Adamou M, Fullen T, Galab N, Mackintosh I, Abbott K, Lowe D, Smith C. Psychological Effects of the COVID-19 Imposed Lockdown on Adults with Attention Deficit/Hyperactivity Disorder: Cross-Sectional Survey Study. JMIR Form Res 2020; 4:e24430. [PMID: 33108312 PMCID: PMC7744136 DOI: 10.2196/24430] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The psychological effects of the COVID-19 government-imposed lockdown have been studied in several populations. These effects however have not been studied in adult populations with attention deficit/hyperactivity disorder (ADHD). OBJECTIVE We wanted to investigate the psychological effects of the COVID-19 imposed lockdown on an adult population with ADHD. METHODS We conducted a cross-sectional survey by administering the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Brief Adjustment Scale-6, Perceived Stress Scale, and Multidimensional Scale of Perceived Social Support to a pragmatic sample of adults with ADHD. RESULTS In total, 24 individuals (male: n=18, 75%; female: n=6, 25%; age: mean 21.75 years, SD 1.85 years) were included in this study. The adults with ADHD we surveyed had significant levels of emotional distress during the COVID-19 pandemic period. However, there was no evidence of significant deterioration to the mental health of our sample during the COVID-19 pandemic. CONCLUSIONS When treatment for ADHD is maintained, the effects of the COVID-19 pandemic on the mental health of adults with ADHD are mild. Targeted psychological interventions may be useful in such circumstances.
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Affiliation(s)
- Marios Adamou
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Tim Fullen
- South West Yorkshrire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Nazmeen Galab
- South West Yorkshrire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Isobel Mackintosh
- South West Yorkshrire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Karl Abbott
- South West Yorkshrire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Deborah Lowe
- South West Yorkshrire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Claire Smith
- South West Yorkshrire Partnership NHS Foundation Trust, Wakefield, United Kingdom
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Tachmazidis I, Chen T, Adamou M, Antoniou G. A hybrid AI approach for supporting clinical diagnosis of attention deficit hyperactivity disorder (ADHD) in adults. Health Inf Sci Syst 2020; 9:1. [PMID: 33235709 PMCID: PMC7680466 DOI: 10.1007/s13755-020-00123-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness. It is considered as an important public health issue and prevalence of, as well as demand for diagnosis, has increased as awareness of the disease grew over the past years. Supply of specialist medical experts has not kept pace with the increasing demand for assessment, both due to financial pressures on health systems and the difficulty to train new experts, resulting in growing waiting lists. Patients are not being treated quickly enough causing problems in other areas of health systems (e.g. increased GP visits, increased risk of self-harm and accidents) and more broadly (e.g. time off work, relationship problems). Advances in AI make it possible to support the clinical diagnosis of ADHD based on the analysis of relevant data. This paper reports on findings related to the mental health services of a specialist Trust within the UK’s National Health Service (NHS). The analysis studied data of adult patients who underwent diagnosis over the past few years, and developed a hybrid approach, consisting of two different models: a machine learning model obtained by training on data of past cases; and a knowledge model capturing the expertise of medical experts through knowledge engineering. The resulting algorithm has an accuracy of 95% on data currently available, and is currently being tested in a clinical environment.
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Affiliation(s)
- Ilias Tachmazidis
- School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - Tianhua Chen
- School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - Marios Adamou
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Grigoris Antoniou
- School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
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21
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Abstract
BACKGROUND Attention deficit hyperactivity disorder is a common neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity and or impulsivity. Since the development of the concept, a reliable biomarker to aid diagnosis has been sought. One potential method is the use of electroencephalogram to measure neuronal activity. The aim of this review is to provide an up to date synthesis of the literature surrounding the potential use of electroencephalogram for diagnosis of attention deficit hyperactivity disorder in adulthood. METHODS A search of PsycINFO, PubMed, and EMBASE was undertaken in February 2019 for peer-reviewed articles exploring electroencephalogram patterns in adults (18 years with no upper limit) diagnosed with attention deficit hyperactivity disorder. RESULTS Differences in electroencephalogram activity are potentially unique to adult attention deficit hyperactivity disorder populations. Strongest support was derived for elevated levels of both absolute and relative theta power, alongside the observation that alpha activity is able to typically differentiate between adult attention deficit hyperactivity disorder and normative populations. CONCLUSIONS Electroencephalogram can have a use in clinical settings to aid adult attention deficit hyperactivity disorder diagnosis, but areas of inconsistency are apparent.
