Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners

Background: Compared to existing literature on childhood attention deficit hyperactivity disorder (ADHD), little published adult data are available, particularly outside of the United States. Using General Practitioner (GP) questionnaires from the United Kingdom, this study aimed to examine a number of issues related to ADHD in adults, across three cohorts of patients, adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood.Methods: Patients with a diagnosis of ADHD and prescribed methylphenidate, dexamfetamine or atomoxetine were identified using data from The Health Improvement Network (THIN). Dates when these drugs started and stopped were used to classify patients into the three cohorts. From each cohort, 50 patients were randomly selected and questionnaires were sent via THIN to their GPs.GPs returned completed questionnaires to THIN who forwarded anonymised copies to the researchers. Datasets were analysed using descriptive statistics.Results: Overall response rate was 89% (133/150). GPs stated that in 19 cases, the patient did not meet the criteria of that group; the number of valid questionnaires returned was 114 (76%). The following broad trends were observed: 1) GPs were not aware of the reason for treatment cessation in 43% of cases, 2) patient choice was the most common reason for discontinuation (56%), 3) 7% of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms, 4) 58% of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed.Conclusion: This study presents some key findings relating to ADHD; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence. Patient choice was identified as the most common reason for treatment cessation. For patients who started pharmacological treatment in adulthood, many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made.

Assessment in primary education in Ireland

This doctoral study examines assessment in primary education in the Republic of Ireland. The nature and purpose of assessment offer an insight into the values which are prioritised by an education system. In 2011, in the Republic of Ireland, the Department of Education and Skills (DES) published a strategy aiming to improve standards of literacy and numeracy. The document, entitled, Literacy and numeracy for learning and life: the national strategy to improve literacy and numeracy for children and young people 2011-2020, contains improvement targets as measured by standardised tests. It also mandates the increased use of standardised tests in primary education, and directs that aggregated scores should be reported to both Boards of Management and the DES. The study is framed by the theoretical perspectives of Michel Foucault and Pierre Bourdieu. Both of these commentators examine social policy and practice in an effort to provide insight into the history and operation of social institutions. This study is especially influenced by Foucault’s archaeology and genealogy of knowledge, and his notion of governmentality. It is also particularly cognisant of Bourdieu’s thoughts on habitus, doxa and capital. The study contains reviews of literature in the areas of assessment, assessment policy, and assessment policy in Ireland. These reviews highlight current debate in each of these areas while also grounding this debate in an historical context. The dissertation contains four empirical sections. 1) It analyses policy documents prepared in the development of the published strategy as well as investigating the strategy itself. In so doing it is aware of the burgeoning influence of pan-national bodies on policy development. 2) A number of high profile policy makers were interviewed as part of the study and their views are interpreted in light of the findings of the literature reviews. 3) The perspective of teachers was sought through a questionnaire survey. This gathered data on these teachers’ views on the purpose of assessment as well as their actual practice. 4) Finally, children were also included as participants in this study. They were interviewed in focus groups and encouraged to contribute drawings as well on their views of assessment in primary school. Literacy and numeracy for learning and life is seen as a seminal document in Irish education. This study is significant in its analysis of original data from high profile policy makers, including two Ministers for Education and Skills. It is also significant in its inclusion of the perspectives of primary school pupils. Finally, the study considers the nature and role of assessment in a holistic manner by including the views of policy makers, teachers and pupils. The study notes that policy development in Ireland underwent a change in the preparation of Literacy and numeracy for learning and life and that international influences, while present, are also mediated to suit the local context. It also highlights a lack of clarity in the definition of assessment in primary education and argues that there is a lack of balance in the approaches that are prioritised. The study demonstrates that teachers are impacted by the strategy but that they also change it by focusing on their own concerns while using assessment tools. The children provide compelling evidence of the impact of assessment on the learner. The study shows how assessment tools (and school subjects) are valued with differing levels of importance by a variety of stakeholders.