‘We’re just not even on the map': Black women’s experiences of adult ADHD diagnosis and care in the United Kingdom

Can Guidelines Help Reduce the Medicalization of Early Childhood?

Treatment Controversies in Adult ADHD.

Prospective Follow-up Studies of ADHD: Helping Establish a Valid Diagnosis in Adults

FIGURE 1. Changes in cortical thickness provide one measure of brain maturation. A large longitudinal study found that for most areas of cortex, children with attention deficit hyperactivity disorder (ADHD) reach peak cortical thickness several years later than typically developing children, supporting presence of developmental delay. The rate of cortical thinning also differed between the group who continued to meet diagnostic criteria into adulthood (persistent ADHD) and those who did not (remitted ADHD). Areas of cortex in which the rate of thinning correlated with adult symptom level (green, more symptoms associated with more thinning) are approximated on medial and lateral simplified representations of cortex. An earlier study also identified multiple areas in which cortex was thinner in adults with persistent ADHD compared with controls (orange). In addition, this study noted some areas of thicker cortex in remitted ADHD when compared with persistent ADHD (blue).

Practical considerations for the evaluation and management of Attention Deficit Hyperactivity Disorder (ADHD) in adults

BackgroundAttention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe.MethodsThe European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated.ResultsBesides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated?ConclusionsADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.

Robotics has made it possible to change and improve many support processes for vulnerable people in different settings. In recent years, its use has been oriented toward supporting therapeutic interventions of neurodevelopmental disorders (NDD), including attention deficit hyperactivity disorder (ADHD). This review of the literature highlights how advances in robotics have evolved in different scenarios of ADHD treatment, its collaboration with other emerging technologies, its results, its limitations, and the research challenges for the future development of robotics in the field of supporting children with ADHD. The authors conducted a literature review based on the location of keywords ‘robotics’ and several NNDs such as ‘ADHD’, ’Autism Spectrum Disorder (ASD)’, ‘cerebral palsy’, and ‘dementia’ in titles, abstracts, and introduction of scientific articles in the Scopus and Web of Science (WoS) database. The reviewed literature was classified according to the type of therapy supported by the robots, the type of robot and the associated technologies. From this analysis, we can solve the research question: Which types of robots have the potential for specific applications in ADHD treatment? Furthermore, this article shows that despite favorable technical results, robotic technologies that support ADHD therapies require significant improvements in terms of scalability, human-machine interaction, and treatment and processing of acquired information to be applied effectively in real-world therapies. The most significant research challenges are proposed to drive research efforts to develop new approaches to enable robotic assistants to participate in ADHD therapies.

Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD.Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining “ADHD” and “prison” keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses.Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7–29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9–47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics.Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis.

Background Attention deficit hyperactivity disorder was previously seen as a childhood developmental disorder, so adult mental health services were not set up to support attention deficit hyperactivity disorder patients who became too old for child services. To our knowledge, this is the first in-depth study of the transition of attention deficit hyperactivity disorder patients from child to adult health services in the UK. Objectives Our objectives were to explore how many young people with attention deficit hyperactivity disorder are in need of services as an adult, what adult attention deficit hyperactivity disorder services are available and how attention deficit hyperactivity disorder stakeholders experience transition from child to adult services. Design An interactive mixed-method design was adopted with three study streams: (1) a 12-month surveillance study with 9-month follow-up to find out how many young people required ongoing medication when they were too old for child services (929 surveys completed by children’s clinicians); (2) a mapping study to identify and describe services for young adults with attention deficit hyperactivity disorder (2686 respondents to online surveys for patients and health workers and freedom of information requests to service providers and commissioners); and (3) a qualitative study to explore key stakeholders’ experiences of transition from child to adult services (144 interviews with 64 attention deficit hyperactivity disorder patients, 28 parents and 52 health clinicians; 38 working in child or adult secondary health services and 14 general practitioners). Members of the public advised at each stage of the study. Results When corrected for non-response and case ascertainment, the annual number of young people with an ongoing need for medication for attention deficit hyperactivity disorder lies between 270 and 599 per 100,000 people aged 17–19 years. Among 315 individuals eligible for transition, 64% were accepted, but only 22% attended their first adult services appointment. Our interactive map describes 294 unique services for adults with attention deficit hyperactivity disorder across the UK, of which 44 are ‘dedicated’ attention deficit hyperactivity disorder services. Few services provide the full range of recommended provision; most focus on diagnosis and medication. Services are unevenly distributed across the UK, with nearly all ‘dedicated’ services being in England. Exploring stakeholders’ experiences revealed how invested the stakeholders are in continuing attention deficit hyperactivity disorder treatment and how the architecture of services affects transition. An association between attention deficit hyperactivity disorder, education and continuance of medication into young adulthood, plus parent involvement and feeling prepared for transition and adult life with attention deficit hyperactivity disorder, influenced investment. However, even with investment, how accessible adult services are, how patient needs fit with the remit of the adult service and the level of patient information available affect transition outcomes. The results also highlight how general practitioners can end up as care co-ordinators during transition by default. Limitations Transition estimates were based on those who want medication, so these indicate a minimum level of need. Conclusions Few of those who need ongoing support for attention deficit hyperactivity disorder successfully transfer to adult services, and a small proportion of those who transfer experience optimal transitional care. Adult attention deficit hyperactivity disorder service provision is patchy. Even among ‘dedicated’ services, few provide the whole range of National Institute for Health and Care Excellence-recommended treatments. Future work We need to evaluate various models of transitional care and adult attention deficit hyperactivity disorder provision, as well as develop and evaluate psychosocial interventions for young people and adults with attention deficit hyperactivity disorder. Trial registration Current Controlled Trials ISRCTN12492022. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 42. See the NIHR Journals Library website for further project information.

