Children and Families Bill

MEMORANDUM SUBMITTED BY THE UK ADHD PARTNERSHIP

(CF 96)

EXECUTIVE SUMMARY

1. The UK ADHD Partnership (UKAP) is a group of medical and educational specialists with experience of working with children with Attention Deficit Hyperactivity Disorder ( ADHD) and Special Educational Needs (SEN), committed to helping drive better access for children to the diagnosis, support and management of ADHD to build better futures for children with the condition.

2. UKAP welcomes the recent publication of the draft SEN Code of Practice alongside the Children and Families Bill and further welcomes the commitment that it should be scrutinised by Parliament.

3. ADHD is under-diagnosed and under- treated with severe consequences for children with the condition, their families and society as a whole 1 . Detailed research demonstrates the significant risks that unidentified and poorly treated ADHD presents in compromising the opportunities children have to experience the benefits of a normal childhood. In such cases, children are at a heightened risk of mental health problems, social exclusion and anti-social and potentially criminal behaviour [1] .

4. UKAP believe that improved diagnosis and access to appropriate support and treatment would be cost effective and could have a radical improvement on outcomes for children across education, criminal justice, family welfare, healthcare and antisocial behaviour .

5. UKAP believe that every school age child with ADHD should have the opportunity to fulfill their life potential through comprehensive assessments in schools, early intervention and appropriate support.

6. UKAP recommend that the SEN Code of Practice and relevant regulations and guidance issued to accompany the Children and Families Bill should include UKAP ’s Call T o A ction: that all children who receive two fixed term exclusions from school are screened for ADHD and, if appropriate, an assessment process for ADHD initiated .

7. We hope that the Committee will take into account the evidence as set out in this submission, and recognise the importance of early screening and intervention for children with suspected ADHD to i mprove outcomes and help build better f utures for children with ADHD.

ABOUT ADHD

8. ADHD is a common behavioural disorder affecting school age children: in the UK, the prevalence figure is 3.62% in boys and 0.85% in girls aged between 5 and 15 years 3 . It is a clinically distinct neurobiological condition that is caused by an imbalance of chemicals affecting specific parts of the brain responsible for behaviour 4 .

HOW UNDIAGNOSED AND UNTREATED ADHD HAS A NEGATIVE EFFECT ON OUTCOMES FOR CHILDREN

9. Children with ADHD often act without thinking, can be hyperactive, and may have trouble focusing. Their symptoms can have a significant impact upon family life, relationships with friends, school discipline and society as a whole 2 :

a. Young people with ADHD display higher rates of conflict behaviours such as negative comments, social irritability, and poorly adapted levels of communication and involvement 3

b. People with ADHD with predominant symptoms of hyperactivity/impulsivity are at high risk of early onset and persistent antisocial behaviour 5 and the association between ADHD and crime is becoming increasingly recognised 6 .

c. Impairments in children with ADHD often lead to a lower probability of completing schooling and a lower ranking occupational position compared to children who don’t have ADHD 9 . Children with ADHD are also more than 100 times greater risk of being permanently excluded from school than other children 7

· 39% of children with ADHD have had fixed term exclusions from school

· 11% of excluded children with ADHD have been excluded permanently

d. The social impact of exclusion is well established, with evidence showing an increased likelihood of antisocial and criminal behaviour 7 .

e. Children with ADHD often have low self-esteem and can develop additional emotional and social problems. The secondary effects of ADHD can be damaging. For example, some children and young adults with ADHD are at increased risk of accidental harm and many later have an increased risk of automotive accidents 3 .

11. However, it doesn’t have to be this way : with early recognition, diagnosis, appropriate treatment, management and support, many children with ADHD can be successful both in school and in society 7 .

PREVENTING NEGATIVE OUTCOMES FOR CHILDREN WITH ADHD: SECOND FIXED TERM EXCLUSION AS AN OPPORTUNITY TO SCREEN CHILDREN WITH POSSIBLE ADHD

12. ADHD is under-diagnosed in the UK 2 and as set out above, the knock-on effects of poorly managed or unidentified ADHD demonstrate the need for early identification .

13. Exclusion from school is often the first event that can label a child a ‘problem’. However, whilst many children will be temporarily excluded from school once for poor behaviour, and will be suitably chastened by the experience, children with untreated developmental problems like ADHD cannot properly moderate their behaviour without the right support, so they are very likely to be excluded more than once.

14. If these behavioural problems can be identified before leading to permanent exclusion from school, it is possible for the child’s behaviour to be managed appropriately and the negative impact of permanent exclusion on the child’s education and future avoided.

