Publications by authors named "Susan Young"

246 Publications

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

Front Psychiatry 2021 19;12:649399. Epub 2021 Mar 19.

Cambridge Cognition, Cambridge, United Kingdom.

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. 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. 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. 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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http://dx.doi.org/10.3389/fpsyt.2021.649399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017218PMC
March 2021

Executive Functions and Impulsivity are Genetically Distinct and Independently Predict Psychopathology: Results from Two Adult Twin Studies.

Clin Psychol Sci 2020 May 20;8(3):519-538. Epub 2020 Apr 20.

Division of Substance Dependence, Psychiatry Department, University of Colorado Denver.

Laboratory executive function (EF) constructs, such as response inhibition, are often conceptually linked with self-report measures of impulsivity, yet their empirical correlations are low. We examined, in two twin studies (s=749 and 761 individuals with EF data), the phenotypic and genetic overlap of three EF latent variables (a Common EF factor predicting response inhibition, working memory updating, and mental set shifting tasks, and Updating- and Shifting-specific factors) with five impulsivity dimensions (negative and positive urgency, lack of premeditation and perseverance, and sensation seeking). In both samples, impulsivity dimensions only modestly correlated phenotypically (s= -.20-.11) and genetically (As= -.44-.04) with Common EF. In both samples, Common EF and multiple impulsivity dimensions, particularly negative urgency, independently predicted Externalizing psychopathology, and multiple impulsivity dimensions, but not Common EF, predicted Internalizing psychopathology. These results suggest that EFs and self-reported impulsivity tap different aspects of control that are both relevant for psychopathology.
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http://dx.doi.org/10.1177/2167702619898814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983400PMC
May 2020

Perceptions and Attitudes of Correctional Staff Toward ADHD-A Challenging Disorder in Everyday Prison Life.

Front Psychiatry 2020 28;11:600005. Epub 2021 Jan 28.

Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is associated with risk-taking behaviors, poor self-control, and interpersonal difficulties. Affected individuals have an increased probability of involvement with the criminal justice system, contributing to a higher rate of arrest, and imprisonment compared with the general population; they are also inadequately treated once sentenced. Because prison staff play a central role in the identification of inmates with mental disorders, they could well be key to improving provision of care. There is however little knowledge of the conceptions, perceptions, and attitudes of prison staff toward ADHD. Such information could help to identify starting points for awareness training and further implementation of specific ADHD treatment. To bridge this gap, we undertook a study based on a qualitatively-driven mixed methods design, combining qualitative data collection in the form of narrative interviews with 19 prison staff from a Swiss correctional facility with quantitative data collection in the form of a survey that included the Attitudes toward Prisoners scale. The interviews were analyzed with QSR NVIVO 11 and a qualitative content analysis approach was used to evaluate findings. Prison staff were generally aware of ADHD and its symptomology, believing it to a be "real," but "fashionable" disorder and favoring hereditary-genetic or biological explanatory models for its development. They viewed inmates with ADHD rather negatively, as complicating correctional efforts, and perceived them as sticking out, as tying up more resources and as frequently being involved in confrontations. Our findings suggest that difficulties in pragmatic aspects of communication and language comprehension may be perceived "as not listening or following instructions," creating additional tensions. Consequently, inmates with ADHD are more often exposed to disciplinary sanctions, such as solitary confinement-an intervention deemed "necessary" by staff. Therefore, staff training on ADHD might need to cover evidence on adverse effects. Non-pharmacological interventions for treatment were preferred and considered to be highly efficacious. Skepticism toward pharmacological treatment prevailed, even when benefits from stimulant medication were described. Interestingly, this skepticism was not the result of negative experiences with the misuse and diversion of stimulants. Acceptance of multimodal treatment among prison staff may require customized strategies.
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http://dx.doi.org/10.3389/fpsyt.2020.600005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901975PMC
January 2021

Recommendations for occupational therapy interventions for adults with ADHD: a consensus statement from the UK adult ADHD network.

BMC Psychiatry 2021 Feb 4;21(1):72. Epub 2021 Feb 4.

Psychology Services Limited, London, UK.

Background: ADHD is neurodevelopmental disorder which persists into adulthood. Presently, therapeutic approaches are mainly pharmacological and psychological whilst the role, scope and approaches of occupational therapists have not been adequately described.

Results: In this consensus statement we propose that by assessing specific aspects of a person's occupation, occupational therapists can deploy their unique skills in providing specialist interventions for adults with ADHD. We also propose a framework with areas where occupational therapists can focus their assessments and give practice examples of specific interventions.

Conclusions: Occupational therapists have much to offer in providing interventions for adults with ADHD. A unified and flexible approach when working with adults with ADHD is most appropriate and further research on occupational therapy interventions is needed.
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http://dx.doi.org/10.1186/s12888-021-03070-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863422PMC
February 2021

ADHD and offending.

J Neural Transm (Vienna) 2021 Feb 4. Epub 2021 Feb 4.

Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK.