Technological advancements are revolutionizing the healthcare sector, notably in the treatment and management of attention deficit/hyperactivity disorder (ADHD). This shift from traditional therapeutic and pharmacological interventions towards a more data-driven approach marks a significant change in ADHD care. The integration of big data (BD) and artificial intelligence (AI) has introduced innovative and effective methods for ADHD management. These technologies not only bring analytical accuracy but also an empathetic understanding of patient needs, enhancing the quality of life through improved screening accuracy, early diagnosis, and the facilitation of remote treatments. This chapter explores a novel method that synergizes BD and AI to enhance the screening, diagnosis, treatment, and monitoring of ADHD. It critically analyzes the increased efficiency and effectiveness in identifying and managing ADHD through a comprehensive literature review and an online questionnaire to forty-eight experts from the healthcare industry. The research underscores the indispensability of BD and AI in developing new clinical approaches, particularly in the backdrop of escalating ADHD cases and broader mental health challenges. The findings align strongly with theoretical expectations, demonstrating significant advancements over previous methodologies. By introducing a strategic technological model that optimally utilizes BD and AI in ADHD care, this research not only proposes an advanced support system for patients but also promotes public health and sustainable, equitable ADHD care practices. Furthermore, it highlights the profound implications for future ADHD studies, potentially revolutionizing the realms of ADHD screening, diagnosis, treatment, and monitoring.

ObjectivesTo summarise service models, facilitators and barriers relevant to recognising and treating attention deficit/hyperactivity disorder (ADHD) within adult public mental health services.MethodsA scoping review following PRISMA-ScR guidelines examined international literature describing adult ADHD care delivered within public mental health systems. Data were charted on models of care, implementation facilitators and barriers, and evidence gaps were identified.ResultsThirteen sources met inclusion criteria. The literature was limited and largely conceptual, consisting predominantly of editorials, commentaries and clinical guidance, with minimal empirical evaluation of implementation or outcomes. Three broad approaches to service delivery were described: embedding ADHD assessment and treatment within existing adult mental health teams; establishing specialist adult ADHD or neurodevelopmental services; and shared-care and primary-care-led models supported by specialist input. Facilitators included targeted workforce training and collaboration with primary care services. Barriers related to diagnostic complexity, clinician confidence, service capacity and concerns regarding prioritisation within public systems.ConclusionsThe literature consistently supports embedding ADHD care within routine adult public mental health teams, supported by targeted registrar and psychiatrist training and structured collaboration with general practitioners. Empirical evaluation of service models is needed to inform sustainable and equitable implementation within publicly funded mental health services.

