Comment: Communication and clarity pay off
Rob Rodrigues Pereira
pp 3-3
Misconceptions about attention deficit hyperactivity disorder (ADHD) are not only found among the general public: I often come across teachers and even doctors who believe certain myths about ADHD. Improving knowledge of transitioning to adult care, co-morbidities and successful therapies, and breaking the silence about stigma is important for every new generation of patients, parents and care providers. It is refreshing to read the article by Ilina Singh and Lauren Baker on the VOICES (Voices on Identity, Childhood, Ethics & Stimulants: Children join the debate) study, where children’s thoughts on expectations, concerns, labelling and treatment are investigated. As professionals, we have to listen carefully to these opinions, as we try to work in the most effective and empathetic way on our patient’s behalf.
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ADHD and stigma: the role of environmental factors
Ilina Singh and Lauren Baker
pp 4-7
The VOICES (Voices On Identity, Childhood, Ethics & Stimulants: Children join the debate) study investigated claims about the ethical harms of attention deficit hyperactivity disorder (ADHD) diagnosis and stimulant drug treatments. We focused on three ethical concepts: authenticity, moral agency and moral responsibility. We also investigated children’s perspectives on broader societal concerns about behavioural norms and childhood experiences; schooling expectations and academic pressures; and stigma associated with ADHD. In this article, we report on the finding that ADHD was viewed and experienced by diagnosed children in different ways in the USA and UK. We discuss the different forms of stigma experienced in these two countries and we show the close association between stigma and contextual understandings of ADHD. We argue that medical professionals should do more to directly engage with their paediatric patients to better understand, and to help combat, stigma.
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What I tell young people about transitioning to adult services
Noreen Ryan
pp 8-10
Preparing for the move from young people’s to adult healthcare services can be a daunting task for many young people and their families. It has been found that young people’s participation in this process is hindered, but it is important for you to consider what services you need in order to stay in good health once you are no longer eligible to see child and adolescent mental health services (CAMHS). There are concerns that the high threshold of need required to access adult services can mean that there is no healthcare service available for young people after adolescence. This means it is important to begin the discussion and preparation as early as possible. With the introduction of National Institute for Health and Care Excellence (NICE) guidelines and the recognition that attention deficit hyperactivity disorder (ADHD) is not a childhood-limited disorder, there has been an increasing need for the provision of adult services. The transition of young people to adult services is common in many other disorders, such as diabetes and asthma; however, there are different considerations for transition when mental health and well-being are concerned. This transition will come about at a time when there may be many other changes happening in your life; for example, changes in education, moving away from home and meeting new friends. Adult services tend to view young people as independent from their families and have different expectations of how you should participate in your own care. If you would like your family and friends to remain involved in your care, you should make this known to adult services.
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Assessment scales for adult ADHD
Nigel Humphrey
pp 11-13
The process of assessing attention deficit hyperactivity disorder (ADHD) in adults is fraught with concerns about subjectivity, as difficulties have been shown with self-reporting, both with over- and under-reporting, of symptoms. There have been some shifts to more objective measures such as infrared tracking of eye movements, computerised continuous performance tests, functional MRI and quantitative electroencephalograms (qEEGs). As these can be expensive to set up, the majority of assessments still tend to rely on self-reporting and corroborative evidence. This article will review some of the more common adult assessment frameworks in use. All of the following tools have been validated empirically and cited widely in peer-reviewed research.
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ADHD and atopy
Hervé Caci and Charles Lehéron
pp 14-15
Attention deficit hyperactivity disorder (ADHD) is a frequent neurodevelopmental disorder characterised by both its clinical heterogeneity and co-existing comorbid disorders. The prevalence of these disorders is higher in patients with ADHD than in those without the condition and, conversely, ADHD is more prevalent in patients diagnosed with these comorbid conditions than in those without them. This can be observed, for example, with anxiety disorders, tics, reading disability, sleep disorders and enuresis. In our department at Nice Paediatric Hospitals, we have drawn attention to some such comorbid disorders; namely, enuresis, obesity and atopy. Allergy and neuropsychiatric disorders Atopy, a term derived from the Greek atopia, meaning ‘different’ or ‘out of place’, was originally proposed in 1923 to include asthma and allergic rhinitis. Eczema, or atopic dermatitis (AD), was added to the group in 1933. Its prevalence in childrem increased from 3% before 1960 to at least 16% in 2000, although this strongly varies according to local environmental conditions (air pollution, latitude, and so on). Atopic manifestations follow a typical sequence of progression, with clinical signs of AD predating the development of asthma and allergic rhinitis – a phenomenon known as the ‘atopic march’.
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Resources: ADDISS
pp 16-16
ADDISS (Attention Deficit Disorder Information and Support Services) was established in the late 1990s by Andrea Bilbow in response to the clear gap in the understanding and social acceptance of what is now more commonly understood as attention deficit hyperactivity disorder (ADHD).
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Adolescent therapy: the role of the reflective team
Isabel Hernández Otero and Maria Jose Ortega Cabrera
pp 17-18
Psychotherapy with adolescents is always a challenge, even more so when impulsivity and hyperactivity are associated with conduct disorders and lead to difficulties in socialisation. A combination of psychotherapy and medication has been broadly demonstrated to be the most effective intervention for attention deficit hyperactivity disorder (ADHD). Among the most promising systemic models, the solution-focused therapy model described by Steve de Shazer has been suggested as being particularly indicated for ADHD. However, this intervention may be unsuccessful in those adolescents who, in their quest for identity formation, sometimes question authority figures. In addition, poor social skills and poor moral development associated with psychopathology require a more balanced relationship between therapists and patients to facilitate co-responsibility. This article aims to share our experience at the Department of Child and Adolescent Psychiatry at the University Hospital Virgen de la Victoria in Malaga, Spain. Our unit is a tertiary service that offers assistance to 1,000,000 people in Malaga and the Costa del Sol. The unit provides specialised interventions for children and adolescents with mental health disorders. Once patients have been evaluated in the outpatient clinic, they are referred to specific programmes at the day centre according to their needs.
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