Neurodevelopmental Psychiatry Consultation: A National Level Analysis
DOI:
https://doi.org/10.20344/amp.19652Keywords:
Attention Deficit Disorder with Hyperactivity, Autism Spectrum Disorder, Mental Health Services, Neurodevelopmental Disorders, Portugal, Transition to Adult CareAbstract
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.
Downloads
References
Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 changes on the national survey on drug use and health. Rockville: Substance Abuse and Mental Health Services Administration; 2016.
Jeste SS. Neurodevelopmental behavioral and cognitive disorders. Continuum. 2015;21:690-714. DOI: https://doi.org/10.1212/01.CON.0000466661.89908.3c
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Publishing; 2013. DOI: https://doi.org/10.1176/appi.books.9780890425596
Thapar A, Cooper M, Rutter M. Neurodevelopmental disorders. Lancet Psychiatry. 2017;4:339-46. DOI: https://doi.org/10.1016/S2215-0366(16)30376-5
Oliveira GG. Epidemiologia do autismo em Portugal: um estudo de prevalência da perturbação do espectro do autismo e de caracterização de uma amostra populacional de idade escolar. 2005. [consultado 2023 abr 18]. Disponível em: http://hdl.handle.net/10316/848.
King C, Merrick H, Le Couteur A. How should we support young people with ASD and mental health problems as they navigate the transition to adult life including access to adult healthcare services. Epidemiol Psychiatr Sci. 2020;29:e90. DOI: https://doi.org/10.1017/S2045796019000830
Davignon MN, Qian Y, Massolo M, Croen LA. Psychiatric and medical conditions in transition-aged individuals with ASD. Pediatrics. 2018;141:S335-45. DOI: https://doi.org/10.1542/peds.2016-4300K
Lord C, Brugha TS, Charman T, Cusack J, Dumas G, Frazier T, et al. Autism spectrum disorder. Nat Rev Dis Primers. 2020;6:1-23. DOI: https://doi.org/10.1038/s41572-019-0138-4
Price A, Mitchell S, Janssens A, Eke H, Ford T, Newlove-Delgado T. In transition with attention deficit hyperactivity disorder (ADHD): children’s services clinicians’ perspectives on the role of information in healthcare transitions for young people with ADHD. BMC Psychiatry. 2022;22:251. DOI: https://doi.org/10.1186/s12888-022-03813-6
Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry. 2018;5:175-86. DOI: https://doi.org/10.1016/S2215-0366(17)30167-0
Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers. 2015;1:15020. DOI: https://doi.org/10.1038/nrdp.2015.20
Kuo AA, Anderson KA, Crapnell T, Lau L, Shattuck PT. Introduction to transitions in the life course of autism and other developmental disabilities. Pediatrics. 2018;141:S267-71. DOI: https://doi.org/10.1542/peds.2016-4300B
Tatlow-Golden M, Gavin B, McNamara N, Singh S, Ford T, Paul M, et al. Transitioning from child and adolescent mental health services with attention-deficit hyperactivity disorder in Ireland: case note review. Early Interv Psychiatry. 2018;12:505-12. DOI: https://doi.org/10.1111/eip.12408
Buescher AV, Cidav Z, Knapp M, Mandell DS. Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatrics. 2014;168:721-8. DOI: https://doi.org/10.1001/jamapediatrics.2014.210
Reale L, Costantino MA, Sequi M, Bonati M. Transition to adult mental health services for young people with ADHD. J Atten Disor. 2018;22:601-8. DOI: https://doi.org/10.1177/1087054714560823
Direção-Geral da Saúde. Programa nacional de saúde infantil e juvenil, atualizado em 31/05/2013 e publicado na Norma da DGS n.º 010/2013. Lisboa: DGS; 2013.
Direção-Geral da Saúde. Abordagem diagnóstica e intervenção na perturbação do espetro do autismo em idade pediátrica e no adulto. Publicado na norma da DGS n.º 002/2019 de 23/04/2019. Lisboa: DGS; 2019.