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Affiliation(s)
- Marios Adamou
- School of Human & Health Sciences, University of Hudderfield, West Yorkshire, United Kingdom
| | - Tim Fullen
- Adult ADHD & Autism Service, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Sarah L Jones
- Adult ADHD & Autism Service, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
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22
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Adamou M, Antoniou G, Greasidou E, Lagani V, Charonyktakis P, Tsamardinos I, Doyle M. Toward Automatic Risk Assessment to Support Suicide Prevention. Crisis 2018; 40:249-256. [PMID: 30474411 DOI: 10.1027/0227-5910/a000561] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Suicide has been considered an important public health issue for years and is one of the main causes of death worldwide. Despite prevention strategies being applied, the rate of suicide has not changed substantially over the past decades. Suicide risk has proven extremely difficult to assess for medical specialists, and traditional methodologies deployed have been ineffective. Advances in machine learning make it possible to attempt to predict suicide with the analysis of relevant data aiming to inform clinical practice. Aims: We aimed to (a) test our artificial intelligence based, referral-centric methodology in the context of the National Health Service (NHS), (b) determine whether statistically relevant results can be derived from data related to previous suicides, and (c) develop ideas for various exploitation strategies. Method: The analysis used data of patients who died by suicide in the period 2013-2016 including both structured data and free-text medical notes, necessitating the deployment of state-of-the-art machine learning and text mining methods. Limitations: Sample size is a limiting factor for this study, along with the absence of non-suicide cases. Specific analytical solutions were adopted for addressing both issues. Results and Conclusion: The results of this pilot study indicate that machine learning shows promise for predicting within a specified period which people are most at risk of taking their own life at the time of referral to a mental health service.
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Affiliation(s)
- Marios Adamou
- 1 South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK.,2 Department of Computer Science, University of Huddersfield, UK
| | | | | | - Vincenzo Lagani
- 3 Gnosis Data Analysis PC, Heraklion, Greece.,5 Institute of Chemical Biology, Ilia State University, Tbilisi, Georgia
| | | | - Ioannis Tsamardinos
- 2 Department of Computer Science, University of Huddersfield, UK.,3 Gnosis Data Analysis PC, Heraklion, Greece.,4 Computer Science Department, University of Crete, Heraklion, Greece
| | - Michael Doyle
- 1 South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
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23
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Adamou M, Johnson M, Alty B. Autism Diagnostic Observation Schedule (ADOS) scores in males and females diagnosed with autism: a naturalistic study. AIA 2018. [DOI: 10.1108/aia-01-2018-0003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Many tools are available for assessing autism in an adult population; however, few have been studied for the effects of gender on diagnostic scores. The purpose of this paper is to evaluate the Autism Diagnostic Observation Schedule (ADOS) assessment for gender bias in a clinical population, specifically whether the ADOS favours a “male-type” of autism.
Design/methodology/approach
The ADOS scores of patients referred to an NHS specialist autism assessment service were retrospectively examined for significant gender differences. The combined ADOS scores and diagnostic outcome were grouped by gender for each participant. The data were analysed in SPSS using independent t-tests to look for significant gender differences between combined ADOS scores and diagnostic outcomes.
Findings
A significant difference was observed in the mean combined ADOS scores for those participants who later received an autism diagnosis (male=10, female=6, t (13)=3.34, p=10; 0.005). However, no significant difference was observed between mean scores of those who did not receive an autism diagnosis (t (26)=1.21, p=0.237).
