Attitudes and reported practice of paediatricians and child psychiatrists regarding the assessment and treatment of ADHD in Ireland

Objectives. This mixed-method national survey has obtained original data on attention deficit hyperactivity disorder (ADHD) attitudes, assessment and treatment regimes reported by paediatricians and child psychiatrists; and has compared their clinics. It has examined the extent of involvement of Irish paediatricians in the management of ADHD. Methods. A questionnaire was designed, based on a review of literature and ADHD guidelines, and piloted by expert clinicians. Universal recruitment was conducted among Child and Adolescent Mental Health Services (CAMHS) consultants (n = 71) and community/general paediatric consultants (n = 72). Quantitative and qualitative data was collected and analysed. Results. There was an overall response rate of 43%. A dedicated ADHD clinic is offered in 79% of CAMHS services, but only in one paediatric service. Participants reported that the assessment of ADHD involves multidisciplinary work and this was only established in CAMHS clinics. Medication is initiated by 82% of child psychiatrists and only 22% of paediatricians. Conclusions. This first national study of ADHD attitudes and practices presents comprehensive data regarding the management of children with ADHD in CAMHS and paediatric settings in Ireland. Paediatricians reported a minor role in managing ADHD. Study limitations are related to subjective reporting rather than case note audit, and a moderate response rate for the paediatricians’ participants

Transitioning from child and adolescent mental health services with attention-deficit hyperactivity disorder in Ireland: case note review

Aim: In a context of international concern about early adult mental health service provision, this study identifies characteristics and service outcomes of young people with attention-deficit hyperactivity disorder (ADHD) reaching the child and adolescent mental health service (CAMHS) transition boundary in Ireland. Methods: The iTRACK study invited all 60 CAMHS teams in Ireland to participate; 8 teams retrospectively identified clinical case files for 62 eligible young people reaching the CAMHS transition boundary in all four Health Service Executive Regions. A secondary case note analysis identified characteristics, co-morbidities, referral and service outcomes for iTRACK cases with ADHD (n = 20). Results: Two-thirds of young people with ADHD were on psychotropic medication and half had mental health co-morbidities, yet none was directly transferred to public adult mental health services (AMHS) at the transition boundary. Nearly half were retained in CAMHS, for an average of over a year; most either disengaged from services (40%) and/or actively refused transfer to AMHS (35%) at or after the transition boundary. There was a perception by CAMHS clinicians that adult services did not accept ADHD cases or lacked relevant service/expertise. Conclusions: Despite high rates of medication use and comorbid mental health difficulties, there appears to be a complete absence of referral to publically available adult mental health services for ADHD youth transitioning from CAMHS in Ireland. More understanding of obstacles and optimum service configuration is essential to ensure that care is both available and accessible to young people with ADHD

How Valid Are Measures of Children’s Self-Concept/ Self-Esteem? Factors and Content Validity in Three Widely Used Scales

Children’s self-esteem/self-concept, a core psychological construct, has been measured in an overwhelming number of studies, and the widespread use of such measures should indicate they have well-established content validity, internal consistency and factor structures. This study, sampling a demographically representative cohort in late childhood/early adolescence in Dublin, Ireland (total n = 651), examined three major self-esteem/self-concept scales designed for late childhood/early adolescence: Piers-Harris Self-Concept Scale for Children 2 (Piers et al. 2002), Self-Description Questionnaire I (Marsh 1992) and Self-Perception Profile for Children (Harter 1985). It also examined findings in light of the salient self factors identified by participants in a linked mixed-methods study. The factor structure of Piers-Harris Self-Concept Scale was not replicated. The Self-Description Questionnaire I and Self-Perception Profile for Children were replicated only in part although in similar ways. In all three scales, a global/ appearance self evaluation factor accounted for the largest variance in factor analyses. Sport/athletic ability, school ability, school enjoyment, maths and reading ability/enjoyment, behaviour, peer popularity, and parent factors were also identified but did not always reflect existing scale structures. Notably, the factors extracted, or items present in these scales, often did not reflect young people’s priorities, such as friendship over popularity, the importance of family and extended family members, and the significance of incremental personal mastery in activities rather than assessing oneself as comparatively good at preferred activities. The findings raise questions about how self-esteem/self-concept scales are used and interpreted in research with children and young people