Objectives: International studies have reported disproportionately higher rates of Attention Deficit Hyperactivity Disorder (ADHD) among youth and adult offenders across police custody, prison, probation and forensic mental health settings, estimated to fall at around 25%. This review aimed to investigate the presentation and vulnerabilities of this subpopulation of people with ADHD compared to those with ADHD in the general population and consider how this may impact on the approach to assessment and treatment in this population.

Methodology: A selective review of the extant literature was conducted to investigate how offenders with ADHD may present differently from their non-ADHD peers in their clinical presentation, criminogenic behaviour and psychological vulnerabilities.

Results: Nearly all (around 96%) offenders with ADHD have additional comorbid problems, including mood, anxiety, conduct, substance use and personality disorders. Compared with offenders without ADHD, they become involved in the criminal justice system (CJS) at a younger age, have higher rates of recidivism, are more likely to make a false confession, engage in behavioural disturbances in custody, have health risk behaviours and a lower quality of life. Assessing and treating ADHD in this subpopulation may be more complex due to their presentation.

Conclusions: Offenders with ADHD are disadvantaged within the system by their ADHD symptoms being unrecognised and/or misunderstood; their diagnosis of ADHD may be missed or misdiagnosed. This is at cost to the individual, from both a health and rehabilitative perspective, as well as more broadly to society.
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http://dx.doi.org/10.1007/s00702-021-02308-0DOI Listing
February 2021

Regulating the traditional kinship care practice in Ghana: Reflections from young people with kinship care experience.

Child Care Health Dev 2021 May 4;47(3):329-335. Epub 2021 Jan 4.

Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.

Background: Kinship care has become a favourable alternative care option for orphans and vulnerable children without adequate parental care in Ghana. However, kinship care practices in Ghana are considered informal cultural practices without formal regulations. The absence of formal regulations could have consequences on the health and development of children due to the lack of proper supervision and empirical assessment of children's needs. In line with recent policy discussions on mechanisms to regulate informal kinship care practices, this study aimed to identify how the State could be involved in improving kinship care experience for children.

Methods: Qualitative in-depth interviews were conducted with 22 young persons (aged 18-23) who had been received into kinship care to share their experiences on how the State could be involved in improving kinship care experience for children. Narratives from the young people were analysed following the constructivist grounded theory approach.

Results: Introduction of a welfare scheme for kinship caregivers, policy on child care, provision of start-up capital and training for caregivers, were measures suggested by the young people to improve kinship care practice. Providing start-up capital to kinship caregivers was identified to mitigate caregivers' unemployment challenges, which could have ripple effects on the well-being of children by escalating caregiver stress.

Conclusion: The study's findings suggest that the State has a significant role to ensure that caregivers are equipped with the needed resources to provide adequate care for children. Regulating kinship care practices should embrace a strength-based empowerment model that builds on the capacity of the caregivers to ensure better outcomes for children. Studies that explore the views of policy makers and caregivers in a larger sample may yield promising results to complement the current findings.
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http://dx.doi.org/10.1111/cch.12845DOI Listing
May 2021

Assessment and treatment of substance use in adults with ADHD: a psychological approach.

J Neural Transm (Vienna) 2020 Nov 19. Epub 2020 Nov 19.

Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.

Over half of young people and adults diagnosed with Attention Deficit Hyperactivity Disorder [ADHD] also have substance use disorder [SUD]. Their use of substances may arise from an attempt to self-medicate and/or to cope with their difficulties. This manuscript reviews key research in the literature and identifies that traditional SUD psychological interventions are an effective treatment for those presenting with a dual diagnosis of ADHD and SUD. However, typically, this is only available to those presenting to specialist SUD services for treatment of harmful use and/or dependency. This misses an opportunity to intervene much earlier, before drug use escalates to these levels. The manuscript aims to provide practical guidance for healthcare practitioners, by detailing a psychological framework for earlier assessment and intervention of problematic drug use in young people and adults with ADHD. Specific techniques are outlined drawing on psychoeducation, motivational interviewing and cognitive behavioural therapy in a phased approach to address factors that motivate initial use of substances and those that maintain use.
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http://dx.doi.org/10.1007/s00702-020-02277-wDOI Listing
November 2020

Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women.

BMC Psychiatry 2020 08 12;20(1):404. Epub 2020 Aug 12.

Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, London, UK.

Background: There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD.

Methods: The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan.

Results: A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them.

Conclusions: This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.
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http://dx.doi.org/10.1186/s12888-020-02707-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422602PMC
August 2020

Mapping UK mental health services for adults with attention-deficit/hyperactivity disorder: national survey with comparison of reporting between three stakeholder groups.

BJPsych Open 2020 Jul 29;6(4):e76. Epub 2020 Jul 29.

Department of Psychiatry, University of Cambridge, UK.

Background: UK clinical guidelines recommend treatment of attention-deficit hyperactivity disorder (ADHD) in adults by suitably qualified clinical teams. However, young people with ADHD attempting the transition from children's to adults' services experience considerable difficulties in accessing care.

