1. Sudipta Sen 2 nd June 2015 INTEGRATED/COLLABORATIVE CARE IN ADHD MANAGEMENT

2. Neurodevelopmental disorder Inattentive Hyperactive/impulsive WHAT DOES DSM V SAY ABOUT ADHD?

3.  <12 years 6 symptoms, 6 months  >17 years 5 symptoms, 6 months  Clinically significant Impairment in 2 settings  Autism Spectrum Disorder not an exclusion  Persisting into adulthood IN DSM 5 socialacademicoccupational

4. CO-MORBIDITIES

5.  ICD-10 criteria 1-2% qualify as moderate ADHD  DSM-IV criteria 3-9% of school age children  Child of any age can be diagnosed with ADHD with age appropriate criteria ADHD IN UK

6. NICE RECOMMENDATIONS Child or Young Person with ADHD Behavioural or Psychological interventions Drug Treatment in children and young people Response to treatment Transition to adult services

7. Care co-ordinator STEPPED CARE MODEL FOR ADHD Tier 1- GP/HV/school/practice nurse Tier 2- CAMHS and/ or Paediatrician Tier 3-multidisciplinary (specialist Paediatrician/psychiatrist/clinica l psychologist/may be SLT/OT) Tier 4-Regional ADHD services/supporter of CAMHS 3(complexity of diagnosis and medication ) ADHD assessment/parent training ADHD/Developmental assessment/ co-morbidities/decision tier 3

8.  Better training of professionals at every step Better behavioural management therapy groups  Better information and awareness KEY TO SUCCESS OF STEP CARE APPROACH

9. GP/Pae diatricia ns Alder Hey ADHD Foundation >14yrs self referrals/ parents school Other agencies INTEGRATED CARE PATHWAY-LIVERPOOL MODEL Referrals are made from different sources

10. PsychotherapistCBT counsellorsPsychologistsNurseSocial Worker Mental Health Workers Youth Participation Workers Doctors ADHD FOUNDATION TEAM

11.  ADHD affects 8 to 12% of US school aged children  Large number of children do not meet full diagnostic criteria of ADHD  Gap in evidence and practice in primary care engagement US-WHAT IS KNOWN?

12.  Engagement with behavioural healthcare is problematic  Low income parents  Presence of behavioural co-morbidities CHALLENGES

13.  2 care management systems  6 to 12-year-old children being evaluated for ADHD  Trained care managers in enhanced arm  To assess - inattention, hyperactivity/impulsivity, oppositionality, social skills  Duration-1 year, starting from ADHD workup RANDOMISED COMPARATIVE EFFECTIVENESS TRIAL (COLLABORATIVE CARE) –SILVERSTEIN ET AL

14.  No formal mental health training  Reports- Vanderbilt ADHD diagnostic Rating skills (P+T)  Trained in medical history taking/behavioural history/social history  Liaisons between primary care providers and decision support panel CARE MANAGERS

15. ADDITIONAL TRAINING OF CARE MANAGERS  Ambivalence towards engagement with behavioural healthcare  Parental mental health  Oppositional child behaviour

16.  No difference between study arms  ADHD consistent, enhanced care better symptom trajectory  Consistent with recent novel approach to behavioural health  Emphasises low income urban group, primary care model  Increased receptivity to medication in enhanced group DISCUSSION

17. Time to look around the world and see what we can have at our door step!!!!