Psychosocial interventions for improving the physical health of young people and adults with attention deficit hyperactivity disorder: a scoping review

Background: Young people and adults with ADHD are at risk of a range of physical health problems. There is limited guidance on how to approach health problems in ADHD, and especially around 16-25 year olds who will be transitioning from paediatric to adult care. The aim of this scoping review was to identify psychosocial interventions that target physical health in young people and adults with ADHD. Methods: We constructed searches in MEDLINE, PsycInfo, EMBASE of adolescents, young people and adults. Inclusion criteria were; studies of psychosocial interventions examining a component of physical health, applicable to people aged 16-25, with clinical or research diagnoses of ADHD. Data were extracted using a data extraction tool and tabulated, including study intervention framing/aims, population, intervention, and relevant outcomes (including specific statistics where relevant). Results: Our search identified 22 unique papers covering, psychosocial interventions targeting at least one of sleep (n=7), smoking (n=3), substance/alcohol use (n=4), physical health/exercise (n=6) and general health (n=3). Studies examined psychotherapy/behaviour interventions (n=12), psychoeducation (n=4), digital (n=2) and social interventions (n=4). There was significant heterogeneity in intervention framing, outcome measures and population. Conclusion: Further work on the impact of targeted physical health interventions, with explicit reference to a conceptual framework of poor health in ADHD is required. Furthermore, future work standardising reporting of physical health outcomes in ADHD is crucial for the development of an evidence base in this field

Patient, supporter and primary healthcare professional perspectives on health risks in over 16s with attention deficit hyperactivity disorder (ADHD) in England: a national survey study

Background: Current research suggests that people with attention deficit hyperactivity disorder (ADHD) are at higher risk of physical and mental health disorders. This study aimed to explore these health risks in ADHD from the perspectives of multiple stakeholders. Methods: This study forms part of the ‘Managing young people with ADHD in Primary care (MAP) study’. A survey developed by the study team was distributed to over 16 year olds with ADHD, their supporters, primary healthcare professionals and health commissioners across England, via social media and through patient/clinical networks (September—October 2022). This survey contained two questions on health risks. Question one asked about views on health risks in ADHD (free text). Question two asked about advice given (options list and free text). Descriptive statistics summarised responses to questions one and two, and qualitative analysis (reflexive thematic analysis) was used to explore free text responses from question one. Results: 782 participants responded to the MAP survey. Of these, 206 healthcare professionals, 157 people with ADHD and 88 supporters answered question one. The most mentioned perceived risks were substance misuse, sleep disorders, weight management and smoking. More people with ADHD reported disordered eating as a health risk (n = 32) than healthcare professionals (n = 5). Generated themes included perceived health risks, impact of living with ADHD, lack of adequate healthcare, and need for ADHD awareness. In respect to advice given (question two), based on responses from 258 professionals, 162 people with ADHD and 100 supporters, the most common advice discussed in consultation was mental health (n = 149, n = 50 and n = 17 respectively). High numbers of respondents reported not giving/receiving advice on wider health (n = 38, n = 88 and n = 61 respectively). Conclusions: Findings demonstrate that respondents perceived a range of physical and mental health risks posed by ADHD. These related to difficulties with activities of daily living, as well as healthcare interactions and the impact of core features of ADHD (e.g. impulsivity, emotional dysregulation). These risks are not currently explicitly addressed in United Kingdom national guidance on ADHD. More work is needed to examine and address the broader health outcomes of people with ADHD

Primary care provision for young people with ADHD: A multi-perspective qualitative study