Originality/value
The ADOS is a popular assessment used for autism diagnosis. These results provide support for a male gender bias. This could have clinical implications for autism assessment services, whereby lower diagnostic thresholds could be considered for female patients. This could allow more females with autism to receive a diagnosis, and access support services.
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24
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Adamou M, Graham K, MacKeith J, Burns S, Emerson LM. Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions. BMC Health Serv Res 2016; 16:632. [PMID: 27821125 PMCID: PMC5100092 DOI: 10.1186/s12913-016-1894-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder is prevalent in adulthood, resulting in serious impairment across multiple domains of living. Despite clinical guidance recommendations, the relative infancy of research on service provision for adults with ADHD, along with the evidence transfer gap, means that there is a lack of specific frameworks for service delivery. Igniting research and developing service delivery frameworks within adult ADHD is an essential step in the provision of effective services for adults with ADHD. METHOD Following the methodology used in previous related research that utilises a Participatory Action Research approach, we gathered data from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed. RESULTS The resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the 'ladder of change', ranging from 'stuck' to 'choice'. CONCLUSIONS The ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.
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Affiliation(s)
- Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK.
- University of Huddersfield, School of Human Health Sciences, Queensgate, HD13DH, UK.
| | - Katharine Graham
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Joy MacKeith
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Sara Burns
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Lisa-Marie Emerson
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
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25
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Young S, Adamou M, Asherson P, Coghill D, Colley B, Gudjonsson G, Hollis C, McCarthy J, Müller U, Paul M, Pitts M, Arif M. Recommendations for the transition of patients with ADHD from child to adult healthcare services: a consensus statement from the UK adult ADHD network. BMC Psychiatry 2016; 16:301. [PMID: 27561259 PMCID: PMC5000407 DOI: 10.1186/s12888-016-1013-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/18/2016] [Indexed: 11/26/2022] Open
Abstract
The aim of this consensus statement was to discuss transition of patients with ADHD from child to adult healthcare services, and formulate recommendations to facilitate successful transition. An expert workshop was convened in June 2012 by the UK Adult ADHD Network (UKAAN), attended by a multidisciplinary team of mental health professionals, allied professionals and patients. It was concluded that transitions must be planned through joint meetings involving referring/receiving services, patients and their families. Negotiation may be required to balance parental desire for continued involvement in their child's care, and the child's growing autonomy. Clear transition protocols can maintain standards of care, detailing relevant timeframes, responsibilities of agencies and preparing contingencies. Transition should be viewed as a process not an event, and should normally occur by the age of 18, however flexibility is required to accommodate individual needs. Transition is often poorly experienced, and adherence to clear recommendations is necessary to ensure effective transition and prevent drop-out from services.
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Affiliation(s)
- Susan Young
- Centre for Mental Health, Imperial College London, Broadmoor Hospital, WLMHT, London, UK.
