In support of mental health awareness week (10-16 May) this blog focuses on Attention Deficit Hyperactivity Disorder (ADHD). ADHD left untreated as a child can lead to significant problems later in life including issues with emotional health, relationships and sometimes other mental health conditions can commonly occur with it.
In this blog East Midlands AHSN Senior Innovation Lead, Laura Rogers highlights the challenges in the system, the importance of an objective test for ADHD diagnosis, local performance and what is next for the Focus ADHD programme in the East Midlands.
What is ADHD?
ADHD is a behavioural disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness and affects around 5%[1] of school-aged children worldwide.
If undiagnosed and /or untreated ADHD can have a significant impact on personal development, academic outcomes and social interaction.
At present, the process for diagnosing ADHD extends over multiple steps. There is no simple test to determine whether a child has ADHD. Assessment is based on the clinician’s judgement, supplemented by subjective reports from parents, teachers and the young person. Sometimes these reports can be contradictory, incomplete and not returned within a timely manner leading to delays in diagnosis.
The challenges
Evidence suggests that ADHD is ‘under-identified, under-diagnosed and undertreated’. Many seeking help can face prejudice and long waiting times for treatment. On average children in the UK wait 18 months to obtain an accurate diagnosis[2].
Assessment for diagnosis due to multiple clinic visits over this period acquires significant costs to the health service estimated at £23 million and the total cost for patients over their lifetime is estimated at more than £102,000[3] (assessment, treatment, management, education and social support).
Quality of care is highly variable across England and there is evidence of a significant unmet clinical need for individuals with ADHD in the UK.
What are the current solutions and what impact does an objective test have on the diagnosis of ADHD?
The East Midlands AHSN supported a 12 month, real-world demonstrator project in three East Midlands Trusts to trial an objective assessment (QbTest) which measures a child's attention, impulsivity and motor activity. All of these indicators are core symptoms of ADHD.
An evaluation was conducted through an audit at each clinic and showed some impressive results including:
- Time from assessment to diagnosis reduced by 153 days
- A reduction in consultant appointments by one per child
- Return on Investment (ROI) to the NHS = £84,460 (median result per trust)
This evidence has led to the national roll out of the ‘Focus ADHD’ programme where all 15 AHSNs have supported the adoption of an objective assessment as part of children's ADHD services across the country.
In the East Midlands, we have eight trusts that provide ADHD services. A typical small trust receives around 25 referrals per month for ADHD so for each trust that includes QbTest in their clinical pathway we know it could release 300 consultant appointments per year, at £58,500. Despite the upfront costs, in year savings would equate to £42,246 per annum for the NHS Trust. Five hospital trusts in the East Midlands are already delivering the objective assessment tool to improve the patient experience, with advanced discussions in two additional trusts. Chesterfield has recently signed up to implement the objective test. The impact of this pathway shift significantly reduces appointments and the time taken for a diagnostic decision to be made.
How has COVID-19 impacted ADHD services?
Whilst all trusts suspended services initially as a result of the pandemic, all trusts have now resumed face to face appointments using clearly defined hygiene protocols.
In the East Midlands, there has been an active upturn of activity to continue to meet the complex needs of children, underpinned by careful planning to ensure safe hygiene processes.
For example, as a part of a wider COVID recovery plan, Northamptonshire Healthcare NHS Foundation Trust has secured a second QbTest site and plans to double the numbers of tests completed for three months to tackle a long waiting list and meet the needs of children and their families.
What is next for the ADHD programme?
We have virtually full coverage of the East Midlands, enabling children from many different backgrounds and postcodes the opportunity to get a more swift and comprehensive assessment enabling appropriate care plans to be commenced. For those who are not diagnosed with ADHD, a more timely assessment will enable their needs to be met by the right clinical team or service more quickly.
We have also harnessed the energy and commitment of the wider ADHD clinical team into a vibrant community of practice who meet quarterly to discuss broad ADHD issues and help to shape the progress of our Focus ADHD programme of work. We are now looking to explore widening the scope of our ADHD programme within the East Midlands building further on the bedrock of good quality care. I am passionate to continue this progress and champion ADHD ensuring that as many eligible children as possible can benefit from the Focus ADHD programme.
Find out more about the East Midlands programme here.
Author
Laura Rogers, Senior Innovation Lead
[1]https://www.scie-socialcareonline.org.uk/the-lifetime-costs-of-attention-deficit-hyperactivity-disorder-adhd/r/a11G0000008MnWRIA0
[2] Fridman, M., Banaschewski, T., Sikirica, V., Quintero, J., & Chen, K. S. (2017). Access to diagnosis, treatment, and supportive services among pharmacotherapy-treated children/adolescents with ADHD in Europe: Data from the caregiver Perspective on Pediatric ADHD survey. Neuropsychiatric Disease and Treatment, 13, 947–958.
[3] https://www.scie-socialcareonline.org.uk/the-lifetime-costs-of-attention-deficit-hyperactivity-disorder-adhd/r/a11G0000008MnWRIA0