Aims: To map the mental health services in the UK for adults who have ADHD and compare the reports of key stakeholders (people with ADHD and their carers, health workers, service commissioners).

Method: A survey about the existence and extent of service provision for adults with ADHD was distributed online and via national organisations (e.g. Royal College of Psychiatrists, the ADHD Foundation). Freedom of information requests were sent to commissioners. Descriptive analysis was used to compare reports from the different stakeholders.

Results: A total of 294 unique services were identified by 2686 respondents. Of these, 44 (15%) were dedicated adult ADHD services and 99 (34%) were generic adult mental health services. Only 12 dedicated services (27%) provided the full range of treatments recommended by the National Institute for Health and Care Excellence. Only half of the dedicated services (55%) and a minority of other services (7%) were reported by all stakeholder groups (P < 0.001, Fisher's exact test).

Conclusions: There is geographical variation in the provision of NHS services for adults with ADHD across the UK, as well as limited availability of treatments in the available services. Differences between stakeholder reports raise questions about equitable access. With increasing numbers of young people with ADHD graduating from children's services, developing evidence-based accessible models of care for adults with ADHD remains an urgent policy and commissioning priority.
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http://dx.doi.org/10.1192/bjo.2020.65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443899PMC
July 2020

Shall We Play the Same? Pedagogical Perspectives on Infants' and Children's Imitation of Musical Gestures.

Front Psychol 2020 3;11:1087. Epub 2020 Jun 3.

Sorbonne-University, CNRS UMR 7225, Paris, France.

Imitation, both gestural and vocal, has been acknowledged to be at the origin of human communication (Donald, 1991). Music is often considered to be the first means of communication of emotion via both vocal and gestural synchronization (Malloch, 1999; Malloch and Trevarthen, 2009). Instrumental music is part of the human heritage for more than 35,000 years before our era (Aimé et al., 2020). However, very little is known about the acquisition of gestures that produce sounds (i.e., musical gestures) and their role in the development of music and musicality. In the present paper, we propose that studying early synchronous imitation of musical gestures is essential both for investigating the development of the early action-perception system and for outlining early music interventions during infancy. We designed double musical objects which can be used in preschool music education for prompting synchronic imitation of musical gestures between adult and child, and between dyads of infants. We conclude by proposing a novel pedagogical perspective in music education for the early years which links the privileged orientation of infants and children towards sound discoveries with the development of perception-action coupling via imitation of musical gestures.
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http://dx.doi.org/10.3389/fpsyg.2020.01087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283546PMC
June 2020

Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus.

BMC Med 2020 05 25;18(1):146. Epub 2020 May 25.

Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

Background: Individuals with co-occurring hyperactivity disorder/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can have complex presentations that may complicate diagnosis and treatment. There are established guidelines with regard to the identification and treatment of ADHD and ASD as independent conditions. However, ADHD and ASD were not formally recognised diagnostically as co-occurring conditions until the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) was published in 2013. Hence, awareness and understanding of both conditions when they co-occur is less established and there is little guidance in the clinical literature. This has led to uncertainty among healthcare practitioners when working with children, young people and adults who present with co-existing ADHD and ASD. The United Kingdom ADHD Partnership (UKAP) therefore convened a meeting of professional experts that aimed to address this gap and reach expert consensus on the topic that will aid healthcare practitioners and allied professionals when working with this complex and vulnerable population.

Method: UK experts from multiple disciplines in the fields of ADHD and ASD convened in London in December 2017. The meeting provided the opportunity to address the complexities of ADHD and ASD as a co-occurring presentation from different perspectives and included presentations, discussion and group work. The authors considered the clinical challenges of working with this complex group of individuals, producing a consensus for a unified approach when working with male and female, children, adolescents and adults with co-occurring ADHD and ASD. This was written up, circulated and endorsed by all authors.

Results: The authors reached a consensus of practical recommendations for working across the lifespan with males and females with ADHD and ASD. Consensus was reached on topics of (1) identification and assessment using rating scales, clinical diagnostic interviews and objective supporting assessments; outcomes of assessment, including standards of clinical reporting; (2) non-pharmacological interventions and care management, including psychoeducation, carer interventions/carer training, behavioural/environmental and Cognitive Behavioural Therapy (CBT) approaches; and multi-agency liaison, including educational interventions, career advice, occupational skills and training, and (3) pharmacological treatments.

Conclusions: The guidance and practice recommendations (Tables 1, 4, 5, 7, 8 and 10) will support healthcare practitioners and allied professionals to meet the needs of this complex group from a multidisciplinary perspective. Further research is needed to enhance our understanding of the diagnosis, treatment and management of individuals presenting with comorbid ADHD and ASD.
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http://dx.doi.org/10.1186/s12916-020-01585-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247165PMC
May 2020

Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice.

Health Care Manag (Frederick) 2020 Apr/Jun;39(2):100-108

Reprinted from Young S, Guo KL. Cultural diversity training: the necessity of cultural competence for health care providers and in nursing practice. Health Care Manag. 2016; 35(2):94-102. doi:10.1097/HCM.0000000000000100. Author Affiliations: Health Care Administration Program, University of Hawaii-West Oahu.

