Skip to main content
×
×
Home

Service innovation: transitional attention-deficit hyperactivity disorder clinic

  • Robert Verity (a1) and John Coates (a2)
Extract

Attention-deficit hyperactivity disorder (ADHD) affects 3–7% of school-age children (Goldman et al, 1998) and causes symptoms of inattention, hyperactivity and impulsivity (DSM–IV; American Psychiatric Association, 1994). In the UK, many adolescents are currently being treated for ADHD; the prevalence of treated ADHD among boys aged 5–14 years was estimated at 5.3 per 1000 in 1999 (Jick et al, 2004). This means that over 40 000 boys aged 5–14 years are currently treated in the UK (2001 Census; http://www.Statistics.gov.uk/census2001/census2001.asp).

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Service innovation: transitional attention-deficit hyperactivity disorder clinic
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Service innovation: transitional attention-deficit hyperactivity disorder clinic
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Service innovation: transitional attention-deficit hyperactivity disorder clinic
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
Hide All
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). APA.
Department of Health (2004) National Service Framework For Children and Young People and Maternity Services. http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/ChildrenServices/ChildrenServicesInformation/fs/en
Faraone, S.V. & Biederman, J. (1998) Neurobiology of attention-deficit hyperactivity disorder. Biological Psychiatry, 44, 951958.
Gittleman, R., Mannuzza, S., Shenker, R., et al (1985) Hyperactive boys almost grown up. I. Psychiatric status. Archives of General Psychiatry, 42, 937947.
Goldman, L. S., Genel, M., Bezman, R. J., et al (1998). Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. JAMA, 279, 11001107.
Jick, H., Kaye, J. A. & Black, C. (2004) Incidence and prevalence of drug treated attention deficit disorder among boys in the UK. British Journal of General Practice, 504, 345347.
Kooij, J. J., Buitelaar, J. K., Van Der Oord, E. J., et al (2005) Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological Medicine, 35, 817827.
Mannuzza, S., Klein, R. G., Bessler, A., et al (1993) Adult outcome of hyperactive boys. Archives of General Psychiatry, 50, 565576.
Verity, R., Omran, M. & Ayyash, H. A. (2006) Transitional and adult service for patients with ADHD. Archives of Disease in Childhood, 91 (suppl. 1), A39.
Weiss, G., Hechtman, L., Milroy, T., et al (1985) Psychiatric status of hyperactives as adults, a controlled perspective 15 year follow-up of 63 hyperactive children. Journal of the American Academy of Child and Adolescent Psychiatry, 24, 211220.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 10 *
Loading metrics...

Abstract views

Total abstract views: 49 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 20th July 2018. This data will be updated every 24 hours.

Service innovation: transitional attention-deficit hyperactivity disorder clinic

  • Robert Verity (a1) and John Coates (a2)
Submit a response

eLetters

Adult ADHD Review Clinic

Obianuju M-A Ugochukwu, Consultant Psychiatrist, Northgate hospital, Great Yarmouth. NR30 1BU
10 April 2007

Verity and Coates (2007) highlighted the need to establish ADHD services for adults. I work in an adult mental health service in Great Yarmouth and the Child and Adolescent Mental Health Service (CAMHS) see children only up to the age of 16. This means that there was an ever increasing number of young people who were being discharged back to the care of their general practitioners when they turned 16. A few were taken up by adult mental health services. Some general practitioners were understandably reluctant to continue prescribing stimulants and one patient had his medication discontinued because his general practitioner would not prescribe without some specialist input. NICE recommends that the diagnosis should be made by a healthcare professional with expertise in ADHD but general practitioners can monitor and prescribe under a sharedcare arrangement.

In August 2006, we developed an ADHD review clinic for patients transferred from CAMHS where they are assessed initially to rule out co-morbidity and subsequently have six monthly reviews to monitor their bloodpressure, weight, height and the need to continue medication. We have drawn up a shared care protocol with our general practitioners and the plan is that we review the patients while they do the prescribing.

In 7 months, we have been referred 20 patients from CAMHS, Community Paediatrics and general practitioners. Our patient’s unmet needs are similar to those treated by services at Rotherham. Our service is purely amedical team and the majority of the patients need support to assess educational opportunities and some help with problem solving. We often refer them to voluntary agencies for further support. However this is a new service and we hope that in future we will be able to provide a multidisciplinary care. There is also a growing number of requests by general practitioners for assessment and diagnosis of adults presenting for the first time with ADHD-like symptoms. We hope to develop expertise in this area.

We are now arranging to have a joint ADHD transfer clinic with consultants in CAMHS at the end of every school year in June/July not onlyto ensure a smooth take over of care but also to improve our skills. NICE is expected to publish a clinical guideline on pharmacological and psychological interventions in children, young people and adults in April 2008 hopefully this will help to promote the care of ADHD sufferers.

ReferencesVerity, R. & Coates, J. (2007) Service innovation: transitional attention deficit hyperactivity disorder. Psychiatric Bulletin, 31: 99-100.

Asherson, P., Chen, W., Craddock, B. & Taylor, E. (2007) Adult Attention Deficit Hyperactivity Disorder: recognition and treatment in general adult psychiatry. Br J Psychiatry 190: 4-5.

www.nice.org.uk/guidance

Declaration of interest: None
... More

Conflict of interest: None Declared

Write a reply

Transitional Services: What about those with ADHD and / or ASD?

Nicole K Fung, Specialist Registrar in Child and Adolescent Psychiatry
13 March 2007

I was interested to read Verity & Coates’ article (2007) because our local service also recognized that there was little specialised provision to meet the needs of young people with not only Attention Deficit Hyperactivity Disorder (ADHD), but also Autism Spectrum Disorders (ASD), beyond the upper age limits of CAMHS.

In Solihull a neurodevelopmental disorders clinic has been funded to extend the local CAMH service for 17 year olds with ADHD and / or ASD who still required medication, giving the young person an additional year to consider a trial without medication. In this year the young person and their family are also helped to access voluntary and statutory agencies for support; educational, vocational and leisure opportunities; and housing and financial aid for when they leave CAMHS.

Similar to the Rotherham Transitional ADHD Service, our service has limitations too and has no additional nursing, social work or psychology input. The greatest limitation however is the lack of adult services. On approaching their 18th birthday, only one of the seven young people seen in 2006 met the criteria for referral to AMHS. It is noteworthy that only one young person was able to reduce and stop medication successfully. For one young person, the GP agreed to take over prescribing and monitoring. Unfortunately, for the rest of the young people seen there are no appropriate adult services, except in the private sector. There is currently no tertiary service for adults with ADHD locally and those with ASD are considered too able for learning disability services.

It would seem that despite recognition that adolescents with mental health problems have been poorly served (Singh, 2005) and the development of services for early psychosis and transitional arrangements between CAMHS and AHMS... a group of young people approaching adulthood with neurodevelopmental disorders has been forgotten.

SINGH, S.P., EVANS, N., SIRELING, L., STUART, H., (2005) Mind the gap: the interface between child and adult mental health services. Psychiatric Bulletin, 29, 292-294

VERITY, R., COATES, J., (2007) Service innovation: transitional attention-deficit hyperactivity disorder clinic. Psychiatric Bulletin, 31,99-100.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *