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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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
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
Merrell C, Tymms PB (2001) Inattention, hyperactivity and impulsiveness: their impact on academic achievement and progress. Brit J Educ Psychol 71:43–56
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
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
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
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
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
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
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
Goodman R, Ford T, Meltzer H (2002) Mental health problems of children in the community. BMJ 324:1496–1497
Jarman B (1984) Underprivileged areas: validation and distribution of scores. BMJ 289:1587–1592
Taylor E, Sandberg S, Thorley G et al (1991) The epidemiology of childhood hyperactivity. Oxford University Press, Oxford
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
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
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
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
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
Rutter M, Tizard J, Whitmore K (1970) Education, health, and behaviour. Longman, London
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
Ford T, Hamilton H, Dosani S et al (2007) The children’s services interview: validity and reliability. Soc Psychiatry Psychiatr Epidemiol 42:36–49
Bussing R, Zima BT, Belin TR (1998) Differential access to care for children with ADHD in special education programs. Psychiatr Serv 49:1226–1229
Cuffe SP, Moore CG, McKeown R (2009) ADHD and health services utilization in the national health interview survey. J Atten Disord 12:330–340
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
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
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
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
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
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
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
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
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
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
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
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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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
- School-based intervention
- Service use