This study was carried out by Prof Jane McGrath, the ADMiRE clinical team, Jamie Madden and Elizabeth Heron. It was published in the Irish Journal of Psychological Medicine https://pubmed.ncbi.nlm.nih.gov/35361298/
Objectives: Consumer satisfaction is considered one of the most important measures of service quality in child mental health; however, there is limited understanding of factors that influence satisfaction. The objective of this study was to investigate key factors influencing satisfaction with care (SWC) in ADMiRE, a specialist service for young people (YP) with attention deficit hyperactivity disorder (ADHD).
Methods: Parents/carers (n = 67) and YP > 9 years (n = 44) attending ADMiRE completed an anonymous Experience of Service Questionnaire (ESQ), a quantitative/qualitative measure of service user satisfaction. Parents/carers also completed symptom severity rating scales. Data were analysed to determine (i) overall SWC, (ii) the relationship between parent- and youth-reported SWC and (iii) the impact of symptom severity on SWC. Thematic analysis of qualitative ESQ data was completed.
Results: Parents/carers were significantly more satisfied than YP (p = 0.028). Symptom severity did not impact significantly on parent/carer satisfaction. YP with severe hyperactive/impulsive and inattentive ADHD symptoms were significantly less satisfied with care than those with less severe ADHD symptoms (p = 0.022 and p = 0.017 respectively). Factors related to the therapeutic alliance were identified as being particularly important to both parents/carers and YP.
Conclusions: This is the first Irish study that has investigated the impact of symptom severity on service user satisfaction in a child mental health service. The results highlight the different perspectives of YP and parents and provide novel insights into the impact of symptom severity on service user satisfaction. The importance of the therapeutic alliance should not be underestimated in future development of services.
Researchers: Dr Imran Khurshid, Dr Kate Maddock, Prof Jane McGrath
Presented at: College of Psychiatrists of Ireland Spring Meeting 2022
Attention Deficit Hyperactivity Disorder (ADHD) is a highly heritable neurodevelopmental disorder, with prevalence estimates of approximately 5% in children and 2.5% in adults. Despite the high rate of ADHD in adults, the disorder remains under-diagnosed and under-treated beyond adolescence.
There is increasing recognition of the negative impact of untreated adult ADHD on a range of health and social outcomes, including difficulties with parenting and parental mental health. Prevalence of adult ADHD in parents of children with ADHD is likely to be significantly higher than 2.5%, with one small study reporting a prevalence of 40% (Starck et al, 2016), however there is a striking lack of research in this area.
The aim of this study is to investigate the presence of ADHD symptoms in parents of children attending ADMiRE, the specialist ADHD service in Linn Dara Child and Adolescent Mental Health Services (CAMHS).
Parents of children with ADHD attending ADMiRE who have previously given informed consent to be contacted for ADHD research purposes were contacted by phone. Consenting parents were invited to complete two questionnaires that have been validated for screening for adult ADHD: the short version of the Wender Utah ADHD (WURS-25) and Adult Self-Report Scale for ADHD, six-item version (ASRS-6), questions relating to mental health and medication status. Established cut-off scores on the WURS-25 was used to divide the cohort into those who screen positive and negative for adult ADHD.
24 parents of YP attending ADMiRE completed the questionnaire. Of the parent respondents, 29% (n=7) scored above the WURS-25 cut-off of 46. No parents had an existing diagnosis of ADHD, however 50% (n=12) respondents reported that they (or their friends/family) suspected they had symptoms of ADHD. 33%(n=8) of parents reported a comorbid mental health condition. Out of those 33.33%, 25% reported depressive illness, 12.5% reported anxiety disorder, 50% reported depression and anxiety and 12.5% reported depressive illness, anxiety and substance misuse. One parent was currently prescribed psychotropic medication.
This study suggests a high presence of undiagnosed adult ADHD in parents of YP with ADHD. Untreated parental ADHD symptoms are likely to have a negative impact on the outcome of interventions for the YP. Further research is required to investigate the prevalence of adults ADHD in parents of YP with ADHD.
Researchers: ADMiRE team, Elizabeth Heron, Jamie Madden, Jane McGrath
This study was related to the study investigating service user satisfaction in ADMiRE.
Background: In March 2020, Covid-19 restrictions significantly affected mental health service provision for young people (YP) with Attention deficit hyperactivity disorder (ADHD) in Ireland. In ADMiRE, Ireland’s first public specialist service for YP with ADHD, clinicians developed and implemented a series of service initiatives to ensure continuation of safe and effective service provision.
Method: Guidelines on ADHD assessment and management published by the European ADHD Guidelines Group /Canadian ADHD Resource Alliance were reviewed. ADMiRE clinicians introduced videoconferencing, a brief physical review clinic and a new system for issuing controlled drug prescriptions. In addition, an online ADHD psychoeducational website was developed and launched. Service user satisfaction was measured pre-Covid-19 (January-March 2020) and post-Covid-19 (Sept-Dec 2020) using the Experience of Service Questionnaire and ADHD rating scale. A dedicated anonymous online questionnaire was developed to assess the website.
Results: There was no significant difference in service user satisfaction with care pre- and post-Covid-19. Satisfaction in parents/carers (n=67) was high (83% reported maximal satisfaction), and was significantly higher than satisfaction in YP with ADHD (n=44) (p=0.028). Youth-reported satisfaction was negatively influenced by higher ADHD symptom severity (p=0.005). 84% of respondents to the website questionnaire (n=49) reported the information as helpful/very helpful.
Conclusion: In response to Covid-19 restrictions, clinicians in ADMiRE developed, implemented and assessed a series of initiatives that resulted in the provision of safe and effective care for young people with ADHD over the course of the pandemic. Current service user satisfaction with care is high and the service developments have improved quality of care in ADMiRE.
The COVID-19 pandemic was a major emergency. Across the world public health measures were taken to stop the virus spreading and minimise the risk to health and life. This included social distancing, school and workplace closure, limitations on travel and leisure activities.
It was recognised that these measures might affect mental health and behaviour in children and young people of young people with mental health or behavioural needs.
The CRISIS study in Trinity College Dublin was part of a big international survey of children and young people in multiple countries.
We asked parents of children or young people aged 3-18 years with either a mental health disorder, autism or another developmental disability to complete a survey to let us know how their child/ young person had been affected. The responses from this survey will provided insights about what we can do to best support and plan services for the future.
Study results have now been accepted for publication in Molecular Autism
For further details on this study please see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553588/
The Antipsychotics and Inflammation Study (InflammAP study) was funded through the National Children’s Research Centre Clinical Research Fellowship. Dr. Karen Conlan investigated the reasons why antipsychotic drugs that are used to treat various mental health disorders are associated with weight gain and obesity.
Currently, it is not possible for doctors to predict which patients will develop these side effects of weight gain from antipsychotic medication. However, previous research has suggested that weight gain is caused by the development of a persistent low-grade inflammatory state.
In this study, we partnered with experts in obesity and inflammation (Dr. Andy Hogan; Maynooth University and Prof. Donal O’Shea, UCD) to study markers of inflammation in children with mental health disorders before and after the start of treatment with antipsychotic medications.
We found that children and adolescents on antipsychotic medications gain weight rapidly within the first few months of treatment. We also found that within three months these participants developed an increase in some inflammatory markers and immune cells called MAIT cells which are known to be associated with obesity. These inflammatory markers are associated with insulin resistance and increased MAIT cell frequencies have been shown in children with obesity. It is possible that this inflammatory state is involved in the metabolic complications of antipsychotic medications such as the metabolic syndrome, insulin resistance and Type II Diabetes. This study has investigated potential mechanisms for SGA-related weight gain and metabolic complications. Future studies identifying novel targets to prevent the SGA-related inflammation from occurring would be highly beneficial.
Title: Development of an Online Resource for ADHD Psychoeducation in ADMiRE, Ireland’s first public specialist service for children with ADHD
Authors: Roisin Guihen, Barbara Cawley, Sandra O'Grady, Daniel McTiernan, Liliana Marques, Ken Mulholland, Catherine Quinn, Deepti Rodrigues, Jack Latvis, Jane McGrath
Background: Attention Deficit Hyperactivity Disorder (ADHD) is the commonest condition in Child and Adolescent Mental Health services (CAMHS) in Ireland, occurring in 1-in-3 presentations1. The importance of psychoeducation in the management of ADHD has been well established2. Health consumers are increasingly turning to online resources as a source of information3 and despite variability in quality and reliability, families typically use the internet as their main source of information about ADHD4,5.
