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Predictors of and barriers to service use for children at risk of ADHD: longitudinal study

Abstract

Many children with, or at risk of, ADHD do not receive healthcare services for their difficulties. This longitudinal study investigates barriers to and predictors of specialist health service use. This is a 5-year follow-up study of children who participated in a cluster randomised controlled trial, which investigated school-level interventions (provision of books with evidence-based information and/or feedback of names of children) for children at risk of ADHD. 162 children who had high levels of ADHD symptoms at age 5 (baseline) were followed up at age 10 years. Using baseline data and follow-up information collected from parents and teachers, children who had and had not used specialist health services over the follow-up period were compared and predictors (symptom severity, comorbid problems, parental perception of burden, parental mental health, and socio-demographic factors) of specialist service use investigated. The most common parent-reported barrier reflected lack of information about who could help. Amongst children using specialist health services who met criteria for ADHD at follow-up, 36 % had been prescribed stimulant medication. Specialist health service use was associated with each one-point increase in teacher-rated symptoms at baseline [inattention symptoms (adjusted OR = 1.40; 95 % CI 1.12–1.76) and hyperactivity/impulsivity symptoms (adjusted OR = 1.23; 95 % CI 1.05–1.44)]. Parental mental health problems were also independently associated with service use (for each one-point increase in symptoms, adjusted OR = 1.41; 95 % CI 1.04–1.91). Severity of teacher-rated ADHD symptoms in early school years is a determinant of subsequent service use. Clinicians and teachers should be aware that parental mental health problems are independently associated with service use for children at risk of ADHD.

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References

  1. 1.

    Polanczyk G, de Lima MS, Horta BL et al (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164:942–948

    Article  PubMed  Google Scholar 

  2. 2.

    Barbaresi WJ, Katusic SK, Colligan RC et al (2007) Long-term school outcomes for children with attention-deficit/hyperactivity disorder: a population-based perspective. J Dev Behav Pediatr 28:265–273

    Article  PubMed  Google Scholar 

  3. 3.

    Merrell C, Tymms PB (2001) Inattention, hyperactivity and impulsiveness: their impact on academic achievement and progress. Brit J Educ Psychol 71:43–56

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Shaw M, Hodgkins P, Herve C et al (2012) A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non treatment. BMC Med 10:99

    Article  PubMed Central  PubMed  Google Scholar 

  5. 5.

    Washbrook E, Propper C, Sayal K (2013) Pre-school hyperactivity and attention problems and educational outcomes in adolescence: prospective longitudinal study. Br J Psychiatry 203:265–271

    Article  PubMed  Google Scholar 

  6. 6.

    Willoughby MT (2003) Developmental course of ADHD symptomatology during the transition from childhood to adolescence: a review with recommendations. J Child Psychol Psychiatry 44:88–106

    Article  PubMed  Google Scholar 

  7. 7.

    Sayal K, Ford T, Goodman R (2010) Trends in recognition and service use for attention deficit/hyperactivity disorder in Britain, 1999–2004. Psychiatr Serv 61:803–810

    Article  PubMed  Google Scholar 

  8. 8.

    Tymms PB, Merrell C (2006) The impact of screening and advice on inattentive, hyperactive and impulsive children. Eur J Spec Needs Educ 21:321–337

    Article  Google Scholar 

  9. 9.

    Sayal K, Owen V, White K et al (2010) The impact of early school-based screening and intervention programs for ADHD on children’s outcomes and access to services—follow-up of a school-based trial at age 10 years. Arch Pediatr Adolesc Med 164:462–469

    PubMed  Google Scholar 

  10. 10.

    Goodman R (1999) The extended version of the Strengths and Difficulties Questionnaire: as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 40:791–799

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Goodman R, Ford T, Meltzer H (2002) Mental health problems of children in the community. BMJ 324:1496–1497

    Article  PubMed Central  PubMed  Google Scholar 

  12. 12.

    Jarman B (1984) Underprivileged areas: validation and distribution of scores. BMJ 289:1587–1592

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. 13.

    Taylor E, Sandberg S, Thorley G et al (1991) The epidemiology of childhood hyperactivity. Oxford University Press, Oxford

    Google Scholar 

  14. 14.

    Asherson P, Brookes K, Franke B et al (2007) Confirmation that a specific haplotype of the dopamine transporter gene is associated with combined-type ADHD. Am J Psychiatry 164:674–677

    Article  PubMed  Google Scholar 

  15. 15.