| | - Marios Adamou
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield UK
| | - Philip Asherson
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London (KCL), London, UK
| | | | - Bill Colley
- Education and Children’s Services, Perth, UK
| | - Gisli Gudjonsson
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London (KCL), London, UK
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jane McCarthy
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London (KCL), London, UK
| | | | - Moli Paul
- Warwick Medical School, Coventry, UK
| | - Mark Pitts
- South London and Maudsley NHS Foundation Trust, London, UK
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Young S, Gudjonsson GH, Goodwin EJ, Jotangia A, Farooq R, Haddrick D, Adamou M. Beyond the Gates: Identifying and Managing Offenders with Attention Deficit Hyperactivity Disorder in Community Probation Services. AIMS Public Health 2014; 1:33-42. [PMID: 29666825 PMCID: PMC5903397 DOI: 10.3934/publichealth.2014.1.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/12/2014] [Indexed: 11/18/2022] Open
Abstract
Research has indicated that, compared with the general population, the prevalence of offenders with ADHD in prison is high. The situation for offenders managed in the community by the Probation Service is unknown. This study aimed to bridge the gap in our knowledge by (1) surveying the awareness of probation staff about ADHD and (2) screening the rate of offenders with ADHD managed within the service. In the first study, a brief survey was circulated to offender managers working in 7 Probation Trusts in England and Wales asking them to estimate the prevalence of offenders with ADHD on their caseload, the presenting problems of these offenders and challenges to their management, and the training received on the treatment and management of offenders with ADHD. The survey had a return rate of 11%. Probation staff perceived that 7.6% of their caseload had ADHD and identified this group to have difficulties associated with neuropsychological dysfunction, lifestyle problems and compliance problems. They perceived that these problems hindered meaningful engagement with the service and rehabilitation. Challenges to their management were perceived to be due to both internal processes (motivation and engagement) and external processes (inadequate or inappropriate interventions). Few respondents had received training in the management of offenders with ADHD and most wanted more support. In the second study, a sub-sample of 88 offenders in one Probation Trust completed questionnaires to screen for DSM-IV ADHD in childhood and current symptoms. The screen found an estimated prevalence of 45.45% and 20.51% for childhood and adulthood ADHD respectively and these were strongly associated with functional impairment. Thus probation staff considerably underestimated the likely rate, suggesting there are high rates of under-detection and/or misdiagnosis among offenders with ADHD in their service. The results indicate that screening provisions are needed in probation settings, together with training for staff.
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Affiliation(s)
- Susan Young
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Charing Cross Campus, Imperial College London, Claybrook Centre, 37 Claybrook Road, London W6 8LN, UK
- Broadmoor Hospital, Crowthorne, UK
| | - Gisli H Gudjonsson
- Broadmoor Hospital, Crowthorne, UK
- Institute of Psychiatry, King's College London, UK
| | | | - Amit Jotangia
- Institute of Psychiatry, King's College London, UK
- North London Forensic Service, Barnet, Enfield & Haringey Mental Health Trust, UK.
| | - Romana Farooq
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
| | | | - Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
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27
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Young S, Gudjonsson GH, Goodwin EJ, Jotangia A, Farooq R, Haddrick D, Adamou M. Beyond the Gates: Identifying and Managing Offenders with Attention Deficit Hyperactivity Disorder in Community Probation Services. AIMS Public Health 2014. [PMID: 29666825 DOI: 10.3934/publichealth.2014.1.33)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Research has indicated that, compared with the general population, the prevalence of offenders with ADHD in prison is high. The situation for offenders managed in the community by the Probation Service is unknown. This study aimed to bridge the gap in our knowledge by (1) surveying the awareness of probation staff about ADHD and (2) screening the rate of offenders with ADHD managed within the service. In the first study, a brief survey was circulated to offender managers working in 7 Probation Trusts in England and Wales asking them to estimate the prevalence of offenders with ADHD on their caseload, the presenting problems of these offenders and challenges to their management, and the training received on the treatment and management of offenders with ADHD. The survey had a return rate of 11%. Probation staff perceived that 7.6% of their caseload had ADHD and identified this group to have difficulties associated with neuropsychological dysfunction, lifestyle problems and compliance problems. They perceived that these problems hindered meaningful engagement with the service and rehabilitation. Challenges to their management were perceived to be due to both internal processes (motivation and engagement) and external processes (inadequate or inappropriate interventions). Few respondents had received training in the management of offenders with ADHD and most wanted more support. In the second study, a sub-sample of 88 offenders in one Probation Trust completed questionnaires to screen for DSM-IV ADHD in childhood and current symptoms. The screen found an estimated prevalence of 45.45% and 20.51% for childhood and adulthood ADHD respectively and these were strongly associated with functional impairment. Thus probation staff considerably underestimated the likely rate, suggesting there are high rates of under-detection and/or misdiagnosis among offenders with ADHD in their service. The results indicate that screening provisions are needed in probation settings, together with training for staff.
