Small Vessel Disease in the Heart and Brain: Current Knowledge, Unmet Therapeutic Need and Future Directions

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Daily report cards as a school-based intervention for children with attention-deficit/hyperactivity disorder

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.This paper describes daily report cards and the evidence relating to their use in schools for children with attention-deficit/hyperactivity disorder (ADHD). This intervention typically involves teachers evaluating a student's behaviour at school against pre-determined targets and parents subsequently providing reinforcement at home for positive reports. Research suggests that the daily report card has been effective in treating a range of ADHD symptoms and improving school outcomes, including academic achievement in some cases. The daily report card also encourages collaboration between teachers and parents, and evidence suggests that the intervention benefits from the inclusion of reinforcement at home. Daily report cards are easy to implement and research finds that teachers consider them an acceptable intervention for ADHD. This paper also considers challenges in using daily report cards, including barriers to their use over the long-term and the risk of stigma for children with a report card. Ideas to address these issues are suggested

Editorial Perspective: When is a ‘small effect’ actually large and impactful?

Reporting of effect sizes is standard practice in psychology and psychiatry research. However, interpretation of these effect sizes can be meaningless or misleading – in particular, the evaluation of specific effect sizes as ‘small’, ‘medium’ and ‘large’ can be inaccurate depending on the research context. A real-world example of this is research into the mental health of children and young people during the COVID-19 pandemic. Evidence suggests that clinicians and services are struggling with increased demand, yet population studies looking at the difference in mental health before and during the pandemic report effect sizes that are deemed ‘small’. In this short review, we utilise simulations to demonstrate that a relatively small shift in mean scores on mental health measures can indicate a large shift in the number of cases of anxiety and depression when scaled up to an entire population. This shows that ‘small’ effect sizes can in some contexts be large and impactful

“You’re 18 now, goodbye”: The experiences of young people with Attention Deficit Hyperactivity Disorder of the transition from child to adult services

This is the author accepted manuscript. The final version is available from Taylor & Francis (Routledge) via the DOI in this record.The term ‘transition’ is used to refer to the process of moving from child to adult services. Among child and adolescent mental health services attenders, young people with Attention Deficit Hyperactivity Disorder (ADHD) are less likely to transition successfully, but there is a gap in understanding their views and why they might disengage from services. The aim of this study was to explore the experiences of transition of young people with ADHD in Southwest England using semi-structured interviews and thematic analysis. Seven young people aged 17-19 years participated. Four key themes were identified: professionals’ roles and relationships with young people; the role of ADHD medication, uncertainties around transition and medication management, and identified needs and increasing independence. Although this study presents the experiences of a small number of people, their stories suggest that best practice around transition is not always being followed. There is consequently a need to better understand the facilitators and barriers to best practice implementation.This research was funded as part of a Doctoral Research Fellowship from the National Institute for Health Research held by Tamsin Newlove-Delgado(Reference: DRF-2012-05- 221). Tamsin Newlove-Delgado is currently funded by an NIHR Academic Clinical Lectureship. Ken Stein is funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula at Royal Devon and Exeter NHS Foundation Trust. This report is independent research and the views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health

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

This is the author accepted manuscript. The final version is available from Springer Verlag via the DOI in this record.The aim of this study was to examine the time to cessation of ADHD medication amongst young people with ADHD aged 16 in the period 2005-2013. Previous studies of prescribing in primary care reported high rates of medication cessation amongst 16 and 17 year olds with ADHD. The examination of trends since the introduction of new NICE guidance in 2008 will support service planning and improvement of outcomes over the vulnerable transition period from child to adult services. We used primary care records from the Clinical Practice Research Datalink and identified cases prescribed ADHD medication at the time of their 16th birthday during the study period. The outcome was time to medication cessation from the age of 16. Cessation of medication was defined as occurring at the beginning of a gap of over 6 months in prescriptions. 1620 cases were included. The median time to cessation was 1.51 years (95% CI 1.42-1.67).The estimated probability of remaining on medication was 0.63 (95% CI 0.61-0.65) at age 17 (i.e., at 1 year) and 0.41 (95% CI 0.39-0.43) at age 18. Young people with ADHD remain at high risk of cessation of medication during the transition from child to adult services. Despite the restriction that only primary care prescribing data were available, the results suggest continuing disparity between expected levels of symptom persistence and continuation of medication.This research was funded as part of a Doctoral Research Fellowship from the National Institute for Health Research held by Tamsin Newlove-Delgado (Reference: DRF-2012-05-221). Tamsin Newlove-Delgado is currently funded by an NIHR Academic Clinical Lectureship. Ken Stein and Obioha C. Ukoumunne were funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula at Royal Devon and Exeter NHS Foundation Trust. This report is independent research and the views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health

