RCPsychiS Working Group on Adult ADHD: origins and evolution

Many college members are likely to be familiar with 'The Scottish Guidelines' on the management of Adult ADHD but are perhaps not familiar with the background of the working group that led to their publication.

Establishing the Working Group

The group was formed in 2016 in response to a college survey that revealed that 32% of psychiatrists felt that they were not confident in assessing ADHD and other neurodevelopmental conditions. 67% desired further training. The initial focus was on creating guidelines with the first published in 2017 with an update in January 2023 (ADHD in adults - Good practice guidance CR235). Alongside the guidelines, workshops were delivered and well received. The importance of advocacy involvement and co-production was embraced from the outset, and the Scottish ADHD Coalition have remained welcome members of the group.

In 2019 the Royal College and the National Autism Implementation Team (NAIT) at the request of the Cabinet Secretary for Health and Sport were asked to develop an Adult ADHD clinical pathway. Members of the working group were seconded to this team and produced a feasibility study report. This concluded that neurodevelopmental rather than single condition approaches should be taken. There was evidence of avoidable morbidity, mortality and societal cost associated with unmet neurodevelopmental needs. The report described mental health services being at critical capacity with neurodevelopmental conditions (NDCs) overwhelming mental health services. A need for a consistent, proportionate, whole system, evidenced based neurodevelopmental pathway was identified.

Evolving to meet changing needs

Since that time, the clinical landscape around Adult ADHD has entered a period of rapid change as service leaders consider how General Adult Psychiatry should respond to unprecedented demand. Regular discussion is also taking place in parliament, with the Scottish Government having pledged to outline a route map for the management of NDCs, incorporating recommendations set out by RCPsychiS building on the feasibility study findings, within the first 100 days of government.

In the context of these rapid changes, impacting the clinical practice of all of us who work in Adult Psychiatry in Scotland, the Adult ADHD Working Group is seeking to evolve to provide greater practical peer-led and peer-steered support in this field.

At this time, the significant co-occurrence of Autism and ADHD is unequivocally recognised, with clinical awareness of overlapping features and co-presentation being in keeping with best practice. For this reason, the working group is changing name and role, becoming the RCPsychiS Adult Neurodevelopmental Psychiatry Group.

Purpose and structure of the group

The intended roles of this group are:

1. to provide a clinical forum for Adult Psychiatrists (and residents) working, or interested in, adult NDCs in Scotland, and:
2. to provide a strategic forum for service development, education and research including both psychiatrists and NDC associated organisations (NAIT, Scottish ADHD Coalition).
   

While the UK wide Neurodevelopmental Disorder Special Interest Group (UK NDD SIG) is understood to perform similar functions, it is recognised that due to differences in healthcare delivery, a Scotland specific forum and approach is required.

The group has previously met 3 monthly, working on guidelines, strategy, and providing peer support to a small number of clinicians working in this field. However, the current shifting landscape necessitates more frequent meetings, which are proposed as monthly, alternating between clinical and strategic meetings.

With these changes ahead, we hope to bring together General Adult Psychiatrists and residents from across Scotland who are involved in this work, whether in specific Adult NDC services, or as an interest within GAP.

Please contact scotland@rcpsych.ac.uk to register an interest; involvement from an early stage of development is encouraged and welcomed to ensure that the group is shaped to meet members’ needs.

Dr Sharon Brown, Chair of the RCPsychiS Adult Neurodevelopmental Psychiatry Group.