Established in 2007

Liverpool Sefton Sept 2012Knowsley Spring 2013Warrington January 2013St Helens Spring 2013

Tony Lloyd PhD

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Comorbidity

20-30% have additional learning difficulties(Wender 2002)

Up to 50% of boys display oppositional behaviour20-40% progress to conduct disorder or the more

serious oppositional defiant disorder(Geller 1998)

18% will attempt suicide (Lahey 2010)

Depression&Anxiety(Thakker & Adler 2006)

17-45% parental Alcohol dependence & 9-30 Parental drug dependence (Willens 1995)

Untreated and unsupported ADHD

Age:6 10 14

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ADHD only–low self esteem

Disruptive behaviour

Poor social skills

Learning delay

Challenging behaviour

ODD

•Criminal behaviour

•School exclusion

•Substance abuse

•Teenage pregnancy

•Conduct disorder

•Lack of motivation

(G. Kewley 2002) Dr. Geoff Kewley Consultant Paediatrician and consultant representative of ADDISS (Attention Deficit Disorder Support Services)

NICE Guidance 2010

”The consequences of severe ADHD for children, their families and for society can be very serious. Children can develop poor self esteem, emotional and social problems and their educational attainment is frequently severely impaired. The pressure on

families can be extreme”.

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We now know that ……..

• Prevalence of ADHD: affects between 3-5% of children/young people both nationally and internationally (NICE guidelines).

• Diagnosis in Liverpool is approx 1.4% of the 92,300 children in Liverpool Sefton is approximately 1%

• – where are the rest? Youth Justice System?

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ADHD is a lifelong condition

(International Consensus Statement on ADHD 2002)

Increased risk of –Anxiety , Depression, (Laitinen-Krispijn 1999)

Mental Health Problems (Kalttialala-heino et al 2003)

Alcohol and substance misuse (Barklay et al 1997) (Green & Chee 1997)

Reduced economic independence (Beiderman & Farraone 2006)

School failureEarly onset cardiovascular disease + increased health care costs throughout life (Chan et al 2002) (Lynch 2000)

Conclusion• Early intervention significantly reduces the severity of ADHD• Intervention needs to be multi modal• Intervention should have a ‘think family’ approach (why?)• With substance misuse explore how some young people ‘self

medicate’ with cannabis or amphetamines – would psychostimulants such as Ritalin be the answer? Research suggests using Ritalin reduces substance misuse (Beiderman 1999) (self medicating linked to acquisitive crime?)

• De stigmatise ADHD – many with this condition experience a sense of relief that they are not ‘mad or bad’ but rather misunderstood. It is a neurobiological condition not a cultural construct or a synonym for anti social behaviour.

• Children & young people can be taught to self manage the condition 7

What we offer

Information Advice and Guidance / Assessment Sessions for parents

Information Advice & guidance sessions for young people (12yrs – 19yrs)

‘CBT based ADHD Skills Building’ training for parents

‘ADHD Skills Building’ training for children 5-12 years

‘ADHD Skills Building’ training for young people 12-19 years Counselling ADHD Brief Solution Focussed Therapy for 12-19 years Counselling Family Therapy Childrens Therapy (5-12 years) from - Spring 2013 Stress Management and Sleep Clinics from - Autumn 2013 Facilitated Parents Peer Support Groups – Monthly from April 2013 Neurofeedback Clinic – September 2013

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G.P.G.P.Education Psychologist?Education Psychologist?

Alder Hey NHS Trust

Paediatricians & Psychiatrists

SPA

Alder Hey NHS Trust

Paediatricians & Psychiatrists

SPA

Referral to the ADHD FoundationReferral to the ADHD Foundation

Information Advice & GuidanceInformation Advice & Guidance

Invited to Parent ADHD Skill Building Group

Invited to Parent ADHD Skill Building Group

Children (5-11) and Young Persons (12-

18)Skill Building Group

Children (5-11) and Young Persons (12-

18)Skill Building Group

Service user Engagement Activities:

 Trustee

 Youth Board

 Parents Support Group

 ADHD Accredited training

 Participation events

 Volunteering opportunities

Service user Engagement Activities:

 Trustee

 Youth Board

 Parents Support Group

 ADHD Accredited training

 Participation events

 Volunteering opportunities

11—19 Youth Activity Service

promoting positive outcomes for Young People

with ADHD

11—19 Youth Activity Service

promoting positive outcomes for Young People

with ADHD

ADHD Counselling Service (12-18)

Family Therapy

Stress Management & Sleep Clinic (Spring 2013)

ADHD Counselling Service (12-18)

Family Therapy

Stress Management & Sleep Clinic (Spring 2013)

Referral Pathway