The relationship between exclusion from school and mental health: a secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007

This is the author accepted manuscript. The final version is available from CUP via the DOI in this record.Background Children with poor mental health often struggle at school. The relationship between childhood psychiatric disorder and exclusion from school has not been frequently studied, but both are associated with poor adult outcomes. We undertook a secondary analysis of the British Child and Adolescent Mental Health Surveys from 2004 and its follow up in 2007 to explore the relationship between exclusion from school and psychopathology. We predicted poorer mental health among those excluded. Method Psychopathology was measured using the Strengths and Difficulties Questionnaire, while psychiatric disorder was assessed using the Development and Well-Being Assessment and applying DSM IV criteria. Exclusion from school and socio-demographic characteristics were reported by parents. Multivariable regression models were used to examine the impact of individual factors on exclusion from school or psychological distress. Results Exclusion from school was commoner among boys, secondary school pupils, and those living in socio-economically deprived circumstances. Poor general health and learning disability among children and poor parental mental health were also associated with exclusion. There were consistently high levels of psychological distress among those who had experienced exclusion at baseline and follow up. Conclusions We detected a bi-directional association between psychological distress and exclusion. Efforts to identify and support children who struggle with school may therefore prevent both future exclusion and future psychiatric disorder.Claire Parker's PhD studentship was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula. Javid Salim worked on this paper while an Academic Clinical Fellow, also funded by NIHR. The initial surveys were funded by the English Departments of Health with contributions from their Scottish and Welsh counterparts, and data collection was led by the Office for National Statistics

Secondary school educational practitioners’ experiences of school attendance problems and interventions to address them: A qualitative study

This is the author accepted manuscript. The final version is available from Taylor & Francis (Routledge) via the DOI in this record.School attendance problems are associated with a range of adverse consequences, and educational practitioners play a role in identifying and responding to attendance problems. This qualitative study explored educational practitioners’ experiences of working with students with attendance problems and interventions to address them. Focus groups were conducted with sixteen practitioners across three secondary schools. Data were analysed using thematic analysis. Attendance problems were considered resource-intensive and emotionally challenging. Practitioners expressed difficulty understanding causes, although individual/family factors were emphasised over school factors. A range of interventions were described, including adaptations to school context and providing emotional support. Views on punitive approaches were mixed. Individualised interventions implemented at the first sign of problems, and a team approach, were considered important. Findings highlight the important role of educational practitioners in identifying attendance problems and implementing interventions. Recommendations include early intervention, team-work, and emotional support for students with, and staff responding to, attendance problems.This work was supported by a PhD studentship from the University of Exeter Medical School, UK

Which children and young people are excluded from school? Findings from a large British birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC)