The purpose of this article is to discuss the need to provide culturally sensitive care to the growing number of diverse health care consumers. A literature review of national standards and research on cultural competency was conducted and specifically focused on the field of nursing. This study supports the theory that cultural competence is learned over time and is a process of inner reflection and awareness. The domains of awareness, skill, and knowledge are essential competencies that must be gained by health care providers and especially for nurses. Although barriers to providing culturally sensitive care exist, gaining a better understanding of cultural competence is essential to developing realistic education and training techniques, which will lead to quality professional nursing practice for increasingly diverse populations.
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http://dx.doi.org/10.1097/HCM.0000000000000294DOI Listing
April 2020

Influenza-Related Parotitis during a Large Mumps Outbreak - Arkansas, 2016-2017.

Arch Clin Case Rep 2019 May 1;2(2):6-8. Epub 2019 May 1.

Arkansas Department of Health, Little Rock, USA.

During August 2016-July 2017, Arkansas experienced a large mumps (parotitis) outbreak; however, mumps-negative cases of parotitis were also identified in this period. Nineteen of 215 samples (9%) randomly selected for influenza PCR testing were positive for influenza A virus. Practitioners should consider influenza as a cause of nonmumps parotitis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181805PMC
May 2019

Shape and Reflectance Reconstruction Using Concentric Multi-Spectral Light Field.

IEEE Trans Pattern Anal Mach Intell 2020 Jul 13;42(7):1594-1605. Epub 2020 Apr 13.

Recovering the shape and reflectance of non-Lambertian surfaces remains a challenging problem in computer vision since the view-dependent appearance invalidates traditional photo-consistency constraint. In this paper, we introduce a novel concentric multi-spectral light field (CMSLF) design that is able to recover the shape and reflectance of surfaces of various materials in one shot. Our CMSLF system consists of an array of cameras arranged on concentric circles where each ring captures a specific spectrum. Coupled with a multi-spectral ring light, we are able to sample viewpoint and lighting variations in a single shot via spectral multiplexing. We further show that our concentric camera and light source setting results in a unique single-peak pattern in specularity variations across viewpoints. This property enables robust depth estimation for specular points. To estimate depth and multi-spectral reflectance map, we formulate a physics-based reflectance model for the CMSLF under the surface camera (S-Cam) representation. Extensive synthetic and real experiments show that our method outperforms the state-of-the-art shape reconstruction methods, especially for non-Lambertian surfaces.
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http://dx.doi.org/10.1109/TPAMI.2020.2986764DOI Listing
July 2020

Cognitive-behavioural group therapy for adolescents with ADHD: study protocol for a randomised controlled trial.

BMJ Open 2020 03 25;10(3):e032839. Epub 2020 Mar 25.

Department of Child and Adolescent Psychiatry, St Olav University Hospital, Trondheim, Norway.

Introduction: Persistence of attention deficit hyperactivity disorder (ADHD) into adolescence is a significant burden to patients. Clinical guidelines recommend non-pharmacological therapies, but the evidence to support this recommendation is sparse. This study aims to evaluate the effect of a 12-week group cognitive-behavioural therapy (CBT) programme for adolescents with ADHD aged 14-18 years, who still have impairing symptoms after treatment with medication. We will study the effect of the treatment on ADHD symptoms and examine moderators and mediators of the effect of the treatment on ADHD.

Methods And Analysis: We conduct a randomised controlled trial of CBT group therapy in adolescents with ADHD recruited from child psychiatric outpatient units in Mid-Norway. 99 adolescents who met inclusion criteria and consented to participation have been randomised to a 12-week group intervention or to a control group receiving treatment as usual. Assessments are made at admission to the clinic, preintervention, postintervention and at a 9-month follow-up, obtaining adolescent, parent and teacher reports. Clinicians blinded to group allocation rate all participants as to their functioning preintervention and at the two postintervention assessment points. The primary outcome is change in symptom scores on the ADHD Rating Scale-IV.

Ethics And Dissemination: The Regional Committee for Medical and Health Research Ethics in South East Norway approved the study protocol (2015/2115). We will disseminate the findings in peer-reviewed publications and conference presentations, to user organisations and at courses attended by families and professionals. Two PhD students will publish and defend dissertations relating to the study. Planned publications include primary and secondary outcomes and patient satisfaction with the treatment. Furthermore, we plan to publish a manual of CBT group therapy in adolescent ADHD to benefit treatment of patients in Norway and elsewhere.

Trial Registration Number: NCT02937142.
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http://dx.doi.org/10.1136/bmjopen-2019-032839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170565PMC
March 2020

FACT: a randomised controlled trial to assess the feasibility of QbTest in the assessment process of attention deficit hyperactivity disorder (ADHD) for young people in prison-a feasibility trial protocol.

BMJ Open 2020 01 20;10(1):e035519. Epub 2020 Jan 20.

Child and Adolescent Mental Health Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, Lancashire, UK.

