A population service evaluation of the ADHD pathway of children and young people's services, Malta

• Published in: European psychiatry Vol. 41; no. S1; pp. S222 - S223
• Main Authors: Saliba, A., Agius, D., Sciberras, E., Camilleri, N.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01-04-2017
• ISSN: 0924-9338; 1778-3585
• DOI: 10.1016/j.eurpsy.2017.01.2215

ADHD is the commonest neurodevelopmental disorder in young people (YP) aged 5–18years. YP with untreated ADHD are 5 times more likely to develop co-morbid psychiatric disorders.
To carry out a population service evaluation of the assessment process and management of YP with ADHD at Child and Young People's Service (CYPS), Malta age 0–16 years for 2014.
To describe the service input, assessment and treatment of YP attending CYPS and compare to ADHD NICE guidelines 2008.
All patients diagnosed with ADHD at CYPS throughout 2014 were included. The incidence of YP with ADHD on treatment age 3–16 years in Malta was calculated. Information was collected from; (i) retrospective case file review and (ii) methylphenidate and atomoxetine registry and compared with NICE guidelines.
One hundred and thirty-six YP were diagnosed with ADHD. The minimum 12-month incidence of ADHD on treatment (3–16 years) in Malta was 553 per 100,000. Pre-diagnosis assessments were more frequently performed by other YP services (n=97, 71.3%, P≤0.01). A psychiatrist or paediatrician confirmed the diagnosis in 113 (83.1%). Sixty-two (45.3%) of YP were prescribed medication, 50 (36.8%) were referred for parental skills course and 55 (40.4%) psychotherapy. Mean waiting time for first appointment was 187.6 days (CI±26.9, 0–720), and first specialist review was 301.0 days (CI±34.4, 0–800) (Tables 1–3).
The incidence for YP (3–16 years) with ADHD on treatment was lower than the US. Since most pre-diagnostic assessments were carried out by other services, this raised the question about the reliability and validity. We recommend a diagnostic MDT meeting following the multimodal assessment to diagnose ADHD. Medication prescribing followed NICE overall, standardising non-pharmacological management is required.