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      Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement

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          Abstract

          Background: Despite evidence-based national guidelines for ADHD in the United Kingdom (UK), ADHD is under-identified, under-diagnosed, and under-treated. Many seeking help for ADHD face prejudice, long waiting lists, and patchy or unavailable services, and are turning to service-user support groups and/or private healthcare for help.

          Methods: A group of UK experts representing clinical and healthcare providers from public and private healthcare, academia, ADHD patient groups, educational, and occupational specialists, met to discuss shortfalls in ADHD service provision in the UK. Discussions explored causes of under-diagnosis, examined biases operating across referral, diagnosis and treatment, together with recommendations for resolving these matters.

          Results: Cultural and structural barriers operate at all levels of the healthcare system, resulting in a de-prioritization of ADHD. Services for ADHD are insufficient in many regions, and problems with service provision have intensified as a result of the response to the COVID-19 pandemic. Research has established a range of adverse outcomes of untreated ADHD, and associated long-term personal, social, health and economic costs are high. The consensus group called for training of professionals who come into contact with people with ADHD, increased funding, commissioning and monitoring to improve service provision, and streamlined communication between health services to support better outcomes for people with ADHD.

          Conclusions: Evidence-based national clinical guidelines for ADHD are not being met. People with ADHD should have access to healthcare free from discrimination, and in line with their legal rights. UK Governments and clinical and regulatory bodies must act urgently on this important public health issue.

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          Most cited references91

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          Diagnostic and Statistical Manual of Mental Disorders

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            Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents.

            The literature on the prevalence of mental disorders affecting children and adolescents has expanded significantly over the last three decades around the world. Despite the field having matured significantly, there has been no meta-analysis to calculate a worldwide-pooled prevalence and to empirically assess the sources of heterogeneity of estimates.
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              The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies.

              This study examined the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood. We analyzed data from published follow-up studies of ADHD. To be included in the analysis, these additional studies had to meet the following criteria: the study included a control group and it was clear from the methods if the diagnosis of ADHD included subjects who did not meet full criteria but showed residual and impairing signs of the disorder. We used a meta-analysis regression model to separately assess the syndromatic and symptomatic persistence of ADHD. When we define only those meeting full criteria for ADHD as having 'persistent ADHD', the rate of persistence is low, approximately 15% at age 25 years. But when we include cases consistent with DSM-IV's definition of ADHD in partial remission, the rate of persistence is much higher, approximately 65%. Our results show that estimates of ADHD's persistence rely heavily on how one defines persistence. Yet, regardless of definition, our analyses show that evidence for ADHD lessens with age. More work is needed to determine if this reflects true remission of ADHD symptoms or is due to the developmental insensitivity of diagnostic criteria for the disorder.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                19 March 2021
                2021
                : 12
                : 649399
                Affiliations
                [1] 1Psychology Services Limited , London, United Kingdom
                [2] 2Department of Psychology, Reykjavik University , Reykjavik, Iceland
                [3] 3ADHD Foundation , Liverpool, United Kingdom
                [4] 4Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London , London, United Kingdom
                [5] 5South London and Maudsley NHS Foundation Trust , London, United Kingdom
                [6] 6Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust , London, United Kingdom
                [7] 7King's Health Partners Academic Health Science Centre , London, United Kingdom
                [8] 8Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London , London, United Kingdom
                [9] 9Leicestershire Partnership NHS Trust , Leicester, United Kingdom
                [10] 10CLC Consultancy , Perth, United Kingdom
                [11] 11SWB (Global) , Glasgow, United Kingdom
                [12] 12Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences & Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton , Southampton, United Kingdom
                [13] 13Solent NHS Trust , Southampton, United Kingdom
                [14] 14Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham , Nottingham, United Kingdom
                [15] 15Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center , New York, NY, United States
                [16] 16The ADHD Clinic, Manor Hospital , Oxford, United Kingdom
                [17] 17Genius Within , Plumpton Green, United Kingdom
                [18] 18Department of Organizational Psychology, Birkbeck College, University of London , London, United Kingdom
                [19] 19AADD-United Kingdom , Bristol, United Kingdom
                [20] 20Bristol Adult ADHD Support Group , Bristol, United Kingdom
                [21] 21Surrey and Borders Partnership NHS Foundation Trust , Leatherhead, United Kingdom
                [22] 22Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London, United Kingdom
                [23] 23ADHD Richmond and Kingston , London, United Kingdom
                [24] 24ADHD Solutions CIC , Leicester, United Kingdom
                [25] 25Cambridge & Peterborough NHS Foundation Trust , Cambridge, United Kingdom
                [26] 26ADHD and Psychiatry Services Limited , Liverpool, United Kingdom
                [27] 27Cheshire and Wirral Partnership NHS Foundation Trust , Chester, United Kingdom
                [28] 28University of Exeter Medical School, University of Exeter , Exeter, United Kingdom
                [29] 29ADHD Consultancy Limited , London, United Kingdom
                [30] 30Adult ADHD and Asperger's Team & Children and Young People's ADHD and ASD Service, Northamptonshire Healthcare NHS Foundation Trust , Kettering, United Kingdom
                [31] 31ADDmire Clinic , West Byfleet, United Kingdom
                [32] 32Epsom and St. Helier University Hospital , Epsom, United Kingdom
                [33] 33Cambridge Cognition , Cambridge, United Kingdom
                [34] 34Psychological Sciences, University of Bristol , Bristol, United Kingdom
                Author notes

                Edited by: Jacobo Albert, Autonomous University of Madrid, Spain

                Reviewed by: Ana Miranda, University of Valencia, Spain; Maurizio Bonati, Mario Negri Pharmacological Research Institute, Italy

                *Correspondence: Susan Young psychltd@ 123456aol.com

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2021.649399
                8017218
                33815178
                cbd04d3a-ca15-4bcb-b6c3-8fd5c1d63b5c
                Copyright © 2021 Young, Asherson, Lloyd, Absoud, Arif, Colley, Cortese, Cubbin, Doyle, Morua, Ferreira-Lay, Gudjonsson, Ivens, Jarvis, Lewis, Mason, Newlove-Delgado, Pitts, Read, van Rensburg, Zoritch and Skirrow.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 04 January 2021
                : 24 February 2021
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 119, Pages: 16, Words: 14269
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                adhd,service provision,healthcare commissioning,assessment,treatment

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