Introduction: The prevalence of attention deficit hyperactivity disorder (ADHD) within the Children and Young People Secure Estate (CYPSE) is much higher than seen in the general population. To make a diagnosis of ADHD, clinicians draw on information from multiple sources, including parents and teachers. However, obtaining these is particularly difficult for young people in the secure estate. There is increasing evidence in the community that QbTest is able to assist in the accurate and earlier diagnosis of ADHD. The objective of this study is to assess the feasibility and acceptability of QbTest in the assessment of ADHD within the CYPSE.

Methods And Analysis: A single-centre parallel group feasibility randomised controlled trial will be conducted. Sixty young people within the CYPSE identified as displaying possible symptoms of ADHD will be randomised to the intervention arm (n=30; QbTest plus usual care) or control arm (n=30; usual care). Primary analyses will be descriptive and a process evaluation will be conducted to assess the contexts involved in implementing the intervention. Interviews will be conducted to explore acceptability and thematic analysis will be used to analyse the data.

Ethics And Dissemination: This study was approved by National Health Service Wales research ethics committee 3 (18/WA/0347) on 15 February 2019. The findings will be published in peer-reviewed journals, presented at relevant conferences and disseminated to the public via summaries cocreated with our patient and public involvement group.

Trial Registration Number: ISRCTN17402196.
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http://dx.doi.org/10.1136/bmjopen-2019-035519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044874PMC
January 2020

FACT: a randomised controlled trial to assess the feasibility of QbTest in the assessment process of attention deficit hyperactivity disorder (ADHD) for young people in prison-a feasibility trial protocol.

BMJ Open 2020 01 20;10(1):e035519. Epub 2020 Jan 20.

Child and Adolescent Mental Health Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, Lancashire, UK.

Introduction: The prevalence of attention deficit hyperactivity disorder (ADHD) within the Children and Young People Secure Estate (CYPSE) is much higher than seen in the general population. To make a diagnosis of ADHD, clinicians draw on information from multiple sources, including parents and teachers. However, obtaining these is particularly difficult for young people in the secure estate. There is increasing evidence in the community that QbTest is able to assist in the accurate and earlier diagnosis of ADHD. The objective of this study is to assess the feasibility and acceptability of QbTest in the assessment of ADHD within the CYPSE.

Methods And Analysis: A single-centre parallel group feasibility randomised controlled trial will be conducted. Sixty young people within the CYPSE identified as displaying possible symptoms of ADHD will be randomised to the intervention arm (n=30; QbTest plus usual care) or control arm (n=30; usual care). Primary analyses will be descriptive and a process evaluation will be conducted to assess the contexts involved in implementing the intervention. Interviews will be conducted to explore acceptability and thematic analysis will be used to analyse the data.

Ethics And Dissemination: This study was approved by National Health Service Wales research ethics committee 3 (18/WA/0347) on 15 February 2019. The findings will be published in peer-reviewed journals, presented at relevant conferences and disseminated to the public via summaries cocreated with our patient and public involvement group.

Trial Registration Number: ISRCTN17402196.
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http://dx.doi.org/10.1136/bmjopen-2019-035519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044874PMC
January 2020

In transition with ADHD: the role of information, in facilitating or impeding young people's transition into adult services.

BMC Psychiatry 2019 12 17;19(1):404. Epub 2019 Dec 17.

University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.

Background: Many national and regional clinical guidelines emphasise the need for good communication of information to young people and their parent/carers about what to expect during transition into adult services. Recent research indicates only a minority of young people in need of transition for Attention Deficit Hyperactivity Disorder (ADHD) experience continuity of care into adulthood, with additional concerns about quality of transition. This qualitative study explored the role that information plays in experiences of transition from the perspectives of parent/carers and young people.

Methods: Participants were recruited from 10 National Health Service Trusts, located across England, with varying service configurations. Ninety two qualitative interviews were conducted: 64 with young people with ADHD at different stages relative to transition, and 28 with parent/carers. Thematic analysis of data was completed using the Framework Method.

Results: Interviewees reported a range of experiences; however reliance on parent/carers to gather and translate key information, and negative experiences associated with poor communication of information, were universal. Three themes emerged: Navigating information with help from parents; Information on ADHD into adulthood; Information about the transition process. The first revealed the essential role of parent in the translation and application of information, the other two explored distinct types of information necessary for a smooth transition. Interviewees made recommendations for clinical practice similar to UK (United Kingdom) National Institute for Health and Care Excellence (NICE) guidelines, with an additional emphasis on providing nuanced information on ADHD as a potentially long term condition. It was important to interviewees that General Practitioners had a basic understanding of adult ADHD and also had access to information about service provision.

Conclusions: Our findings illustrate that the availability and communication of information to young people and their parent/carers is an essential component of the transition process between child and adult ADHD services. How and when it is provided may support or impede transition. This study constitutes a substantial contribution to the evidence base, drawing on interviews from a range of participants across England and from Trusts offering different types of services.
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http://dx.doi.org/10.1186/s12888-019-2284-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918680PMC
December 2019

Randomised controlled trial of the short-term effects of OROS-methylphenidate on ADHD symptoms and behavioural outcomes in young male prisoners with attention-deficit/hyperactivity disorder (CIAO-II).

