ADHD: Training and Support for Clinicians

Aims
The ADHD website aims to give information to clinicians including general practitioners, GPWsi's, community paediatricians and CAMHS staff on:
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a) ADHD and related neurodevelopmental disorders;
b) Identifying the signs and symptoms of ADHD including consideration of the differential diagnoses, co-morbid disorders and associated functional difficulties;
c) Management options for children with ADHD and their families including behavioural strategies and prescribing options;
d) How to manage ongoing care and support for children with ADHD and their families including medication monitoring.
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The information provided on the website could be used as :

1. an introductory training package for GP's with a special interest (GPWsi's) in children's mental health, in particular in ADHD, who wish to take a lead on this topic within their practice area;
2. an introductory training package for non consultant clinical staff who work in ADHD clinics run by either by Child and Adolescent Mental Health Services (CAMHS) or paediatric departments e.g. GP clinical assistants, senior nurse practitioners and junior/ middle grade medical staff. It is advised that this information is complemented by on site clinical supervision from a consultant with special expertise in ADHD.
3. training materials about ADHD for all GP's who have children and young people on their lists with this disorder and to act as a pointer to websites which may be useful to clinicians and parents. The site may be of particular interest to GP's providing ADHD monitoring enhanced services.
4. an aid for a seamless transfer of specific aspects of patient treatment from the secondary sector to general practice. Information is provided on the nature of the condition treated, the medications in question, the monitoring required and the responsibilities of the parties involved.

This website can also be utilised as a part of a PG Cert Course (30 credits at Masters Level, ‘subject to validation’) with the University of Wales, Newport. Please contact amanda.kirby@newport.ac.uk for further information.
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The course aims are as follows:
The module will provide student knowledge in the following areas

• An understanding of the signs and symptoms of ADHD in children, adolescents and adults
• An understanding of the assessment and diagnosis of ADHD in children and adolescents
• The principles of a multi-modal treatment package for ADHD.
• The knowledge of non pharmacological interventions for ADHD
• An understanding of the pharmacological interventions for ADHD
• The understanding of issues of medication including
• Starting medication
• Switching medication and polypharmacy
• Medication monitoring
• The issues of the management of the ADHD- follow up clinics
• Consideration of ADHD in relationship to other co-morbid disorders

The Learning Outcomes are as follows:

On completion of the PG Cert module the student would:

1. Have an understanding of current knowledge and theory relating to the aetiology underpinning ADHD and related co-morbid disorders.
2. Be able to critically reflect upon the management and intervention options for supporting an individual with ADHD.
3. Demonstrate knowledge of current practices in the management of the individual with ADHD in the context of common health and educational practices and through a consideration of research undertaken in this area.
4. Demonstrate an understanding of the choices for treatment both pharmacological and non pharmacological.
5. Critically reflect upon the different factors that may impact on the individual’s difficulties at home and at school and in further education.
6. The student will gain knowledge of the management principles of running a follow up ADHD clinic.

These aims are informed by the following philosophy:

Improving access to knowledge on ADHD for the groups of clinicians above will help to combine the best of primary and secondary care for the benefit of these patients and their families.

Shared care arrangements between primary and secondary care are thought to be essential for safe, effective and efficient treatment with complex drugs such as those used in the medical treatment of ADHD.

Entry into a shared care arrangement is voluntary for all parties involved. It should be noted that clinical responsibility lies with the prescribing doctor.

GPs and other clinicians should therefore familiarise themselves with the drug treatments they are prescribing, ensure an acceptable monitoring arrangement is in place and feel confident that they can obtain appropriate specialist support when required.

Glossary of Abbreviations

• ADHD = Attention Deficit HyperactivityDisorder
• ASD = Autistic Spectrum Disorder
• CBT = Cognitive Behaviour Therapy
• CD = Conduct Disorder
• DCD = Developmental Co-ordination Disorder
• DSM-1V= Diagnostic and Statistical Manual of Mental Disorders (4th Edition)
• HKD = Hyperkinetic Disorder
• ICD-10 = International Classification of Diseases (10th version)
• IEP = Individual Education Plan
• LSA = Learning Support Assistant
• LEA = Local Education Authority
• ODD = Oppositional Defiant Disorder
• SDQ = Strengths and Difficulties Questionnaire
• SEN = Special Educational Need
• SENCO= Special Educational Needs Co-ordinator
• TCA = Tricylic antidepressant
• WISC = Wechsler Intelligence Scale for Children