Who I Am: The Meaning of Early Adolescents’ Most Valued Activities and Relationships, and Implications for Self-Concept Research

Self-concept research in early adolescence typically measures young people’s self-perceptions of competence in specific, adult-defined domains. However, studies have rarely explored young people’s own views of valued self-concept factors and their meanings. For two major self domains, the active and the social self, this mixed-methods study identified factors valued most by 526 young people from socioeconomically diverse backgrounds in Ireland (10-12 years), and explored the meanings associated with these in a stratified subsample (n = 99). Findings indicate that self-concept scales for early adolescence omit active and social self factors and meanings valued by young people, raising questions about content validity of scales in these domains. Findings also suggest scales may under-represent girls’ active and social selves; focus too much on some school-based competencies; and, in omitting intrinsically salient self domains and meanings, may focus more on contingent (extrinsic) rather than true (intrinsic) self-esteem

“It’s like my kid came back overnight”: Experiences of trans and non-binary young people and their families seeking, finding and engaging with clinical care in England

Background: Trans and non-binary children and young people in England, UK struggle to gain access to affirming clinical care, despite the international research evidence pointing towards this best practice approach. Concurrently, they are subject to constant discussion in UK national media and politics, where many negative assumptions are made about their needs, experiences and clinical provision. Their journey to seek appropriate care has not yet been documented. Aims: We trace the experiences of trans and non-binary children and youth and their families in their decision to seek, searches for and experiences with affirmative and non-affirmative clinical input for help with their gender. Method: 27 dyadic, semi-structured interviews were undertaken with trans and non-binary children and young people and their parents from 13 families. Results: The process of seeking support via National Health Service clinical routes in England, UK is beset with lengthy waiting lists, issues with geographical inaccessibility, a lack of relevant clinical knowledge, and a failure to recognise the value of family expertise. Family doctors provide contraceptive hormones in lieu of proper access to puberty blocking or gender affirming hormones, and most families resort to private care they can ill afford. Discussion: Training in gender identity and gender dysphoria is recommended for both family doctors, and children’s mental health services. Gender identity development services could be decentralised, with local hubs offering more accessible support

What do general practitioners know about ADHD? Attitudes and knowledge among first-contact gatekeepers: systematic narrative review

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder with international prevalence estimates of 5 % in childhood, yet significant evidence exists that far fewer children receive ADHD services. In many countries, ADHD is assessed and diagnosed in specialist mental health or neuro-developmental paediatric clinics, to which referral by General (Family) Practitioners (GPs) is required. In such ‘gatekeeper’ settings, where GPs act as a filter to diagnosis and treatment, GPs may either not recognise potential ADHD cases, or may be reluctant to refer. This study systematically reviews the literature regarding GPs’ views of ADHD in such settings. Methods: A search of nine major databases was conducted, with wide search parameters; 3776 records were initially retrieved. Studies were included if they were from settings where GPs are typically gatekeepers to ADHD services; if they addressed GPs’ ADHD attitudes and knowledge; if methods were clearly described; and if results for GPs were reported separately from those of other health professionals. Results: Few studies specifically addressed GP attitudes to ADHD. Only 11 papers (10 studies), spanning 2000–2010, met inclusion criteria, predominantly from the UK, Europe and Australia. As studies varied methodologically, findings are reported as a thematic narrative, under the following themes: Recognition rate; ADHD controversy (medicalisation, stigma, labelling); Causes of ADHD; GPs and ADHD diagnosis; GPs and ADHD treatment; GP ADHD training and sources of information; and Age, sex differences in knowledge and attitudes. Conclusions: Across times and settings, GPs practising in first-contact gatekeeper settings had mixed and often unhelpful attitudes regarding the validity of ADHD as a construct, the role of medication and how parenting contributed to presentation. A paucity of training was identified, alongside a reluctance of GPs to become involved in shared care practice. If access to services is to be improved for possible ADHD cases, there needs to be a focused and collaborative approach to training