Trials 2019 Dec 2;20(1):663. Epub 2019 Dec 2.

Division of Psychiatry, University of Edinburgh, Morningside Park, Edinburgh, EH10 5HF, UK.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder, seen in 20-30% of young adult prisoners. Pharmacoepidemiological studies, a small randomised controlled trial and open trial data of methylphenidate suggest clinically significant reductions in ADHD symptoms, emotional dysregulation, disruptive behaviour and increased engagement with educational activities. Yet, routine treatment of ADHD in offenders is not yet established clinical practice. There is continued uncertainty about the clinical response to methylphenidate (MPH), a first-line treatment for ADHD, in offenders, who often present with an array of complex mental health problems that may be better explained by states of inattentive, overactive, restless and impulsive behaviours. To address this problem, we will conduct an efficacy trial to establish the short-term effects of osmotic-controlled release oral delivery system (OROS)-methylphenidate (Concerta XL), an extended release formulation of MPH, on ADHD symptoms, emotional dysregulation and behaviour.

Methods: This study is a parallel-arm, randomised, placebo-controlled trial of OROS-MPH on ADHD symptoms, behaviour and functional outcomes in young male prisoners aged 16-25, meeting Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria for ADHD. Participants are randomised to 8 weeks of treatment with OROS-MPH or placebo, titrated over 5 weeks to balance ADHD symptom improvement against side effects. Two hundred participants will be recruited with a 1:1 ratio of drug to placebo. The primary outcome is change in level of ADHD symptoms after 8 weeks of trial medication.

Discussion: Potential benefits include improvement in ADHD symptoms, emotional dysregulation, attitudes towards violence and critical incidents and increased engagement with educational and rehabilitation programmes. Demonstrating the efficacy and safety of MPH on ADHD symptoms and associated impairments may provide the data needed to develop effective healthcare pathways for a significant group of young offenders. Establishing efficacy of MPH in this population will provide the foundation needed to establish long-term effectiveness studies with the potential for demonstrating significant reductions in criminal behaviour and improved health-economic outcomes.

Trial Registration: ISRCTN registry, ISRCTN16827947, 31st May 2016; EudraCT number, 2015-004271-78, 31st May 2016. Last particpant last visit 6 June 2019. Data lock 27 August 2019.
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http://dx.doi.org/10.1186/s13063-019-3705-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889577PMC
December 2019

Clinician perspectives on the use of National Institute for Health and Care Excellence guidelines for the process of transition in Attention Deficit Hyperactivity Disorder.

Child Care Health Dev 2020 01 19;46(1):111-120. Epub 2019 Dec 19.

Child Health, University of Exeter Medical School, UK, University of Exeter Medical School, Exeter, UK.

Background: The UK National Institute for Health and Care Excellence (NICE) clinical guidelines recommends the following steps in the transition from child to adult services for young people with attention deficit hyperactivity disorder (ADHD): reassessment before and after transition, transition planning, formal meeting between services, and involvement from young person and carer, completed by age 18.

Methods: A UK surveillance study asked clinicians to report young people on their caseloads with ADHD in need of transition to adult services in 2016 to support their continued access to medication need. Clinicians reported young people as they aged to within 6 months of the transition boundary, a prospective questionnaire prior to transition asked about intended transition and the use of local transition protocols. A retrospective questionnaire sent 9 months later established which steps recommended by NICE were followed during transition. Clinicians (38) working in child or adult services were interviewed about their experiences of transition and the use of NICE guidelines during transition and were analysed using a framework approach.

Results: Information was shared between services in 85% of the 315 identified transition cases. A joint meeting was planned in 16% of cases; joint working before transfer occurred in 10% of cases. Clinicians were aware of NICE guidelines; they had mixed views on whether (local) guidelines or protocols were helpful. The main reason for not following guidelines was workload and resources: "NICE recommends stuff that is miles above what we will ever be able to provide".

Conclusions: Clinicians involved in the transition process of young people with ADHD judged NICE guidelines to be unrealistic given the current limited resources and service organization. More open dialogue is needed for recommendations on service models to bridge the gap between guideline recommendations and what is viewed as feasible and how implementation of guidance is funded, monitored, and prioritized. This may lead to valuable changes in the consultation process, for example, consideration of a layered (gold, standard, and minimal) system for some NICE guidelines.
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http://dx.doi.org/10.1111/cch.12718DOI Listing
January 2020

Adoption of hypofractionated radiation therapy for early breast cancer in private practice: the GenesisCare experience 2014–2016.

J Med Imaging Radiat Oncol 2020 02 10;64(1):127-133. Epub 2019 Oct 10.

GenesisCare, Alexandria, New South Wales, Australia.

