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[Neurodevelopmental Psychiatry Consultation: A National Level Analysis]
Joana Costa Alves1, Sofia Morais2, António Ferreira de Macedo2
1Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal.
Insights
Limited adult neurodevelopmental disorder clinics and physician training hinder care continuity. Improved communication, protocols, and multidisciplinary teams are crucial for addressing these gaps in care.
Area of Science:
- Neuroscience
- Psychiatry
- Developmental Pediatrics
Background:
- Neurodevelopmental disorders (NDDs) impact motor, social, language, and cognitive skills across the lifespan.
- Continuity of care for NDDs is vital from childhood through adulthood.
- Existing research indicates significant barriers to accessing adult healthcare for NDDs.
Purpose of the Study:
- To investigate the current state of adult neurodevelopmental disorder care within psychiatric departments.
- To identify challenges faced by physicians in managing patients with NDDs transitioning to adulthood.
- To assess the perceived need for specialized adult NDD services and training.
Main Methods:
- A national, cross-sectional, anonymous survey was distributed to psychiatry physicians.
- The survey was conducted between October 6 and December 6, 2020.
- Data were collected from 83 psychiatry physicians (residents and specialists).
Main Results:
- Only 16.9% of psychiatric departments had specialized neurodevelopment clinics.
- Most physicians (72.3%) saw few or no NDD patients weekly.
- Clinics often lacked multidisciplinary teams (64.3%), and patient transitions were poorly protocolized (15.7%).
- A significant majority (88%) recognized the need for adult NDD clinics and reported insufficient specialized training.
Conclusions:
- Significant barriers exist in providing continuous care for NDD patients into adulthood.
- Key challenges include lack of physician training, poor inter-departmental communication, and insufficient specialized services.
- Establishing dedicated neurodevelopmental disorder clinics with multidisciplinary teams and clear transition protocols is essential.
Introduction:
Neurodevelopmental disorders are characterized by delay or variation in the acquisition of abilities or skills in several domains of development: motor, social, language, and cognitive. These disorders can manifest from childhood to adulthood, and therefore continuity of care is essential throughout these various developmental periods. However, several studies show that there is limited access to adult health care in this clinical domain.
Methods:
A cross-sectional observational study was carried out by distributing an anonymous survey among psychiatry physicians, at a national level, in the period between October 6 and December 6, 2020.
Results:
Data was collected from 83 psychiatry physicians (43 residents and 40 specialists). At the national level, only 16.9% of psychiatric departments had a subspecialized neurodevelopment clinic. Physicians reported that they observed few patients with neurodevelopment disorders: 72.3% observed one or none per week. When there was a neurodevelopmental disorders clinic in the psychiatry department, 64.3% of physicians reported that this clinic did not include a multidisciplinary team. The transition of these patients from the pediatric/child and adolescent psychiatry department to the psychiatric department occurred through regular intrahospital transfer in 51.8% of cases, but it occurred through a specific protocol or with a transitional medical appointment in only 15.7% of cases. Finally, 88% of psychiatry physicians considered the existence of a neurodevelopmental disorders clinic in adults to be pertinent and reported not having specialized training in the field of neurodevelopment.
Conclusion:
This study made it possible to identify some difficulties and barriers regarding adequate access for patients with neurodevelopmental disorders throughout the various developmental stages, from childhood to adulthood: lack of training in this clinical field, need of better communication between departments, lack of specific protocols, shortage of multidisciplinary teams, and asymmetry in the distribution of differentiated care.
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