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Affiliation(s)
- Susan Young
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Charing Cross Campus, Imperial College London, Claybrook Centre, 37 Claybrook Road, London W6 8LN, UK.,Broadmoor Hospital, Crowthorne, UK
| | - Gisli H Gudjonsson
- Broadmoor Hospital, Crowthorne, UK.,Institute of Psychiatry, King's College London, UK
| | | | - Amit Jotangia
- Institute of Psychiatry, King's College London, UK.,North London Forensic Service, Barnet, Enfield & Haringey Mental Health Trust, UK
| | - Romana Farooq
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
| | | | - Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
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Bolea-Alamañac B, Nutt DJ, Adamou M, Asherson P, Bazire S, Coghill D, Heal D, Müller U, Nash J, Santosh P, Sayal K, Sonuga-Barke E, Young SJ. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2014; 28:179-203. [PMID: 24526134 DOI: 10.1177/0269881113519509] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common condition with a high societal burden. The present guidelines summarise current literature, generating expert consensus recommendations for the treatment of ADHD in children and adults. These guidelines also provide a review of recent research in the fields of neuroimaging, neuropsychology and genetics of ADHD. Novel discoveries in these areas have informed physiological models for the disease. Since the publication of the previous British Association for Psychopharmacology guidelines in 2008, new drugs have been licensed and further compounds are being investigated. The publication of randomised controlled trials of psychological interventions has contributed to the range of treatment options for ADHD. As the disorder has been diagnosed more frequently there has been greater focus on comorbid conditions and how they impact treatment. Services have continued to develop for the treatment of ADHD in adults and care agreements have been introduced to facilitate access to treatment.
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Rösler M, Ginsberg Y, Arngrim T, Adamou M, Niemelä A, Dejonkheere J, van Oene J, Schäuble B. Correlation of symptomatic improvements with functional improvements and patient-reported outcomes in adults with attention-deficit/hyperactivity disorder treated with OROS methylphenidate. World J Biol Psychiatry 2013; 14:282-90. [PMID: 21517701 DOI: 10.3109/15622975.2011.571283] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate correlations between symptom severity and daily functioning in adults with ADHD. METHODS In the 5-week, double-blind LAMDA study, 401 adults with ADHD were randomly assigned to Osmotic-Release Oral System (OROS) methylphenidate (MPH) 18, 36 or 72 mg/day, or placebo. The primary variable - investigator-rated Conners' Adult ADHD Rating Scale (CAARS:O-SV) - has been presented previously. Secondary endpoints included the self-reported version of CAARS (CAARS-S:S) and Clinical Global Impression - Severity (CGI-S). Daily functioning and quality of life were assessed using the Sheehan Disability Scale (SDS) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Relationships between symptom and functional outcomes were evaluated in post-hoc Pearson partial correlation, multivariate regression and mediator analyses. RESULTS Improvements in CAARS-S:S, CGI-S and SDS scores were significantly greater in each OROS MPH arm versus placebo (P < 0.01 for all comparisons). Correlations between symptom and functioning scores were significant for all comparisons (P < 0.0001). In regression analyses, CAARS Hyperactivity/Impulsivity subscale and CGI-S were correlated with SDS (P < 0.05). CAARS Inattention was correlated with the SDS Family Life domain (P < 0.05). In a mediator analysis, the impact of treatment on SDS scores was fully mediated by improvement in CAARS:O-SV score. CONCLUSIONS OROS MPH 18-72 mg/day was associated with significant improvements in ADHD symptoms, which correlated with improved daily functioning and health-related quality of life.
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Affiliation(s)
- Michael Rösler
- Saarland University Hospital, Neurocentre, Homburg/Saar, Germany.