Ordem dos Médicos. Estatísticas de médicos inscritos na Ordem dos Médicos – estatísticas por especialidades; 2019. [consultado 2019 dez 29]. Disponível em: https://ordemdosmedicos.pt/wp-content/uploads/2020/01/ESTATISTICAS_ESPECIALIDADES_2019.pdf.
Kohn MA, Senyak J. Sample size calculators. UCSF CTSI. 2020. [citado 2021 fev 02]. Disponível em: https://www.sample-size.net/.
Statistics Kingdom. Mann Whitney U test calculator. 2017. [consultado 2021 fev 02]. Disponível em: http://www.statskingdom.com/.
Zeng S, Strain A, Sung C. Health care transition services and adaptive and social-emotional functioning of youth with autism spectrum disorder. J Autism Dev Disord. 2021;51:589-99. DOI: https://doi.org/10.1007/s10803-020-04564-7
Nathenson RA, Zablotsky B. The transition to the adult health care system among youths with autism spectrum disorder. Psychiatr Serv. 2017;68:735-8. DOI: https://doi.org/10.1176/appi.ps.201600239
Young S, Adamou M, Asherson P, Coghill D, Colley B, Gudjonsson G, et al. Recommendations for the transition of patients with ADHD from child to adult healthcare services: a consensus statement from the UK adult ADHD network. BMC Psychiatry. 2016;16:301. DOI: https://doi.org/10.1186/s12888-016-1013-4
Reale L, Frassica S, Gollner A, Bonati M. Transition to adult mental health services for young people with attention deficit hyperactivity disorder in Italy: parents’ and clinicians’ experiences. Postgrad Med. 2015;127:671-6. DOI: https://doi.org/10.1080/00325481.2015.1070658
Cheak-Zamora NC, Teti M. “You think it’s hard now... It gets much harder for our children”: youth with autism and their caregiver’s perspectives of health care transition services. Autism. 2015;19:992-1001. DOI: https://doi.org/10.1177/1362361314558279
Kuhlthau KA, Warfield ME, Hurson J, Delahaye J, Crossman MK. Pediatric provider’s perspectives on the transition to adult health care for youth with autism spectrum disorder: current strategies and promising new directions. Autism. 2015;19:262-71. DOI: https://doi.org/10.1177/1362361313518125
Malik-Soni N, Shaker A, Luck H, Mullin AE, Wiley RE, Lewis ME, et al. Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood. Pediatr Res. 2022;91:1028-35. DOI: https://doi.org/10.1038/s41390-021-01465-y
Kooij JJ, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019;56:14-34. DOI: https://doi.org/10.1016/j.eurpsy.2018.11.001
National Institute for Health and Care Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87). London: NICE; 2018.
National Institute for Health and Care Excellence (NICE). Autism spectrum disorder in adults: diagnosis and management. London: NICE; 2012.
Hartmann K, Urbano MR, Raffaele CT, Kreiser NL, Williams TV, Qualls LR, et al. Outcomes of an emotion regulation intervention group in young adults with autism spectrum disorder. Bull Menninger Clin. 2019;83:259-77. DOI: https://doi.org/10.1521/bumc.2019.83.3.259
Björk A, Rönngren Y, Wall E, Vinberg S, Hellzen O, Olofsson N. A nurse-led lifestyle intervention for adult persons with attention-deficit/hyperactivity disorder (ADHD) in Sweden. Nord J Psychiatry. 2020;74:602-12. DOI: https://doi.org/10.1080/08039488.2020.1771768
Gentile JP, Atiq R. Psychotherapy for the patient with adult ADHD. Psychiatry. 2006;3:31.
American Occupational Therapy Association. Occupational therapy using a sensory integration-based approach with adult populations. Fact Sheet. North Bethesda; AOTA; 2011.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.
