Attention Deficit Hyperactivity Disorder (ADHD) in the European Consensus Statement on Diagnosis and Treatment of Adult ADHD is described as one of the most common psychiatric disorders of childhood.
It is now known to persist into adulthood (Kooij 2010), with approximately 65% of children continuing to have symptoms in adulthood and 15% meeting the full diagnostic criteria (Barkley 2002; Faraone 2006). It is classified as a neurodevelopmental disorder, together with specific learning disabilities, in DSM-5 (APA 2013). It occurs in 5% - 7% of children continuing into adulthood in 3.4% - 4.4% (Faraone 2005; Kessler 2006) with 1.5% having the full syndrome (Faraone 2006).
In Ireland, assessment and treatment of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) is provided through the Child and Adolescent Mental Health Services (CAMHS). The HSE Fifth Annual Child and Adolescent Mental Health Annual Report (2012-13) indicated ADHD was again the most common primary presentation with a peak in the 5-9 year age group. Likewise, both children and adults with intellectual disability who have co-morbid ADHD have access to Mental Health Intellectual Disability Services. The latter provide assessment, care and treatment for ADHD and their expansion to ensure full geographic coverage in Ireland is the subject of an ongoing Service Improvement Project (HSE Service Plans 2015-2018).
However there are virtually no equivalent public services for adults with ADHD who do not have a moderate or greater degree of intellectual disability.
In recognition of this, the HSE’s Mental Health Division (MHD) and Clinical Strategy and Programmes Division (CPSD) in conjunction with the College of Psychiatrists of Ireland (COPI) established a National Clinical Programme for ADHD in Adults in 2016. The MHD and CSPD then established a Working Group for this National Clinical Programme (NCP) and work began in Autumn 2016.
Purpose of the National Working Group
The Working Group was charged with designing and developing a Model of Care for the strategic and operational delivery of services for adults with ADHD taking into consideration:
- The interests of adults aged 18 years and over
- Relevant national and international policy documents and reports
- Relevant national and international research, evidence-based practice and standards.
The Working Group was chaired by the then National Clinical Advisor Group Lead Mental Health who has since been appointed Clinical Lead for the National Clinical Programme. The members of the Working Group are listed here and include multi-disciplinary and service user representation, in keeping with the principles outlined in A Vision for Change for service development (AVFC 2006).
The Model of Care should not be considered as in-depth clinical practice guidance. Clinical aspects of it may be developed as such in the future through the Department of Health’s National Clinical Effectiveness Committee.
The specific aims of this Clinical Programme are:
- To provide for the assessment of adults with symptoms suggestive of ADHD by trained and skilled staff.
- To provide multi-modal treatment involving a combination of pharmacological and non pharamacological interventions.
- To ensure that young people attending CAMHS for ADHD who continue to have significant symptoms of ADHD and/or co-morbid mental illness who require treatment can be transferred to adult mental health services. That this transfer is planned in advance to ensure it occurs smoothly.
- That all of the above is delivered through a clearly defined and integrated clinical pathway.
In devising the Model of Care recommended by this National Clinical Programme the following information was considered:
- A comprehensive literature review1
- Current Irish research on ADHD in adults
- The service user perspective
- Invited presentations on:
- the assessment process
- the role of a specialist ADHD Occupational Therapist
- psycho-education and cognitive behavioural therapy for adults with ADHD
- Submission from a specialist ADHD coach.
1 Data bases used: Pubmed, Clinahl, Psychinfo, Cochrane; Grade System.