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Adamou M, Arif M, Asherson P, Aw TC, Bolea B, Coghill D, Guðjónsson G, Halmøy A, Hodgkins P, Müller U, Pitts M, Trakoli A, Williams N, Young S. Occupational issues of adults with ADHD. BMC Psychiatry 2013; 13:59. [PMID: 23414364 PMCID: PMC3599848 DOI: 10.1186/1471-244x-13-59] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 01/31/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ADHD is a common neurodevelopmental disorder that persists into adulthood. Its symptoms cause impairments in a number of social domains, one of which is employment. We wish to produce a consensus statement on how ADHD affects employment. METHODS This consensus development conference statement was developed as a result of a joint international meeting held in July 2010. The consensus committee was international in scope (United Kingdom, mainland Europe, United Arab Emirates) and consisted of individuals from a broad range of backgrounds (Psychiatry, Occupational Medicine, Health Economists, Disability Advisors). The objectives of the conference were to discuss some of the occupational impairments adults with ADHD may face and how to address these problems from an inclusive perspective. Furthermore the conference looked at influencing policy and decision making at a political level to address impaired occupational functioning in adults with ADHD and fears around employing people with disabilities in general. RESULTS The consensus was that there were clear weaknesses in the current arrangements in the UK and internationally to address occupational difficulties. More so, Occupational Health was not wholly integrated and used as a means of making positive changes to the workplace, but rather as a superfluous last resort that employers tried to avoid. Furthermore the lack of cross professional collaboration on occupational functioning in adults with ADHD was a significant problem. CONCLUSIONS Future research needs to concentrate on further investigating occupational functioning in adults with ADHD and pilot exploratory initiatives and tools, leading to a better and more informed understanding of possible barriers to employment and potential schemes to put in place to address these problems.
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Affiliation(s)
- Marios Adamou
- South West Yorkshire NHS Partnership Foundation Trust Manygates Clinic, Portobello Road, WF1 5PN, Wakefield, UK.
| | | | | | - Tar-Ching Aw
- Department of Community Medicine, College of Medicine & Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Blanca Bolea
- Trincay Medical Centre & Urgent Care, George Town, Cayman Islands
| | - David Coghill
- Division of Neuroscience, Medical Research Institute, University of Dundee, Ninewells’ Hospital and Medical School, London, UK
| | | | - Anne Halmøy
- Department of Biomedicine, Psychiatry, University of Bergen (UiB), Bergen, Norway
| | | | - Ulrich Müller
- ADHD Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Mark Pitts
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Anna Trakoli
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nerys Williams
- Independent Consultant in Occupational Medicine, Solihull, UK
| | - Susan Young
- King’s College London, Institute of Psychiatry, London, UK
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Djibo H, Diakite O, Adamou M. P342: Patient safety and risk management in health center in Niger. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688389 DOI: 10.1186/2047-2994-2-s1-p342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Bolea B, Adamou M, Arif M, Asherson P, Gudjonsson G, Müller U, Nutt DJ, Pitts M, Thome J, Young S. ADHD matures: time for practitioners to do the same? J Psychopharmacol 2012; 26:766-70. [PMID: 21890596 DOI: 10.1177/0269881111410898] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Attention deficit and hyperactivity disorder (ADHD) is not restricted to children. Abundant evidence from follow-up studies accumulated since the 1970s supports the concept of ADHD in adulthood. Genetic research points to a heritability of 76%, and neuroimaging studies have reported structural and functional brain abnormalities in patients with ADHD. Contrary to popular belief, ADHD is not a culturally bound disorder and has been described worldwide. ADHD has a cost for society, as adults with this disorder suffer from increased rates of unemployment and psychiatric comorbidity, including substance use disorders. Studies undertaken in forensic populations describe high rates of ADHD in these groups, particularly amongst young offenders. One of the main issues in the diagnosis of ADHD in the adult is the fact that most clinicians have not been educated to diagnose and treat ADHD. Effective pharmacological treatments for ADHD are available and should be prescribed for these patients. The National Institute for Health and Clinical Excellence (NICE) and the British Association for Psychopharmacology (BAP) guidelines established a benchmark for service development required to treat ADHD adequately in the adult population. However, the implementation of new services has been slow. More resources are needed to effectively assess and treat ADHD in the adult.