Introduction: Cancer Australia guidelines recommend that hypofractionation should be considered for women over the age of 50 years with early breast cancer. GenesisCare is the largest provider of radiation therapy services in Australia. This study aimed to investigate variation in hypofractionation across 4 states encompassing the period when the most recent guidelines had been released.

Methods: Patients with T1 N0 and T2 N0 breast cancer who received radiation therapy as adjuvant therapy after breast conservation surgery between 2014 and 2016 were reviewed. Patient, treatment and disease-related variables were included in the univariate and multivariate models together with other potential explanatory variables such as the state, in which the patient was treated, radiation oncologist and distance from the treatment centre.

Results: Of 3374 patients included, 44% received a hypofractionated schedule. There was an increase in the use of hypofractionation from 32% in 2014 to 56% in 2016. Older patients were more likely to receive a hypofractionated treatment schedule - 75% for patients 80 years and over. Multivariate modelling revealed older age, year of treatment, higher T stage and grade, chemotherapy and the individual radiation oncologist (and state) as independent predictors of the use of hypofractionation. There was no difference in hypofractionation based on laterality.

Conclusions: Guidelines from Cancer Australia may impact clinician behaviour. The influence of the individual radiation oncologist remains paramount, and their practice is affected by their immediate colleagues. Subsequent analysis of hypofractionation rates after presentation of these data has resulted in a significant increase in its use.
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http://dx.doi.org/10.1111/1754-9485.12964DOI Listing
February 2020

Autistic spectrum disorder symptoms in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analytical review.

Psychol Med 2020 10 18;50(13):2240-2253. Epub 2019 Sep 18.

University College London, London, UK.

Background: Research identifies highly variable prevalence estimates for autism spectrum disorder (ASD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), particularly between community and clinical samples, warranting quantitative meta-analyses to investigate the true prevalence of ASD in children and adolescents with ADHD.

Methods: Studies were identified through a systematic literature search of PsycINFO, MEDLINE and Web of Science through January 2018. Twenty-two publications met inclusion criteria (total N = 61 985). Two random effects meta-analyses were conducted: (1) to identify the proportion of children and adolescents with ADHD that met criteria for ASD; and (2) to compare the severity of dimensionally-measured ASD symptomology in children and adolescents with and without ADHD.

Results: The overall pooled effect for children and adolescents with ADHD who met threshold for ASD was 21%. There was no significant difference between community samples (19%) and clinical samples (24%) or between US studies v. those from other countries. Children and adolescents with ADHD had substantially more dimensionally-measured ASD traits compared with those who did not have ADHD (d = 1.23).

Conclusion: The findings provide further evidence that ADHD and ASD are associated in nature. Clinical and research implications are discussed.
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http://dx.doi.org/10.1017/S0033291719002368DOI Listing
October 2020

Transition between child and adult services for young people with attention-deficit hyperactivity disorder (ADHD): findings from a British national surveillance study.

Br J Psychiatry 2020 11;217(5):616-622

Associate Professor, Department of Public Health, University of Southern Denmark, Denmark; and Honorary Associate Professor, University of Exeter Medical School, St. Luke's Campus, UK.

Background: Optimal transition from child to adult services involves continuity, joint care, planning meetings and information transfer; commissioners and service providers therefore need data on how many people require that service. Although attention-deficit hyperactivity disorder (ADHD) frequently persists into adulthood, evidence is limited on these transitions.

Aims: To estimate the national incidence of young people taking medication for ADHD that require and complete transition, and to describe the proportion that experienced optimal transition.

Method: Surveillance over 12 months using the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow-up questionnaires.

Results: Questionnaire response was 79% at baseline and 82% at follow-up. For those aged 17-19, incident rate (range adjusted for non-response) of transition need was 202-511 per 100 000 people aged 17-19 per year, with successful transition of 38-96 per 100 000 people aged 17-19 per year. Eligible young people with ADHD were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria.

Conclusions: As inclusion criteria required participants to be on medication, these estimates represent the lower limit of the transition need. Two critical points were apparent: referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences.
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http://dx.doi.org/10.1192/bjp.2019.131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589988PMC
November 2020

Attention Problems Predict Risk of Violence and Rehabilitative Engagement in Mentally Disordered Offenders.

Front Psychiatry 2019 7;10:279. Epub 2019 May 7.

University of Reykjavik, Reykjavik, Iceland.

Mentally disordered offenders (MDOs) endorse difficulties with attention, impulsivity, and hyperactivity. Assessing these difficulties among MDOs may confer practical benefits for the management and provision of care for this population, by informing strategies to improve rehabilitative engagement and risk assessments for violence. However, there is a dearth of literature exploring these cognitive problems in MDOs in relation to outcome factors. Forty-eight MDOs from a high-security hospital completed the QbTest, which measures the domains of inattention, impulsivity, and hyperactivity. Comprehensive file review of clinical and occupational/vocational rehabilitative engagement and Historical Clinical Risk Management-20 (HCR-20) were used as outcome measures of interest. Participants displayed greater cognitive deficits in attention, impulsivity, and hyperactivity compared to the general population. The domain of inattention and omission errors was related to occupational/vocational therapy engagement as well as a higher risk of present and future violence as measured by the HCR-20. The findings suggest that QbTest is a helpful objective tool that could be incorporated into the assessment of MDOs. Specifically, inattention emerged as a strong predictor of patients' risk of violence as well as patient's vocational therapy engagement. Therefore, cognitive skills programs targeting attention problems should be introduced to improve outcomes for this population.
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http://dx.doi.org/10.3389/fpsyt.2019.00279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514136PMC
May 2019

Attention Deficit Hyperactivity Disorder (ADHD) in the Prison System.

