Outcomes for children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD).
Randomised controlled trials test specific interventions for childhood neurodevelopmental disorders under controlled conditions, but how can the typical package of health and educational services be evaluated? The 'classic evaluation problem' for retrospective designs which look at outcomes in child mental health is difficulty in identifying a suitable control group. Ideally, controls would be a group of children who share symptom severity, but have never been diagnosed, nor received any service support. Diagnosis with ASD or ADHD triggers service support in the forms of extra educational resources for children, specialist mental health support, behavioural therapies, respite care for parents and sometimes medication for children. The project aims to evaluate outcomes associated with the service support that children and families make use of after a diagnosis is applied.
Diagnosis of ASD or ADHD (and/or subsequent service contact) has an effect on behavioural outcomes, compared with an undiagnosed group who have comparable symptoms.
If developmental trajectories of diagnosed children treated by services are compared with a control group who present similar symptoms but remain unidentified in the community and untreated, then it should be possible to isolate the effects of the diagnosis and service use, in theory at least. A growing body of work in epidemiological psychiatry suggests such a control group does exist- that many children suffer from neurodevelopmental disorders but are never bought to the clinic or identified at school. As a result they may never receive any formal help.
This project utilises data from The Avon Longitudinal Study of Parents and Children (ALSPAC), which has been running for over 18 years and follows a cohort of over 10,000 children. It aims to ascertain effectiveness of service use, in community real-world settings, for children diagnosed with ASD or ADHD by retrospective analysis of existing data. This innovative methodology compares the outcomes of children with a clinical diagnosis with a comparison group who, unbeknownst to both children and parents, have received a 'research diagnosis' of ASD or ADHD by a child psychiatrist. This project has developed from my .The analysis will co-vary for important confounders, particularly IQ, which has been shown to be a major indicator of prognosis, and the development of speech and language. A comparison of the two groups, (the one group diagnosed in the clinic, the other diagnosed by research ratings), will also identify differences in social and demographic factors in the children's backgrounds. In other words, the work will shed light on the social factors that influence why some children are bought to the clinic, while others are not.