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ADHD in Adults

The assessment and treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults was prioritised by the Health Service Executive (HSE) Mental Health and Clinical Strategy and Programmes in conjunction with the College of Psychiatrists of Ireland (COPI) for development as a Clinical Programme.

Scope of the National Clinical Programme

This clinical programme applies to HSE mental health services for adults with Attention Deficit Hyperactivity Disorder (ADHD). The programme applies to all clinical stages of the disorder, and will work collaboratively with other relevant clinical programmes in terms of presentations in other settings.

The terms of reference of this Working Group are to design and develop a model of care for the strategic and operational delivery of services for adults with ADHD taking into consideration:

  • The interests of adults aged 18 years and over
  • Relevant national and international policy documents and reports
  • Relevant national and international research, evidence based practice and standards.

ADHD is in the European Consensus Statement on Diagnosis and Treatment of Adult ADHD described as one of the most common psychiatric disorders of childhood which is now known to persist into adulthood (Kooij 2010).  ADHD in adults is an impairing lifelong condition which is underdiagnosed in most European countries (including Ireland) leading to impaired quality of life following ineffective treatment thereby resulting in on-going distress and impairment. People with ADHD once diagnosed benefit from mental health treatment including psychosocial interventions.

Aims and Objectives:

There are three aims, the sum objective of which is to ensure adults with ADHD have access to assessment and treatment. The scope of each is outlined under each aim:

Assessment of Adults with ADHD

  • Adults with symptoms of ADHD are referred to a General Adult Psychiatry Service for assessment.
  • Adults who have previously been treated for ADHD as children and/or adolescents and who have symptoms suggestive of ADHD are referred to a General Adult Psychiatry Service for assessment.
  • Assessment is carried out by a psychiatrist who has received training in the diagnosis and treatment of ADHD.

Treatment of Adults with ADHD

  • Treatment is multimodal involving a combination of pharmacological and non-pharmacological interventions.
  • The treatment is delivered by mental health professionals trained in the diagnosis and treatment of ADHD.

Transition to Adult Services

  • Young people with ADHD receiving care and treatment from CAMHS or paediatric services should be transferred to General Adult Psychiatry Services if they continue to have significant symptoms of ADHD or other comorbid mental health problems that require treatment.
  • Joint planning between CAMHS and General Adult Psychiatry Services for this transition.

Quality

  • Improve identification and recovery though evidence based treatment by trained, skilled staff;
  • Reduce morbidity and mortality through enhanced risk management;
  • Service user involvement and feedback;
  • Regular evaluation of clinical outcomes.

Access

  • Improve initial assessment screening;
  • Timely access to consultation for referrers;
  • Reduce waiting times to assessment and treatment;
  • Provide a needs-based, stepped care model of service delivery;
  • Seamless transitions across services and from the CAMHS services though guideline development.

Cost

  • Early intervention to improve good management of the condition;
  • Use of evidence based assessment to reduce misdiagnosis and reduce adverse symptoms for adults with this condition;
  • Reduce relapse of symptoms though appropriate psycho education and better self management.

Achievements to Date:

Establishing a multidisciplinary national working group with service user representation to design a Model of Care for ADHD adult services in the HSE based on international best practice.

Tasks completed include:

  • A comprehensive literature review
  • Review of existing Irish research
  • The perspective of adults with ADHD in Ireland
  • Invited presentations on:
    • the role of a specialist ADHD Occupational Therapist
    • ADHD specific cognitive behavioural therapy
    • the assessment process
  • Received invited submissions:
    • HADD-ADHD Ireland
    • ADHD specific coach
  • Presentations to the national HADD-ADHD Ireland conferences in TCD
  • Established links with other key clinical programmes
  • Defined a core clinical outcome dataset
  • Updated draft MOC to CAG aADHD in the COPI

Based on the above, the Clinical Lead and Programme Manager have completed the second draft of the Model of Care, which has been submitted to the College of Psychiatrists of Ireland and its ADHD in Adults Clinical Advisory Group (CAG). The latter was specifically established to consider the clinical components of the document. It’s role is to ensure that what the National Clinical Programme is recommending is in line with best evidenced based practice.

Goals 2018 / 2019

  • Collaboration with the College of Psychiatry of Ireland CAG
  • Identify HSE aADHD resource requirements for demonstration sites
  • Define HSE staff competencies - training and CPD requirements
  • Assist in setting up of a number of Adult ADHD demonstration sites in CHOs
  • Update the core clinical outcome dataset based on site feedback
  • Establish a national oversight implementation group

Whilst the work directly related to creating the National Clinical Programme Model of Care is taking place, the Clinical Lead and Programme Manager in conjunction with the National Clinical Advisor & Group Lead for Mental Health proactively consider what may be required to implement the Programme.

Contact Details

National Clinical Lead:Dr. Margo Wrigley
Programme Manager:Ms. Fiona O'Riordan
Email:fiona.oriordan@hse.ie

National Working Group

List of Members:

NameNominating Body
Margo WrigleyNational Clinical Lead
Fiona O’RiordanProgramme Manager
Kate Carr-FanningHADD - ADHD Ireland
Dimitrios AdamisResearch / Academic nominee
Raju BangaruExecutive Clinical Directors Group
David HanlonGeneral Practitioner Lead
Pavashne MariahSocial Work
Tom McMonagleCollege of Psychiatrists of Ireland
Aisling MulliganCollege of Psychiatrists of Ireland
Brian MurphyAssistant Director of Nursing
Mark O’CallaghanPsychology
Padraic O’FlynnOccupational Therapy
Clinical Strategy and Programmes Division