Social gradients in the receipt of medication for attention-deficit hyperactivity disorder in children and young people in Sheffield

Background Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by inattention and hyperactivity-impulsivity that can affect people throughout their lifecourse. A social gradient exists in the prevalence of ADHD in the UK. Studies in other countries have shown that social gradients also exist in the receipt of medication for ADHD. Socioeconomic position is potentially an unrecognised and modifiable factor in children and young people’s receipt of medication for ADHD in the UK. Aim The aim of the study was to investigate if socioeconomic could explain in part whether or not children and young people in Sheffield are receiving medication for ADHD. Method We used multivariable logistic regression modelling to investigate whether socioeconomic could explain variation in receipt of medication for ADHD in children and young people in a cross sectional study. We collected data from 1354 children and young people with a diagnosis of ADHD across three Sheffield centres between January and December 2016. Independent variables were age, sex, religion, ethnicity, comorbidities, and Index of Multiple Deprivation decile (derived from home postcode). Results Our results showed a social gradient in the receipt of medication for ADHD (p<0.01); an increase in one decile of the Index of Multiple Deprivation was associated with 10% lower odds of receipt of medication for ADHD (aOR 0.90; 95%CI 0.84–0.970). Conclusion Children and young people from more deprived backgrounds are more likely to receive medication for ADHD. This is the first time that a social gradient in children and young people’s receipt of medication for ADHD has been shown in a UK sample

Guideline development for technological interventions for children and young people to self-manage ADHD: A realist evaluation

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder characterised by inattention, hyperactivity and impulsivity. ADHD can affect the individual, their family and the community. ADHD is managed using pharmacological and non-pharmacological treatments, which principally involves others helping children and young people (CAYP) manage their ADHD rather than learning self-management strategies themselves. Over recent years, technological developments have meant that technology has been harnessed to create interventions to facilitate the self-management of ADHD in CAYP. Despite a clear potential to improve the effectiveness and personalisation of interventions, there are currently no guidelines based on existing evidence or theories to underpin the development of technologies that aim to help CAYP self-manage their ADHD. Objective: To create evidence-based guidelines with key stakeholders that will provide recommendations for the future development of technological interventions, which aim to facilitate the self-management of ADHD. Methods: A realist evaluation approach was adopted in five phases. Phase one involved identifying propositions (or hypotheses) outlining what could work for such an intervention. Phase two involved the identification of middle-range theories of behaviour change to underpin the propositions. Phase three involved the identification and development of Context Mechanism Outcome Configurations (CMOCs), which essentially state, which elements of the intervention could be effected by which contexts and what the outcome of these could be. Phase four involved the validation and refinement of the propositions via interviews with key stakeholders (CAYP with ADHD, their parents and specialist clinicians). Phase five involved the development of the guidelines based on the identified middle-range theories and interview data. Results: Six specialist clinicians, eight parents and seven CAYP were recruited to this study. Seven key themes were identified 1) Positive rewarding feedback, 2) Downloadable gaming resources, 3) Personalisable and adaptable components, 4) Psychoeducation component, 5) Integration of self-management strategies, 6) Goal setting and 7) Context (environmental and personal). The identified mechanisms interacted with the variable contexts a complex technological intervention of this nature could be delivered in. Conclusions: Complex intervention development for complex populations such as CAYP with ADHD should adopt various methodologies and methods such as realist evaluation and user-centered design that involves developing the intervention with key stakeholders to increase the likelihood that the intervention will succeed. The guidelines we describe can be used for the future development of technologies that aim to facilitate self-managed ADHD for CAYP

Psychoeducation intervention effectiveness to improve social skills in young people with ADHD: a meta-analysis

Objective: Attention Deficit Hyperactivity Disorder (ADHD) can be associated with limited understanding of the condition and poor social skills. Some evidence favors a psychoeducational approach, but little is known about the effectiveness of psychoeducation. Methods: Systematic review and meta-analysis of studies assessing psychoeducational interventions that aim to improve social skills of young people with ADHD. Results: Ten studies, including 943 participants, reported across 13 papers met the inclusion criteria. Although effect sizes were small, findings suggest the included interventions significantly improved social skills in young people with ADHD. Conclusions: Results show promise for psychoeducational behavioral interventions . However, the recommendations that can be developed from existing evidence are somewhat limited by the low quality of studies. Further rigorous trials are needed. In addition, future research should consider the long-term outcomes for these interventions, they should be iteratively co-designed and research should consider the context they intend to be delivered in

The impact of ADHD on the health and well-being of ADHD children and their siblings

Childhood attention-deficit/hyperactivity disorder (ADHD) has been associated with reduced health and well-being of patients and their families. The authors undertook a large UK survey-based observational study of the burden associated with childhood ADHD. The impact of ADHD on both the patient (N = 476) and their siblings (N = 337) on health-related quality of life (HRQoL) and happiness was quantified using multiple standard measures [e.g. child health utility-9D (CHU-9D), EuroQol-5D-Youth]. In the analysis, careful statistical adjustments were made to ensure a like-for-like comparison of ADHD families with two different control groups. We controlled for carers' ADHD symptoms, their employment and relationship status and siblings' ADHD symptoms. ADHD was associated with a significant deficit in the patient's HRQoL (with a CHU-9D score of around 6 % lower). Children with ADHD also have less sleep and were less happy with their family and their lives overall. No consistent decrement to the HRQoL of the siblings was identified across the models, except that related to their own conduct problems. The siblings do, however, report lower happiness with life overall and with their family, even when controlling for the siblings own ADHD symptoms. We also find evidence of elevated bullying between siblings in families with a child with ADHD. Overall, the current results suggest that the reduction in quality of life caused by ADHD is experienced both by the child with ADHD and their siblings

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in childhood (5.3% to 7.1% worldwide prevalence), with substantial overall financial burden to children/adolescents, their families, and society. The aims of this study were to describe the clinical characteristics of children and adolescents with ADHD in Spain, estimate the associated direct/indirect costs of the disorder, and assess whether the characteristics and financial costs differed between children/adolescents adequately responding to currently available pharmacotherapies compared with children/adolescents for whom pharmacotherapies failed. Methods: This was a multicenter, cross-sectional, descriptive analysis conducted in 15 health units representative of the overall Spanish population. Data on demographic characteristics, socio-occupational status, social relationships, clinical variables of the disease, and pharmacological and non-pharmacological treatments received were collected in 321 children and adolescents with ADHD. Direct and indirect costs were estimated over one year from both a health care system and a societal perspective. Results: The estimated average cost of ADHD per year per child/adolescent was ¿5733 in 2012 prices; direct costs accounted for 60.2% of the total costs (¿3450). Support from a psychologist/educational psychologist represented 45.2% of direct costs and 27.2% of total costs. Pharmacotherapy accounted for 25.8% of direct costs and 15.5% of total costs. Among indirect costs (¿2283), 65.2% was due to caregiver expenses. The total annual costs were significantly higher for children/adolescents who responded poorly to pharmacological treatment (¿7654 versus ¿5517; P = 0.024), the difference being mainly due to significantly higher direct costs, particularly with larger expenses for non-pharmacological treatment (P = 0.012). Conclusions: ADHD has a significant personal, familial, and financial impact on the Spanish health system and society. Successful pharmacological intervention was associated with lower overall expenses in the management of the disorder