Curr Psychiatry Rep 2019 04 29;21(6):41. Epub 2019 Apr 29.

Teesside University, Middlesbrough, UK.

Purpose Of Review: To examine recent advances in the understanding of attention deficit hyperactivity disorder (ADHD) among the prison population.

Recent Findings: Efforts have been made to develop useful tools for assessing ADHD among prisoners. Prisoners with ADHD demonstrate incremental vulnerability due to comorbid psychiatric disorders, neurodevelopmental disorders and traumatic brain injury. Compared with prisoners without ADHD, prisoners with ADHD become involved in the criminal justice system at a younger age and have higher rates of recidivism in adulthood. Recent studies demonstrate the effectiveness of extended release stimulant medication and psychological interventions. Early identification and treatment of prisoners with ADHD have the potential to demonstrate health economic benefits. Our understanding of ADHD among prisoners continues to develop. However, further research is needed, particularly among neglected groups such as females. Much more attention is needed by the prison service to engender better outcomes for this at-risk population.
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http://dx.doi.org/10.1007/s11920-019-1022-3DOI Listing
April 2019

The Risk of Making False Confessions: The Role of Developmental Disorders, Conduct Disorder, Psychiatric Symptoms, and Compliance.

J Atten Disord 2021 Mar 21;25(5):715-723. Epub 2019 Mar 21.

Institute of Psychiatry, Psychology & Neuroscience Library, London, UK.

To investigate salient predictors of self-reported false confessions. The conditions included mild intellectual disability (ID), autism spectrum disorder (ASD), ADHD, conduct disorder (CD), psychiatric symptoms, and compliance. The sample consisted of 386 male Scottish prisoners, who completed a diagnostic ADHD interview, psychometric tests, and a questionnaire about false confessions they had given to police over their lifetime. There was a high rate of reported false confessions (33.4%); the reason for the majority (62.2%) being to "cover up for somebody else." CD, ADHD, psychological distress and psychiatric symptoms, and compliance were all significant predictors of false confession. When examining the influence of underlying domains of ADHD, it was found that hyperactivity/impulsivity drove the association with false confession after adjusting for coexisting CD. CD and ADHD were the two most powerful predictors of false confessions, with CD mediating some of the effects of ADHD.
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http://dx.doi.org/10.1177/1087054719833169DOI Listing
March 2021

Teaching about Decoloniality: The Experience of Non-Indigenous Social Work Educators.

Am J Community Psychol 2018 12 2;62(3-4):306-318. Epub 2018 Dec 2.

Social Work and Social Policy, University of Western Australia, Nedlands, WA, Australia.

This paper provides a way to theorize and practice Decoloniality in teaching and learning within higher education. Two social work academics develop a framework for teaching about decoloniality which they hope is useful for other academics from different "helping" professions who also work with First Nations peoples. Rather than a fixed and firm framework it is intended to be used to inform practice and assist students in developing their own framework for practice. The article begins by offering how the authors define decoloniality, then presents a theory for practice/practice to theory framework and explanation of how we use this framework for teaching/learning and practice.
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http://dx.doi.org/10.1002/ajcp.12285DOI Listing
December 2018

Predictors of adult outcomes in clinically- and legally-ascertained youth with externalizing problems.

PLoS One 2018 1;13(11):e0206442. Epub 2018 Nov 1.

Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States of America.

Externalizing problems (EP), including rule-breaking, aggression, and criminal involvement, are highly prevalent during adolescence, but the adult outcomes of adolescents exhibiting EP are characterized by heterogeneity. Although many youths' EP subside after adolescence, others' persists into adulthood. Characterizing the development of severe EP is essential to prevention and intervention efforts. Multiple predictors of adult antisocial personality disorder (ASPD) and legal outcomes of a large sample (N = 1205) of clinically- or legally-ascertained adolescents (ages 12-19 years) with severe EP were examined. Many psychosocial predictors hypothesized to predict persistence of EP demonstrated zero-order associations with adult outcomes, but accounted for little unique variation after accounting for baseline conduct disorder symptoms (CD) and demographic factors. Baseline measures of intelligence, which explained independent variation in legal outcomes, provided the only consistent exception to this pattern, though future work is needed to parse these effects from those of socioeconomic factors. CD severity during adolescence is a parsimonious index of liability for persistence of EP into adulthood that explains outcome variance above and beyond all other demographic and psychosocial predictors in this sample.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206442PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211688PMC
April 2019