A population service evaluation of the attention deficit hyperactivity disorder pathway of children and young people’s services, Malta

Abstract

Background: Attention Deficit Hyperactivity Disorder (ADHD) is the commonest neurodevelopmental disorder in young people (YP) aged 5-18 years. YP with untreated ADHD are five times more likely to develop co-morbid psychiatric disorders. The aims were to carry out a population service evaluation of the assessment process and management of YP with ADHD at the Children and Young People’s Service (CYPS), Malta ages 0-16 years for 2014. Also to describe the service input, assessment and treatment of YP attending CYPS and compare to ADHD NICE guidelines 2008.

Methods: All YP diagnosed with ADHD at CYPS throughout 2014 were included. The incidence of YP with ADHD on treatment age 3-16 years in Malta was calculated. Information was collected from; i. Retrospective case file review and ii. Methylphenidate and Atomoxetine registry and compared with NICE guidelines.

Results: 136 YP were diagnosed with ADHD. The minimum 12-month incidence of ADHD on treatment (3-16 years) in Malta was 553 per 100,000. Pre-diagnosis assessments were more frequently performed by other YP services (n = 97, 71.3%, p = < 0.01). A psychiatrist or paediatrician confirmed the diagnosis in 113 (83.1%) YP. 62 (45.3%) YP were prescribed medication, 50 (36.8%) were referred for parental skills course and 55 (40.4%) for psychotherapy. The mean waiting time for the first appointment was 187.6 days (CI ± 26.9, 0-720), and 301.0 days (CI ± 34.4, 0-800) for the first specialist review.

Conclusions: The incidence for YP (3-16 years) with ADHD on treatment was lower than the US. Since most pre-diagnostic assessments were carried out by other services, this raised the question about the reliability and validity. We recommend a diagnostic multidisciplinary team meeting following the multimodal assessment to diagnose ADHD. Medication prescribing followed NICE overall however standardising non-pharmacological management is required.