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Practitioner Review: Pathways to care for ADHD - a systematic review of barriers and facilitators
Nicola Wright1, Maria Moldavsky2, Justine Schneider3
1School of Health Sciences, University of Nottingham, Nottingham, UK.
Insights
Access to care for children with Attention-Deficit/Hyperactivity Disorder (ADHD) is complex. This review highlights barriers and facilitators across multiple levels, emphasizing the need for better interventions to improve ADHD service access for children.
Area of Science:
- Neurodevelopmental Disorders
- Pediatric Mental Health
- Healthcare Access Research
Background:
- Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder impacting children and adults.
- Effective management involves medication and nonpharmacological interventions.
- Significant disparities exist in accessing ADHD services for at-risk children.
Purpose of the Study:
- To systematically review factors influencing children's access to ADHD services.
- To identify barriers and facilitators in the pathway to care for pediatric ADHD.
Main Methods:
- Comprehensive search of international peer-reviewed and grey literature up to April 2012.
- Screening of 23,156 articles by at least two independent reviewers.
- Narrative synthesis due to heterogeneity in study designs.
Main Results:
- Twenty-seven papers were included, categorized into determinants, identification, entry/continuity of care, and interventions.
- Barriers and facilitators operate at individual, organizational, and societal levels.
- Limited evidence exists for effective interventions to enhance ADHD service access.
Conclusions:
- Multilayered obstacles impede access to care for children at risk of ADHD.
- There is a lack of evidence-based interventions targeting these access issues.
- Findings indicate crucial areas for service development and future research in pediatric ADHD care.
Background:
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder starting in childhood that may persist into adulthood. It can be managed through carefully monitored medication and nonpharmacological interventions. Access to care for children at risk of ADHD varies both within and between countries. A systematic literature review was conducted to investigate the research evidence related to factors which influence children accessing services for ADHD.
Method:
Studies investigating access to care for children at risk of ADHD were identified through electronic searches of the international peer-reviewed and grey literature. Databases were searched from inception till 30th April 2012. This identified 23,156 articles which were subjected to three levels of screening (title, abstract and full text) by a minimum of two independent reviewers. Due to the heterogeneity in the study designs, a narrative approach was used to present the findings.
Results:
Twenty-seven papers met the inclusion criteria; these were grouped into four main themes, with some papers being included in more than one. These were wider determinants (10 papers); identification of need (9 papers); entry and continuity of care (13 papers) and interventions to improve access (4 papers). Barriers and facilitators to access were found to operate at the individual, organisational and societal level. Limited evidence of effective interventions to improve access was identified.
Conclusion:
This review explored the multilayered obstacles in the pathway to care for children at risk of ADHD and the lack of evidence-based interventions designed to address these issues, thereby indicating areas for service development and further evaluative research.