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Background Exclusion from school is increasingly recognized as pertinent to child health. National educational data reveal that boys, children who are looked-after, living in poverty, have special educational needs, or from certain ethnic minorities, are disproportionately excluded from school. As population-based data on the wider characteristics of excluded children are scarce, we aimed to describe predictors of school exclusion in the Avon Longitudinal Study of Parents and Children. Method Avon Longitudinal Study of Parents and Children, a prospective U.K. population-based birth cohort study, collected parent reports of permanent school exclusions by 8 years and parent and self-reports of permanent and fixed-term exclusions in the preceding 12 months at 16 years. Potential risk factors were examined for associations with exclusion using logistic regression, with a focus on child mental health and neurodevelopment. Results Analyses were based on all available data on 53/8,245 (0.6%) pupils excluded from school by 8 years and 390/4,482 (8.7%) at 16 years. Key factors associated with exclusion at both time points included male gender, lower socio-economic status, maternal psychopathology, mental health and behavioural difficulties, psychiatric disorder, social communication difficulties, language difficulties, antisocial activities, bullying/being bulled, lower parental engagement with education, low school engagement, poor relationship with teacher, low educational attainment, and special educational needs (all p < .05). Conclusion Exclusion from school was associated with child, family and school-related factors identifiable at, or prior to, primary school age. Child health professionals have an important role in the holistic, multidisciplinary assessment of children who are at risk of exclusion from school. Mental health and neurodevelopmental difficulties should be recognized and supported, to improve the health and educational outcomes among this vulnerable group.NIHR Research Trainees Coordinating Centre. Grant Number: 1975 Academic Clinical Fellowship in Child Healt

Australia's coastal fisheries and farmed seafood: An ecological basis for determining sustainability

In response to consumer concerns about the sustainability of Australian-sourced seafood we derive a set of criteria within an explicit decision-process that can be used to determine whether locally farmed and wild-caught Australian seafood products meet standards of ecological sustainability and Ecologically Sustainable Development. These criteria substantially address the ecological deficiencies we identified in other systems commonly used for assessing seafood sustainability. The criteria address the issues that are relevant to local seafood production, and are populated with indicators (metrics) and benchmarks relevant to the Australian context. The indicators establish performance thresholds drawn from public domain data about the products, including observed empirical data and proxies, and include default decisions to be applied in the absence of adequate information. This decision structure is set within a peer-reviewed expert jury decision-making process. The criteria, decision process and decision outcomes from assessment of a number of pilot products were tested in a real seafood market (Melbourne), where we found a high level of producer, reseller and consumer acceptance of the judgements and ratings. The use of ecologically-derived standards results in several outcomes that differ from those of other seafood assessment systems, especially those assessments more focused on production standards, such as government, industry and NGO-supported programs, popularly used in Australia and worldwide. We conclude that despite high levels of uncertainty surrounding many of the population parameters, ecological patterns and processes, empirical cost-effective proxies can be used to reasonably estimate a form of sustainability that matches consumer interests/expectations for production of fresh local seafood. Despite the plethora of industry and government programs, there remains a significant but presently unmet consumer demand for ecologically-based, technically robust, independently derived, and readily available information about the local sustainability attributes of Australian wild-caught and farmed fresh seafood

Prioritising Targets for School-Based ADHD Interventions: A Delphi Survey

AbstractMany studies have investigated the effectiveness of school-based ADHD interventions at modifying different social, emotional and behavioural target outcomes. However, there is a lack of evidence about which targets stakeholders perceive to be most important. This study sought to obtain consensus on which outcomes are perceived to be most important. A total of 114 people with ADHD, educational professionals, parents of children with ADHD, clinicians and researchers participated in a Delphi survey with 3 rounds. The importance of 52 intervention targets was rated on a scale from 0 to 8 (8 being extremely important). Consensus was reached if &gt;70% of a stakeholder group rated a target as between 6–8 and &lt;15% rated it as 0–2. Targets were dropped from subsequent rounds if more than 50% of stakeholder groups rated it as 0–5. Targets that all four stakeholder groups reached consensus on in any round were automatically included in our final outcome set. Comments were analysed using Thematic Analysis. All four stakeholder groups reached consensus on the importance of seven targets: ability to pay attention, conflict with teachers and peers, executive functioning, global functioning and quality of life, inattention symptoms, organisation skills and self-esteem. Four overarching themes were identified: Complexity of ADHD, Relationships, School Context, and What ADHD means to me. School-based ADHD interventions should target outcomes identified as most important to those who stand to benefit from such interventions. Some outcomes prioritised by our participants have not yet been targeted in school-based ADHD interventions. Implications of our findings for intervention and research design are discussed.</jats:p