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 Design and Innovation, in conjunction with the College of Psychiatrists of Ireland (COPI), for development as a Clinical Programme because of the absence of such services in Ireland.

The National Clinical Lead for ADHD in Adults explains the Programme and the importance of getting an early diagnosis. To illustrate this, an actor from UCC Drama Society recounts the story of a young person with ADHD, their journey in seeking a diagnosis and access to specialist services. This highlights how much their life improved following pharmacological and non-pharmacological interventions as they learned to manage their diagnosis.

Scope of the National Clinical Programme

This clinical programme applies to adults with Attention Deficit Hyperactivity Disorder (ADHD). It will be delivered as part of the HSEs mental health service provision and across government departments to ensure a holistic, integrated, person-centered response. The programme applies to all clinical stages of the disorder and works collaboratively with voluntary agencies.

The terms of reference of this Working Group were 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 in the European Consensus Statement on Diagnosis and Treatment of Adult ADHD is described as one of the most common disorders of childhood which is now known to persist into adulthood (Kooij 2010).  ADHD in adults is a lifelong condition which was underdiagnosed in most European countries and still is in Ireland leading to poorer quality of life, on-going distress and difficulties in coping with life. People with ADHD once diagnosed benefit from skilled mental health treatment including psychosocial interventions.

Aims and Objectives:

The sum aims and objectives of the Programme are to ensure adults with ADHD have access to assessment and treatment. The scope of each is outlined below:

Assessment of Adults with ADHD

• Adults with symptoms of ADHD are referred to their local General Adult Psychiatry Service for mental health assessment and each person referred is also asked to complete two ADHD screening questionnaires. This includes adults who have previously been treated for ADHD as children and/or adolescents and who have current symptoms suggestive of ADHD.
• Assessment is carried out by a psychiatrist who is trained in the diagnosis and treatment of ADHD.
• There is a specific transitional pathway for young people attending Child and Adolescent Mental Health Services (CAMHS) for ADHD who are due to reach their 18th birthday and who continue to need ongoing treatment for their 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.

Access

• The provision of access to diagnosis and treatment for adults with ADHD;
• Timely access to consultation for referrers;
• Provide a needs-based pathway, integrated model of service delivery based on individuals preferences;
• Seamless transition from the CAMHS services through a modified pathway.

Quality

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

Economic gains

• Early intervention to improve good management of the condition;
• Use of evidence-based assessment and treatment to improve diagnosis and optimise treatment and so reduce adverse symptoms for adults with this condition;
• Reduce relapse of symptoms though appropriate psychoeducation and better self-management.
• Overall exchequer savings if people seen and treated effectively.

Achievements to Date:

Established Model of Care 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:
  • ADHD Ireland
  • ADHD specific coach

The Clinical Programme Model of Care has now been fully completed and formally approved (July 2019). It launched by the Minister of State for Mental Health and Older People, Mary Butler T.D. on the 14.01.2021. 

Recruitment for two Adult ADHD teams is near completion.

Training for staff commenced in June 2019 with an online programme on diagnosing and managing ADHD.

This involved:

• assessment and diagnosis of ADHD in Adults
• specific medication for ADHD
• psychosocial interventions – scheduled for Q1 2021.

Goals 2021

• Support and oversee the setting up of a number of Adult ADHD sites in CHOs
• Work closely with CHOs in the provision of adequate accommodation for new adult ADHD teams
• Continue the provision of specific ADHD training to new ADHD teams and other relevant frontline mental health staff in conjunction with the UK Adult ADHD Network (UKAAN)
• Update the core clinical outcome dataset based on ADHD site feedback
• Establish a National Oversight Implementation Group for ADHD in Adults NCP
• Continue collaborative work with ADHD Ireland and Department of Psychology in UCD
• Update the core clinical outcome dataset based on-site feedback
• Establish a national oversight implementation group

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