Objective: To create and evaluate a reliable, specialist-verified, up-to-date source of online information about ADHD.
Methods: Mental health professionals in ADMiRE, Ireland’s first public specialist service for children and adolescents with ADHD6, developed an online psychoeducational package including current, evidence-based information about ADHD and reliable online/published resources. To evaluate the website, an anonymous online survey was developed in Qualtrics, a web-based survey tool. Links to the website and survey were circulated to all families attending ADMiRE (n~230) and listed on the ADHD-Ireland website (Ireland’s largest ADHD advocacy group) in January 2021.
Results: Overall response to the website was very positive. 59% of respondents were parents/carers, 23% had an ADHD diagnosis and 9% were healthcare professionals. 84% reported the information as ‘very helpful’ or ‘helpful’, and 73% found the resource links particularly useful.
Discussion: The ADMiRE website provides a reliable, validated, user-friendly source of information about ADHD. Since the initial launch of the website, it has been used regularly for ADHD psychoeducation in the ADMiRE service, and has recently been used by a number of CAMHS teams and general practitioners nationally.
Title : Prevalence of autism spectrum disorder in young people attending ADMiRE, Ireland’s first specialist paediatric Attention Deficit Hyperactivity Disorder service
There is a high prevalence of autism spectrum disorder (ASD) in young people (YP) diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), with previous studies estimating 33-37% comorbidity. When both disorders co-occur, they cause greater morbidity and create a more complicated clinical challenge. ASD services are required for this cohort, however are very limited in Ireland. The aim of this study was to investigate ASD prevalence and ASD-service access in YP referred to ADMiRE, an ADHD specialist service.
A retrospective file review of 254 referrals to ADMiRE between November 2019 and September 2021 was completed. The following data was collected from each file: 1/ Existing ASD diagnosis at time of referral, 2/ SRS scores (>T-score 70) on parent/teacher rating scales, 3/ Whether ASD assessment had been completed on those who had been referred following ADHD assessement. Data were recorded in Excel and statistics calculated.
Of 254 YP referred to ADMiRE for ADHD assessment, 21% (n=45) had an existing formal diagnosis of ASD on referral. 28.9 % (n=61) had SRS scores in the severe range suggesting undiagnosed ASD. Of YP referred for ASD assessment following ADHD assessment in ADMiRE, only 14% (n=9) had received assessment.
This study demonstrates a high prevalence of ASD in an ADHD cohort and highlights poor access to ASD services locally. There is an urgent need for ASD-specific services in Ireland for both diagnosis and intervention. Without ASD services, it is not possible to provide optimal intervention to YP with ADHD and ASD.
This work was presented at the European Society for Child and Adolescent Psychiatry Conference in June 2022.
Researchers: Emily Cleary, Jane McGrath, Rob Whelan
Objective: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental syndrome associated with behavioural symptoms that can cause impairment of functioning. Debate surrounding the classification and heritability of ADHD remains to be elusive. However, the dual-pathway model has been proposed to illustrate the heterogeneity in symptoms of ADHD by two independent psychological pathways based on separate brain circuits. We aimed to explore reward processing and reversal learning, a hypothesised motivational deficit in individuals with ADHD, among an adult clinical sample, their first-degree relatives and controls.
Method: Thirty seven adults with a diagnosis of ADHD, eight first-degree relatives and thirty six typically developing controls between the ages of 18-61 were analysed based on their performance on a probabilistic selection task (PST-r). Reaction times (RT) and reversal errors were analysed using the Ratcliff diffusion model (DDM), which divides decisional time into separate estimates of information processing efficiency (i.e., drift rate) and an estimate of general non-decisional time.
Results: The groups did not differ in terms of RT or accuracy on the PST-r. However, individuals which demonstrated high levels of ADHD behavioural symptoms had a lower drift rate compared to those with lower levels of symptoms. Additionally, higher levels of ADHD symptoms and first-degree relatives were associated with less non-decisional time.
Conclusion: RT and accuracy performance in ADHD appears to reflect a stronger link to cognitive over motivational deficits among adults with ADHD. Findings support that of the dual-pathways model which suggests two distinct brain circuits. Clinical implications and future research are discussed in terms of assessment and treatments for ADHD.