The importance of general practice involvement in the care of attention-deficit/ hyperactivity disorder (ADHD) is increasing due to the rising numbers of patients who present with the disorder. It has been suggested by consensus bodies that GPs should be identifying and referring patients at the severe end of the ADHD spectrum and managing those with less severe symptoms. However, GPs' views of their role in ADHD care are unknown. Our aim was to explore the attitudes and practices of Australian GPs towards the diagnosis and management of ADHD. We conducted a series of focus groups to explore GPs' beliefs regarding the causes of ADHD, their perceived role in ADHD diagnosis and management and their views on the role of behaviour therapies and pharmacotherapies in ADHD management. The subjects were 28 GPs in six focus groups. GPs in this study did not want to be the primary providers of care for patients with ADHD. Participants indicated a preference to refer the patient to medical specialists for diagnosis and treatment of ADHD, and expressed low levels of interest in becoming highly involved in ADHD care. Concerns about overdiagnosis and misdiagnosis of the disorder, diagnostic complexity, time constraints, insufficient education and training about the disorder, and concerns regarding misuse and diversion of stimulant medications were the reasons cited for their lack of willingness. The Australian GPs in this study identify a role for themselves in ADHD care which is largely supportive in nature, and involves close liaison with specialist services.

Editors' Note Karen Powell Sears and Stacey L. Brown Recent public health, political, cultural, economic, and environmental changes have refocused public attention on women's intimacy, sexuality, family, and relationship experiences. While academic research in these areas increased in recent years, our understanding of Black women's experiences remains limited. Research and public discourse have often framed Black women's lives through a "problem and pathology" prism. In popular culture, a functional classroom to the masses, essentialist tropes of Black womanhood persist offering contemporary spins on historical notions of our sub-humanity reflected in exaggerations of our power, understatements of our vulnerability and denied evidence of our joy and pain. The storied history of academic research about Black women reflects patterns seen in the public sphere. Across disciplines Black women have been understudied and frequently misrepresented. The dearth of research about our organic needs and desires reflect the priorities of the gatekeeping power structures that define and govern the parameters of knowledge deemed scientific and worthy. We recognize that the opportunity to focus on Black women's experience- in the academy and in general social discourse- in ways that is celebratory and uninhibited is a rarely granted privilege. All too often definitions about what is worthy and valid knowledge reflects the same unequal power structures that question Black women's value outside of the academy. It has often been the case that "worthy science" reflects "outsider" imaginations at the exclusion of Black women's insider knowledge. Black and African Diasporic women continue to experience dramatic and rapid shifts in family/intimacy patterns worldwide. With global changes in Black and African Diasporic women's family and relationship formation patterns, discourse in sociology, psychology, Black Studies and Women Studies suggest a need for additional theoretical and methodological perspectives. [End Page 1] The need to engage these issues is of particular concern as crises such as the COVID-19 pandemic, climate instability, and persistent anti–Black racism pose obvious threats to Black women's lives health and sense of wellbeing in the global context. This special issue attempts to respond to this need by exploring the nuanced experiences of Black women's sexuality, intimacy, and leadership from Black scholars from a range of fields including psychology, sociology, Black studies and women's studies. We are grateful for the courage and determination of academic pioneers, past and present, who have broken through erected institutional boundaries to share the insider stories of Black women's experiences. This volume is a collection of such pioneers, who offer new and renewed perspectives, illuminate social patterns that have been obscured and celebrate a range of Black women's humanity. The authors in this collection explore diverse meanings and constructions of intimacy, sexuality, relationships and satisfaction and contemplate Black women's vulnerability in ways that resist narratives of pathology and make visible offer powerful re-conceptualizations of Black women's humanity. [End Page 2] Copyright © 2023 James C. Wadley