Psychosocial Needs of Children in Foster Care and the Impact of Sexual Abuse

Children in family foster care, especially those who have experienced sexual abuse, require a safe and nurturing environment in which their psychosocial needs are met. However, there is limited knowledge on how youth prioritize various needs and what impact previous experiences have on these needs. In this study, we asked youth (formerly) in family foster care to indicate their psychosocial needs, and analyzed if youth with a history of sexual abuse have different needs. A Q methodological study was conducted with 44 youth (age 16–28). Fifteen of them reported sexual abuse during their childhood. Using by-person factor analyses, respondents who share similar subjective views were grouped together. Qualitative interpretations of the factors show differences and similarities between and within the two groups, related to help from others, being independent, processing the past, and working toward the future. Although the needs of youth with and without experiences of sexual abuse seem mostly similar, one group of sexually abused youth specifically indicated not wanting an emotional connection to foster parents, but instead a strictly instrumental, professional relationship. This study captured the diverse perspectives of youth themselves, revealing that children in foster care differ with regard to what they consider as (most) important safety, belonging, self-esteem and self-actualization needs

“They were saying it was delicious”: Very young children’s understanding of food advertising

YouTube is rising to become one of the most widely used media by children today with the 2017 Media Uses and Attitudes Ofcom report indicating that half of children in the UK aged 3-4 years and over eight of ten children and young people aged 5 to 15 years using this platform. In digital media, children are widely exposed to advertising but the effects of this on their health and well-being have rarely been explored. Yet strong evidence exists for effects of broadcast marketing communications on children’s food preferences and choices. Also largely unexplored is very young children’s understanding of food advertising, although studies demonstrate that they become aware of food brands from at least the age of 3 years. In a changing media landscape, and in the context of high rates of overweight and obesity among children and young people with consequences for their physical and mental well-being, these gaps in knowledge are a concern. This study explored children’s responses to advertisements for four food and drink brands hosted on YouTube. In individual interviews, 143 children (3-5 years) viewed the advertisements for a chocolate-flavoured cereal, ice cream, frozen chips and a smoothie. The ads varied in pace and narrative structure and in the extent to which they could be considered to be aimed at children, with the ads for chips and smoothie more adult-focused. Semi-structured individual interviews and mixed methods analyses explored children’s liking of advertisements and understanding of the content they had viewed. No more than one in ten children was able to repeat any of an ad’s voiceover content. Yet up to nine out of ten children said they liked each of the advertisements; described some narrative content from the ad; and identified at least some of the food items featured. Findings indicate that children aged 3 to 5 years respond positively to and can absorb the content of substantial amounts of food-related content in YouTube/TV food advertising. This paper will conclude by discussing implications for children’s learning from digital screen media and with implications for policy makers, regulators and those concerned about childhood obesity

“They were saying it was delicious”: Very young children’s understanding of food advertising

YouTube is rising to become one of the most widely used media by children today with the 2017 Media Uses and Attitudes Ofcom report indicating that half of children in the UK aged 3-4 years and over eight of ten children and young people aged 5 to 15 years using this platform. In digital media, children are widely exposed to advertising but the effects of this on their health and well-being have rarely been explored. Yet strong evidence exists for effects of broadcast marketing communications on children’s food preferences and choices. Also largely unexplored is very young children’s understanding of food advertising, although studies demonstrate that they become aware of food brands from at least the age of 3 years. In a changing media landscape, and in the context of high rates of overweight and obesity among children and young people with consequences for their physical and mental well-being, these gaps in knowledge are a concern. This study explored children’s responses to advertisements for four food and drink brands hosted on YouTube. In individual interviews, 143 children (3-5 years) viewed the advertisements for a chocolate-flavoured cereal, ice cream, frozen chips and a smoothie. The ads varied in pace and narrative structure and in the extent to which they could be considered to be aimed at children, with the ads for chips and smoothie more adult-focused. Semi-structured individual interviews and mixed methods analyses explored children’s liking of advertisements and understanding of the content they had viewed. No more than one in ten children was able to repeat any of an ad’s voiceover content. Yet up to nine out of ten children said they liked each of the advertisements; described some narrative content from the ad; and identified at least some of the food items featured. Findings indicate that children aged 3 to 5 years respond positively to and can absorb the content of substantial amounts of food-related content in YouTube/TV food advertising. This paper will conclude by discussing implications for children’s learning from digital screen media and with implications for policy makers, regulators and those concerned about childhood obesity