    Sayal K, Hornsey H, Warren S et al (2006) Identification of children at risk of ADHD: a school-based intervention. Soc Psychiatry Psychiatr Epidemiol 41:806–813

    Article  PubMed  Google Scholar 

  16. 16.

    Sayal K, Taylor E (2005) Parent ratings of school behaviour in children at risk of attention deficit/hyperactivity disorder. Acta Psychiatr Scand 111:460–465

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Sayal K, Goodman R (2009) Do parental reports of child hyperkinetic disorder symptoms at school predict teacher ratings? Eur Child Adolesc Psychiatry 18:336–344

    Article  PubMed  Google Scholar 

  18. 18.

    Goodman R, Ford T, Richards H et al (2000) The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry 41:645–655

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Rutter M, Tizard J, Whitmore K (1970) Education, health, and behaviour. Longman, London

    Google Scholar 

  20. 20.

    Rodgers B, Pickles A, Power C et al (1999) Validity of the malaise inventory in general population samples. Soc Psychiatry Psychiatr Epidemiol 34:333–341

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Ford T, Hamilton H, Dosani S et al (2007) The children’s services interview: validity and reliability. Soc Psychiatry Psychiatr Epidemiol 42:36–49

    Article  PubMed  Google Scholar 

  22. 22.

    Bussing R, Zima BT, Belin TR (1998) Differential access to care for children with ADHD in special education programs. Psychiatr Serv 49:1226–1229

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Cuffe SP, Moore CG, McKeown R (2009) ADHD and health services utilization in the national health interview survey. J Atten Disord 12:330–340

    Article  PubMed  Google Scholar 

  24. 24.

    Ford T, Hamilton H, Meltzer H et al (2008) Predictors of service use for mental health problems among British school children. Child Adolesc Ment Health 13:32–40

    Article  Google Scholar 

  25. 25.

    Sawyer MG, Rey JM, Arney FM et al (2004) Use of health and school-based services in Australia by young people with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 43:1355–1363

    Article  PubMed  Google Scholar 

  26. 26.

    Sayal K (2004) The role of parental burden in child mental health service use: longitudinal study. J Am Acad Child Adolesc Psychiatry 43:1328–1333

    Article  PubMed  Google Scholar 

  27. 27.

    Sourander A, Santalahti P, Haavisto A et al (2004) Have there been changes in children’s psychiatric symptoms and mental health service use? A 10-year comparison from Finland. J Am Acad Child Adolesc Psychiatry 43:1134–1145

    Article  PubMed  Google Scholar 

  28. 28.

    Tick NT, van der Ende J, Verhulst FC (2008) Ten-year increase in service use in the Dutch population. Eur Child Adolesc Psychiatry 17:373–380

    Article  PubMed  Google Scholar 

  29. 29.

    Verhulst FC, van der Ende J (1997) Factors associated with child mental health service use in the community. J Am Acad Child Adolesc Psychiatry 36:901–909

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Froehlich TE, Lanphear BP, Epstein JN et al (2007) Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med 161:857–864

    Article  PubMed  Google Scholar 

  31. 31.

    Sawyer MG, Rey JM, Graetz BW et al (2002) Use of medication by young people with attention-deficit/hyperactivity disorder. Med J Aust 177:21–25

    PubMed  Google Scholar 

  32. 32.

    Tremmery S, Buitelaar JK, Steyaert J et al (2007) The use of health care services and psychotropic medication in a community sample of 9-year-old school children with ADHD. Eur Child Adolesc Psychiatry 16:327–336

    Article  PubMed  Google Scholar 

  33. 33.

    Bussing R, Zima BT, Gary FA et al (2003) Barriers to detection, help-seeking, and service use for children with ADHD symptoms. J Behav Health Serv Res 30:176–189

    Article  PubMed  Google Scholar 

  34. 34.

    Moldavsky M, Groenewald C, Owen V et al (2013) Teachers’ recognition of children with ADHD: role of subtype and gender. Child Adolesc Mental Health 18:18–23

    Article  Google Scholar 

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Acknowledgments

We thank the participating parents and schools, Francis Ndaji for data preparation, Min Yang and Adetayo Kasim for statistical advice and the Department of Health and Department of Education and Skills for funding this follow-up.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Correspondence to Kapil Sayal.

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Sayal, K., Mills, J., White, K. et al. Predictors of and barriers to service use for children at risk of ADHD: longitudinal study. Eur Child Adolesc Psychiatry 24, 545–552 (2015). https://doi.org/10.1007/s00787-014-0606-z

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Keywords

  • ADHD
  • Hyperactivity/inattention
  • School-based intervention
  • Longitudinal
  • Barriers
  • Service use