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Affiliation(s)
- B Bolea
- Psychopharmacology Unit, University of Bristol, Bristol, UK.
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Abstract
OBJECTIVES We wanted to investigate how one element of the transitional process of adolescents to an adult ADHD service, namely the use of medication, fared when compared to the recommendations of national guidelines. METHODS We did a chart review of the dose of stimulants in a cohort of transitional patients after they were transferred to an adult ADHD service, whilst investigating if other variables such as severity of ADHD, age, gender and comorbidity played any role in determining the dose of stimulants at transition. RESULTS The dose of stimulants when calculated in mg/kg was almost half the recommended whist the patients were also severely symptomatic. Reported comorbidity with Autistic Spectrum Disorders was also very high. CONCLUSIONS A handover approach of adolescents with ADHD to an adult service, may hide gaps at least as far as prescribing is concerned. This gap may need considerable resources to address successfully. We suggest that establishing transitional processes may help minimise this problem.
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Affiliation(s)
| | - Sara Bowers
- Leeds Partnerships NHS Foundation Trust, Leeds, UK
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Young SJ, Adamou M, Bolea B, Gudjonsson G, Müller U, Pitts M, Thome J, Asherson P. The identification and management of ADHD offenders within the criminal justice system: a consensus statement from the UK Adult ADHD Network and criminal justice agencies. BMC Psychiatry 2011; 11:32. [PMID: 21332994 PMCID: PMC3050801 DOI: 10.1186/1471-244x-11-32] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 02/18/2011] [Indexed: 11/10/2022] Open
Abstract
The UK Adult ADHD Network (UKAAN) was founded by a group of mental health specialists who have experience delivering clinical services for adults with Attention Deficit Hyperactivity Disorder (ADHD) within the National Health Service (NHS). UKAAN aims to support mental health professionals in the development of services for adults with ADHD by the promotion of assessment and treatment protocols. One method of achieving these aims has been to sponsor conferences and workshops on adult ADHD.This consensus statement is the result of a Forensic Meeting held in November 2009, attended by senior representatives of the Department of Health (DoH), Forensic Mental Health, Prison, Probation, Courts and Metropolitan Police services. The objectives of the meeting were to discuss ways of raising awareness about adult ADHD, and its recognition, assessment, treatment and management within these respective services. Whilst the document draws on the UK experience, with some adaptations it can be used as a template for similar local actions in other countries. It was concluded that bringing together experts in adult ADHD and the Criminal Justice System (CJS) will be vital to raising awareness of the needs of ADHD offenders at every stage of the offender pathway. Joint working and commissioning within the CJS is needed to improve awareness and understanding of ADHD offenders to ensure that individuals are directed to appropriate care and rehabilitation. General Practitioners (GPs), whilst ideally placed for early intervention, should not be relied upon to provide this service as vulnerable offenders often have difficulty accessing primary care services. Moreover once this hurdle has been overcome and ADHD in offenders has been identified, a second challenge will be to provide treatment and ensure continuity of care. Future research must focus on proof of principle studies to demonstrate that identification and treatment confers health gain, safeguards individual's rights, improves engagement in offender rehabilitation programmes, reduces institutional behavioural disturbance and, ultimately, leads to crime reduction. In time this will provide better justice for both offenders and society.
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Affiliation(s)
| | - Marios Adamou
- South West Yorkshire Partnership NHS Foundation Trust, Manygates Clinic, Belle Isle Healthpark, Portobello Road, Wakefield, WF1 5PN, UK
| | - Blanca Bolea
- Psychopharmacology Unit, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY, UK
| | - Gisli Gudjonsson
- King's College London, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK
| | - Ulrich Müller
- Department of Psychiatry, Box 189, Level E4, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Mark Pitts
- Adult ADHD Service, South London & Maudsley Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Johannes Thome
- Institute of Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Philip Asherson
- King's College London, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK
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Affiliation(s)
- Philip Asherson
- MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, King's College London SE5 8AF.
