ADHD and the Irish Criminal Justice System: The Question of Inertia

Studies report ADHD rates of 26% for incarcerated adults and 30% for young people, highlighting an overrepresentation of this cohort within the prison/ detention systems. There has been some progress internationally in terms of developing guidelines and protocols for criminal justice practitioners when presented with diagnosed and/or suspected cases of ADHD within the adult and youth justice fields. Further, there is a growing body of literature supporting better outcomes, in terms of reoffending and general life course progression, for those who are identified as having the condition and treated accordingly. However, the Irish system has been slow to make progress in this space. This paper presents international research, discusses why the Irish system has failed to develop a strategy to explore the potential for approaches currently being adopted elsewhere, and makes suggestions for next steps

ADHD and the Irish Criminal Justice System: The Question of Inertia

Studies report ADHD rates of 26% for incarcerated adults and 30% for young people, highlighting an overrepresentation of this cohort within the prison/ detention systems. There has been some progress internationally in terms of developing guidelines and protocols for criminal justice practitioners when presented with diagnosed and/or suspected cases of ADHD within the adult and youth justice fields. Further, there is a growing body of literature supporting better outcomes, in terms of reoffending and general life course progression, for those who are identified as having the condition and treated accordingly. However, the Irish system has been slow to make progress in this space. This paper presents international research, discusses why the Irish system has failed to develop a strategy to explore the potential for approaches currently being adopted elsewhere, and makes suggestions for next steps

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

Primary Care and Youth Mental Health in Ireland: Qualitative Study in Deprived Urban Areas

BACKGROUND: Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15-24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people\u27s unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals\u27 experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16-25 years) in primary care in deprived urban settings in Ireland. METHODS: The chosen method for this qualitative study was inductive thematic analysis which involved semi-structured interviews with 37 healthcare professionals from primary care, secondary care and community agencies at two deprived urban centres. RESULTS: We identified three themes in respect of interventions to increase screening and treatment: (1) Identification is optimised by a range of strategies, including raising awareness, training, more systematic and formalised assessment, and youth-friendly practices (e.g. communication skills, ensuring confidentiality); (2) Treatment is enhanced by closer inter-agency collaboration and training for all healthcare professionals working in primary care; (3) Ongoing engagement is enhanced by motivational work with young people, setting achievable treatment goals, supporting transition between child and adult mental health services and recognising primary care\u27s longitudinal nature as a key asset in promoting treatment engagement. CONCLUSIONS: Especially in deprived areas, primary care is central to early intervention for youth mental health. Identification, treatment and continuing engagement are likely to be enhanced by a range of strategies with young people, healthcare professionals and systems. Further research on youth mental health and primary care, including qualitative accounts of young people\u27s experience and developing complex interventions that promote early intervention are priorities

ADHD and the Irish Criminal Justice System: The Question of Inertia

Studies report ADHD rates of 26% for incarcerated adults and 30% for young people, highlighting an overrepresentation of this cohort within the prison/ detention systems. There has been some progress internationally in terms of developing guidelines and protocols for criminal justice practitioners when presented with diagnosed and/or suspected cases of ADHD within the adult and youth justice fields. Further, there is a growing body of literature supporting better outcomes, in terms of reoffending and general life course progression, for those who are identified as having the condition and treated accordingly. However, the Irish system has been slow to make progress in this space. This paper presents international research, discusses why the Irish system has failed to develop a strategy to explore the potential for approaches currently being adopted elsewhere, and makes suggestions for next steps

ADHD and the Irish Criminal Justice System: The Question of Inertia

Studies report ADHD rates of 26% for incarcerated adults and 30% for young people, highlighting an overrepresentation of this cohort within the prison/ detention systems. There has been some progress internationally in terms of developing guidelines and protocols for criminal justice practitioners when presented with diagnosed and/or suspected cases of ADHD within the adult and youth justice fields. Further, there is a growing body of literature supporting better outcomes, in terms of reoffending and general life course progression, for those who are identified as having the condition and treated accordingly. However, the Irish system has been slow to make progress in this space. This paper presents international research, discusses why the Irish system has failed to develop a strategy to explore the potential for approaches currently being adopted elsewhere, and makes suggestions for next steps