Optimal treatment of a child or adolescent with attention-deficit/hyperactivity disorder (ADHD) begins by establishing a collaborative care team consisting of the family, school personnel, primary care clinician (PCC), mental health and subspecialty clinicians, and other adults, such as tutors and coaches.1 To facilitate communication among care team members, a standardized, reliable system should be established to securely collect and share information about the child's ADHD symptoms and functioning, medication side effects, receipt of ADHD treatments, family treatment preferences and goals, and educational resources.1Unfortunately, the fragmentation of ADHD care across health care, mental health, and education sectors is a substantial barrier to communication and collaboration among care team members.1,2 Each sector has its own rules and policies regarding confidentiality and privacy, and individual daily schedules are typically incompatible, making a meaningful, timely, and efficient exchange of information, whether synchronous (eg, phone call) or asynchronous (eg, e-mail), extremely challenging.In many quality improvement efforts to implement the ADHD guidelines, team communication and collaboration have been addressed, most commonly by focusing on improving the receipt of parent- and teacher-completed ADHD rating scales to inform clinician medical decision-making. These efforts have included developing extensive tool kits and online educational resources for PCCs3,4; redesigning office workflows (eg, designating a staff member to manage rating scale collection)5,6; using care managers to serve as the conduit of information across PCCs, parents, teachers, and other clinicians7,8; and developing or adopting ADHD-specific electronic systems or portals that may stand alone and/or be integrated with the electronic health record to varying degrees.9 Over time, these ADHD portals have become increasingly robust in their functionality and usability and have been shown to improve clinician adherence to ADHD guidelines as well as reduce ADHD symptoms in children.10 In some practices, ADHD portals have become the standard of care for children with ADHD.In this issue of Pediatrics, Guevara et al11 compare the effectiveness of a patient portal combined with care management with that of a patient portal alone on ADHD symptoms, treatment goal attainment, and other patient-reported outcome measures. Embedded in the electronic health record, the ADHD patient portal was designed to facilitate the collection and communication of ADHD symptoms and impairment, family treatment preferences and goals, and medication side effects among parents, teachers, and PCCs. ADHD-care managers contacted families and teachers by phone, text message, or e-mail at least once every 3 months to provide education on ADHD treatment, monitor the attainment of treatment goals, and address the patient's and/or family's emerging concerns. The authors found that, although both groups had reductions in ADHD symptoms over time, there was no difference between the 2 groups in ADHD symptom improvement, goal attainment, or other outcomes at any time point. This suggested that care management did not lead to improved ADHD symptoms beyond the effect of the patient portal alone.These results are somewhat surprising in light of other work revealing the benefits of care management for families of children with ADHD7,8 as well as for adults with depression and other chronic conditions.12 Indeed, in sensitivity analyses, Guevara et al11 did find that, although parent and teacher engagement with care managers was modest overall, children in families who received ≥2 care management sessions experienced greater ADHD symptom reduction than those with 1 or 0 sessions. The authors speculated that the virtual nature of their care management intervention (ie, e-mail, phone, or text message) may not have engaged parents as much as would otherwise be expected, compared with studies involving face-to-face care management.What should not be overlooked in this study, however, is that 68% of all study participants used the ADHD portal to complete rating scales at least once, and 30% had a teacher complete rating scales. Considering the impersonal nature of an electronic system, this is an impressive level of parent and teacher engagement, which is essential to the success of care for children and adolescents with ADHD. Engaged parents are more likely to participate in the collaboration activities that inform shared decision-making, such as completing ADHD rating scales regularly, scheduling and keeping ADHD follow-up appointments, and discussing treatment options, preferences, and goals with other care team members. Similarly, engaged teachers are more likely to complete rating scales and implement appropriate classroom-based interventions.Ultimately, the specific method by which to engage parents and teachers in ADHD collaborative care and treatment adherence matters less than the fact that there are a variety of effective methods that can be tailored for best fit with different families. Some will require the "high touch" of a human being; some will do well with a patient portal; others may need both. The overall goal remains the same: to reduce functional impairment and maximize the well-being of children with ADHD.

Purpose of Review: Attention-Deficit/Hyperactivity Disorder (ADHD) is increasingly recognised as a lifelong neurodevelopmental condition that persists into adulthood, often associated with significant functional impairment and high psychiatric comorbidity. Despite global advances, services in India remain severely underdeveloped. This paper reviews international guidelines—including those from NICE, the Canadian ADHD Resource Alliance (CADDRA), the British Association for Psychopharmacology (BAP), and the Indian Psychiatric Society (IPS)—to identify best practices for the assessment and multimodal treatment of adult ADHD. Collection and Analysis of Data: The paper reviews international guidelines on adult ADHD care, highlighting convergent recommendations and their applicability to the Indian context. It analyses systemic gaps in India’s service delivery, including the shortage of trained mental health professionals, low public and professional awareness, lack of culturally adapted tools and materials, and limited access to pharmacological and psychosocial interventions. As an applied example, the paper presents Amaha’s adult ADHD care model—developed in 2022—as a scalable, evidence-based approach tailored to the Indian ecosystem. The model integrates psychiatrist-led assessments using the DIVA-5 tool, structured psychoeducation, cautious pharmacotherapy, and adjunctive psychotherapy within a digitally enabled care framework prioritising, continuity of care, family engagement, and community support. Conclusions: This review proposes recommendations to strengthen ADHD care infrastructure in India. These include workforce training, public awareness initiatives, development of India-centric resources, telepsychiatry reforms, and integration of ADHD into public policy and insurance schemes. Addressing adult ADHD in India is both a clinical and public health imperative, requiring scalable, multidisciplinary, and context-sensitive solutions.