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Abstract
OBJECTIVE Anticonvulsants are used in clinical practice for the treatment of PTSD. However, a systematic investigation of their effects in the treatment of PTSD is currently lacking from the literature. Our aim is to review and appraise the evidence for the use of the anticonvulsant valproate for the treatment of PTSD. METHODS We performed a systematic review and meta-analysis of the literature where valproate was used for the treatment of PTSD. Studies of treatment of PTSD with valproate were located using a search protocol which was applied to the electronic databases CINAHL, EMBASE, MEDLINE and PSYCHINFO. A search of the National PTSD Centre Pilots Database and of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) were also conducted. FINDINGS We only found one single-blinded study, four open-label studies and three case reports. These data do not allow for robust conclusions because of the design of the studies which are of limited patient number and open to bias. However, the studies reported that valproate was generally effective for the treatment of symptoms of PTSD by reducing hyperarousal, improving irritability and anger outbursts and improving mood. CONCLUSIONS The limited evidence base suggests that valproate can be effective as a monotherapy for the treatment of both PTSD and mood symptoms. A double blind controlled study should be the next step to robustly study the efficacy of valproate on the treatment of PTSD.
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Affiliation(s)
- Marios Adamou
- R&D Centre, Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, Kent, UK.
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Adamou M. Community service models for schizophrenia: evidence-based implications and future directions. Psychiatry (Edgmont) 2005; 2:24-30. [PMID: 21179632 PMCID: PMC3004717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Schizophrenia is a chronic relapsing and remitting mental illness with lifetime prevalence between 0.40 to 1.4 percent. Most people with schizophrenia are treated in psychiatric units of local general hospitals for short periods of time when acutely ill. With the worldwide trend toward closure of asylums and institutions in the 1950s, there has been an increasing focus on treatment in the community. Community mental health teams (CMHT) are the kernel of community treatment. Although their composition and modus operandi differ according to patient need, all models claim superiority over outcomes of long inpatient stay. Case management, assertive outreach, and crisis resolution sometimes compete for resources. What is the evidence for their efficacy? What is the right mix of their use? As we discuss these, we propose that there may be room for the application of established industry models of service delivery, such as Just-in-Time (JIT), in the treatment of patients with schizophrenia.
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Affiliation(s)
- Marios Adamou
- Dr. Adamou is with the Kent Institute of Medicine and Health Sciences, Research and Development Centre, University of Kent, Canterbury, England
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Adamou M. Symptom control and patient adherence to treatment: key goals in the treatment of psychosis. Psychiatry (Edgmont) 2004; 1:18-19. [PMID: 21197371 PMCID: PMC3012612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A CLINICIAN'S KEY GOALS WHEN TREATING PSYCHOSIS ARE TO control disease symptoms and to ensure patient adherence to treatment. Efficacy as well as side-effect profile are, therefore, the major selection criteria when choosing an antipsychotic medication.
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Affiliation(s)
- Marios Adamou
- Dr. Adamou is a Lecturer at the Kent Institute of Medicine and Health Sciences Research & Development Centre, University of Kent at Canterbury, United Kingdom
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Abstract
OBJECTIVE To describe a never previously reported case of erotomania induced by venlafaxine and highlight the effect of antidepressants on the dopaminergic system. METHOD A case of erotomania is described. RESULT Erotomania occurring in two separate occasions developed after treatment with high doses of venlafaxine. The episode remitted only after lowering the dose of the venlafaxine. CONCLUSION Erotomania may occur with agents such as antidepressants. The dopamine neurotransmission of mood can provide further evidence for the development of newer classes of antidepressants.
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Affiliation(s)
- M Adamou
- St Martins Hospital, Canterbury, United Kingdom.
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Adamou M. Relationship of the lunar cycle and the presentation of individuals with psychiatric problems to an accident and emergency department: a casecontrol study. ACTA ACUST UNITED AC 2001. [DOI: 10.1185/135525701317094476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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