A prospective longitudinal investigation of the (dis)continuity of mental health difficulties between mid- to late-childhood and the predictive role of familial factors

Understanding individual variation in the continuity of youth mental health difficulties is critical for identifying the factors that promote recovery or chronicity. This study establishes the proportion of children showing psychopathology at 9 years, whose pathology had either remitted or persisted at 13. It describes the socio-demographic and clinical profiles of these groups, and examines the factors in 9-year-olds’ familial environments that predict longitudinal remission vs. persistence of psychopathology. The study utilised data from a prospective longitudinal study of 8568 Irish children. Child psychopathology was assessed using the Strengths and Difficulties Questionnaire (SDQ). Analysis established the rates of continuity of SDQ classifications between 9 and 13 years. Analysis also investigated the familial factors that predicted the remission vs. persistence of psychopathological symptoms, controlling for socio-demographic and child factors. Average SDQ scores improved between the ages of 9 and 13, F(1, 7292) = 276.52, p < 0.001, η2p = 0.04. Of children classified Abnormal aged 9, 41.1% remained so classified at 13, 21.4% were reclassified Borderline, and 37.6% Normal. Demographic and child risk factors for persistence of pathology were maleness (β = −1.00, p = 0.001, CI = 0.20–0.67), one-carer households (β = −0.71, p = 0.04, CI = 0.25–0.97), poor physical health (β = −0.64, p = 0.03, CI = 0.30–0.92), and low cognitive ability (β = 0.61, p = 0.002, CI = 1.26–2.70). Controlling for these factors, the only familial variable at 9 years that predicted subsequent pathological persistence was caregiver depression (β = −0.07, p = 0.03, CI = 0.87–0.99). The analysis highlights substantial rates of psychopathological discontinuity in a community sample and identifies the children most at risk of chronic mental health problems. These results will inform the targeting of early interventions and distribution of clinical resources

The global impact on mental health almost 2 years into the COVID-19 pandemic

Approaching 2 years into a global pandemic, it is timely to reflect on how COVID-19 has impacted the mental health of the global population. With research continuing apace, a clearer picture should crystallise in time. COVID-19 has undoubtedly had some impact on population mental health, although the severity and duration of this impact remain less clear. The exceptional period of COVID-19 has provided a unique prism through which we can observe and consider societal mental health. This is a momentous time to be involved in mental health research as we strive to understand the mental health needs of the population and advocate for adequate resourcing to deliver quality mental healthcare in the post-pandemic period. </p

Understanding the “battleground” of homework and ADHD: A qualitative study of parents’ perspectives and experiences

Children with Attention deficit hyperactivity disorder (ADHD) are known to have poorer academic outcomes and experience challenges with homework. The Aim of this research is to explore parents' subjective experiences and perspectives of the challenges presented by ADHD and homework and consider what type of intervention may be helpful to parents. In depth semi-structured interviews were conducted with participants (n = 13). Transcripts were analysed for thematic content. Results showed homework was experienced by parents of children with ADHD as a persistently stressful part of their family’s daily life. Eight themes were identified. Given the poorer academic outcomes of children with ADHD together with the challenges parents experience, a targeted parenting intervention to address these challenges is needed and warrants further research

International declaration on youth mental health.

The vision of the International Declaration is that every young person with mental health problems gets the help they need when and where they need it. Inspire Ireland are delighted to have contributed to this declaration. The declaration highlights the importance of changing the way we think about youth mental health in keeping with innovative services like ReachOut.com How did the declaration come about The International Declaration on Youth Mental Health evolved from the Youth Mental Health Summit which took place in Killarney in 2010. The Summit provided a forum for 80 young people, family members, clinicians, researchers and policy makers to share practice innovation and research in the field of youth mental and to discuss and debate the content of this declaration. What does the declaration mean The International Declaration on Youth Mental Health articulates core principles and targets for youth mental health service provision. It aims to influence how people think about and respond to young people’s mental health needs. It will be used to leverage support for the development of timely and appropriate youth mental health services internationally. The Declaration sets out a range of measurable targets that can be achieved over a ten year period. Inspire Ireland is very proud to be involved in the development of such a visionary declaration and are pleased to be hosting the declaration online