Background: Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. United Kingdom (UK) guidance states primary care has a vital role in effective ADHD management including referral, medication prescribing and monitoring, and providing broader mental health and wellbeing support. However, many general practitioners (GPs) feel unsupported to provide healthcare for young people with ADHD. Inadequate healthcare is associated with rising costs for patients and society. Aim: To investigate the experiences of young people with ADHD accessing primary care in England, from the perspectives of people with lived experience of ADHD (LE), and healthcare professionals (HPs). Design and Setting: Qualitative interviews were conducted with HPs (GPs, practice mangers, and a wellbeing worker), and people with LE (young people aged 16-25, and their supporters) located in Integrated Care Systems, across England. Method: Semi-structured interviews were conducted with participants at five purposively selected general practices (varying by: deprivation, ethnicity, rural-urban setting). Questions focused on experiences of accessing/providing healthcare for ADHD. Reflexive thematic analysis was undertaken within a critical realist framework, to understand how provision works in practice and explore potential improvements. Results: Twenty interviews were completed with 11 HPs and 9 people with LE. Three themes were generated: a system under stress, incompatibility between ADHD and the healthcare system, and strategies for change. Conclusion: Standardisation of ADHD management in primary care, providing better information and support for HPs, and advising on reasonable adjustments for people with LE could help improve access to effective treatments for young people living with ADHD

Childhood/adolescent Sydenham’s chorea in the UK and Ireland: a BPSU/CAPSS surveillance study

Objective: To conduct the first prospective surveillance study of Sydenham’s chorea (SC) in the UK and Ireland, and to describe the current paediatric and child psychiatric service-related incidence, presentation and management of SC in children and young people aged 0–16 years. Design: Surveillance study of first presentations of SC reported by paediatricians via the British Paediatric Surveillance Unit (BPSU) and all presentations of SC reported by child and adolescent psychiatrists through the Child and Adolescent Psychiatry Surveillance System (CAPSS). Results: Over 24 months from November 2018, 72 reports were made via BPSU, of which 43 met the surveillance case definition of being eligible cases of suspected or confirmed SC. This translates to an estimated paediatric service-related incidence rate of new SC cases of 0.16 per 100 000 children aged 0–16 per year in the UK. No reports were made via CAPSS over the 18-month reporting period, although over 75% of BPSU cases presented with emotional and/or behavioural symptoms. Almost all cases were prescribed courses of antibiotics of varying duration, and around a quarter of cases (22%) received immunomodulatory treatment. Conclusions: SC remains a rare condition in the UK and Ireland but has not disappeared. Our findings emphasise the impact that the condition can have on children’s functioning and confirm that paediatricians and child psychiatrists should remain vigilant to its presenting features, which commonly include emotional and behavioural symptoms. There is a further need for development of consensus around identification, diagnosis and management across child health settings

Support for primary care prescribing for adult ADHD in England: national survey

Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with effective pharmacological treatments that improve symptoms and reduce complications. NICE guidelines recommend primary care practitioners prescribe medication for adult ADHD under shared care agreements with adult mental health services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support. Aim: This study aimed to describe supportive elements (prescribing, shared care, AMHS availability) of primary care prescribing for adult ADHD medication in England, to inform service improvement and improve access for this underserved population. Design and Setting: Three interlinked cross-sectional surveys asked every integrated care board (ICB) in England (Commissioners), and convenience samples of healthcare professionals (HP) and people with lived experience (LE), about elements supporting pharmacological treatment of ADHD in primary care. Method: Descriptive analyses used percentages and confidence intervals to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software. Results: Data from 782 respondents (42 Commissioners; 331 HP; 409 LE) revealed differences in reported provision by stakeholder group, including for prescribing (94.6% of HP vs 62.6% of LE). Over 40% of respondents reported extended AMHS waiting times of two years or more. There was some variability by NHS region, for example London had highest rates of HP reported prescribing (100%), and lowest reported extended waiting times (25.0%). Conclusion: Elements supporting appropriate shared care prescribing of ADHD medication via primary care are not universally available in England. Co-ordinated approaches are needed to address these gaps

Letter to Drew Wagnon from John Newlove

This is a letter to Drew Wagnon from John Newlove, dated October 13, 1964. In this letter, John Newlove includes the poem, "Black Night Window" and discusses current political events

Letter to Drew Wagnon from John Newlove

Letter from John Newlove to Drew Wagnon, May 15, 1964. In this letter, John Newlove thanks Drew Wagnon for sending him the card and Wild Dog. He asks Drew Wagnon to send him issues 6 and 7 of the Wild Dog magazine. He also discusses his financial situation and hardships

Postcard to Andrew Wagnon

This is a postcard from John Newlove to Drew Wagnon, dated December 4, 1964. On this postcard, John Newlove writes of his new address