15. UKAP recommend that all children who receive two fixed term exclusions from school are screened for ADHD and, if appropriate, an assessment process for ADHD is initiated.

16. Key behaviours related to ADHD are readily observable in children at school and, therefore, it would be advantageous for teachers to be able to recognise those pupils who may have ADHD 3 .

17. Research in the UK has shown that two thirds of parents with children with ADHD had been in contact with teachers about their concerns 8 . However, studies have shown that teachers’ perceived competence in the management of children with ADHD in the classroom is variable and is correlated with their professional knowledge and experience 3 . In one report 43% of medical specialists felt that teachers were not aware of ADHD so they didn’t realise children should be referred 1 .

18. By increasing teachers’ knowledge of ADHD alongside the provision of clear advice on how to work with children who might have ADHD, identification and therefore outcomes in the long term may be improved.

19. Teachers can play a crucial role in assisting with timely and accurate ADHD identification. More should be done in the normal classroom setting to raise awareness, reduce stigma and improve teachers’ knowledge of the symptoms of ADHD and resulting educational needs 3 .

20. A screening programme at second fixed term exclusion for ADHD has several attractions: the early identification of problems; early intervention; and, if repeated regularly throughout primary and secondary school, recognising cases that ‘slip through the net’ or have a late onset. To the best of the knowledge of the NICE Guideline Development Group and the review team, no screening interventions for children with ADHD are carried out in schools in the UK 3 .

21. The B ill presents an opportunity to make the necessary provisions to ensure that both teachers and school staff are more aware of ADHD and that the appropriate screening programmes are in place.

22. We recommend that regulations with regards to the assessment and planning process take account of the evidence set out above, and consider our call to action that all children who receive two fixed term exclusions from school are screened for ADHD and, if appropriate, an assessment process for ADHD is initiated .

The UK ADHD Partnership (UKAP) is a group of medical and educational specialists with experience of working with children with Attention Deficit Hyperactivity Disorder ( ADHD) and Special Educational Needs (SEN), committed to helping drive better access for children to the diagnosis, support and management of ADHD to build better futures for children with the condition.

Members of t he UK ADHD Partnership:

Bill Colley

Educational Consultant

Peter Hill

Consultant Child & Adolescent Psychiatrist

Valerie Ivens

ADHD Coach

Sheila Keeting

Development Manager

Add+up

Dr Geoffrey Kewley

Consultant Paediatrician

The Learning Assessment & Neurocare Centre

Jane Padm ore

CAMHS Consultant Nurse

Fintan O’Regan

SEN Consultant

Louise Theodosiou

Child & Adolescent Psychiatrist

Dr Susan Young

Senior Lecturer and Consultant Clinical and Forensic Psychologist, Institute of Psychiatry and Broadmoor Hospital, West London Mental Health Trust

References:

1 ADDISS, ADHD: Paying Enough Attention? A research report investigating ADHD in the UK. Accessed 2012. http://www.addiss.co.uk/payingenoughattention.pdf

2 ADHD Europe. Contribution to the TC Green Paper on improving the mental health of the population 2006.

3 NICE Full Clinical Guidance - Attention Deficit Hyperactivity Disorder: Diagnosis and management of ADHD in children, young people and adults 2009, London: NICE

4 Green C., Chee . K. Understanding ADHD - A Parents Guide to Attention Deficit Hyperactivity Disorder in Children. 2 nd Edition 1997. Vermilion Publishing.

5 Babinski, L.M., Hartsough , C.S. & Lambert, N.M. Childhood Conduct Problems, hyperactivity – impulsivity, and inattention as predictors of adult criminal activity. Journal of Child Psychology and Psychiatry 1999, 40: 347-355

6 Pratt, T. et al. The Relationship of Attention Deficit Hyperactivity Disorder to Crime and Delinquency: a Meta-Analysis. International Journal of Police Science and Management 2002; 4: 335–2544

7 O’Regan, F. Persistent disruptive behaviour and exclusion: ADHD in Practice 2009, 1 (1): 8 - 11

8 Sayal, K., Goodman, R. & Ford, T. Sayal K. Barriers to the Identification of Children with Attention Deficity /Hyperactivity Disorder. The Journal of Child Psychology and Psychiatry 2006; 47(7): 744-775

9 Manuzza S et al. (1997) Educational and Ocupational outcome of hyperactive boys grown up. Journal of the American Academy of Child and Adolescent Psychiatry 36: 1222-1227

April 2013


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Prepared 24th April 2013