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Clinical perspectives on the identification of neurodevelopmental conditions in children and changes in referral

Barry Coughlan1, Matt Woolgar2, Alissa Mann3

  • 1Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK bc471@medschl.cam.ac.uk.

BMJ Open
|April 14, 2022
PubMed

Insights

General practitioners (GPs) identify autism and ADHD using diverse information, but referral pathway changes impact their role. Further evaluation of these new pathways is needed.

Area of Science:

  • Neurodevelopmental disorders
  • General practice
  • Healthcare systems

Background:

  • General practitioners (GPs) play a role in identifying neurodevelopmental conditions like autism spectrum disorder (autism) and attention deficit hyperactivity disorder (ADHD).
  • Recent changes in referral pathways have shifted the identification and referral process for these conditions, involving educational professionals and health visitors instead of GPs.

Purpose of the Study:

  • To explore how GPs identify autism and ADHD in their practice.
  • To understand GP perspectives on recent changes to neurodevelopmental referral pathways.
  • To investigate Child and Adolescent Mental Health Services (CAMHS) specialists' views on the GP's role in identification.

Main Methods:

  • Semistructured interviews were conducted with 8 GPs, 7 local CAMHS specialists, and 10 national CAMHS professionals.
  • Interviews took place between January and May 2019.
  • Thematic analysis using a framework approach was employed to analyze the collected data.

Main Results:

  • GPs utilize a range of information, including behavioral markers, parental reports, family history, and expert/lay resources, for identification.
  • GP opinions on the altered referral pathways were divided, with some finding them beneficial and others problematic.
  • CAMHS specialists suggested that GPs need enhanced neurodevelopmental training and more consultation time.

Conclusions:

  • This study confirms that GPs employ multiple information sources for autism and ADHD referral decisions.
  • The reconfiguration of neurodevelopmental referral pathways, diminishing the GP's role, requires urgent evaluation.
Abstract

Keywords:
Child & adolescent psychiatryCommunity child healthDevelopmental neurology & neurodisabilityPRIMARY CAREQUALITATIVE RESEARCH

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