Established in 2007 Tony Lloyd PhD Liverpool Sefton Sept 2012 Knowsley Spring 2013 Warrington January 2013 St Helens Spring 2013 Tony Lloyd PhD

Comorbidity 20-30% have additional learning difficulties (Wender 2002) Up to 50% of boys display oppositional behaviour 20-40% progress to conduct disorder or the more serious oppositional defiant disorder (Geller 1998) 18% will attempt suicide (Lahey 2010) Depression&Anxiety (Thakker & Adler 2006) 17-45% parental Alcohol dependence & 9-30 Parental drug dependence (Willens 1995) It is my belief, based on experience working with children and adolescents, that many have emotional problems – caused by a variety of adverse life events – such as family breakdown, bereavement, psychological trauma, abusive or absent parents, exp of being bullied – all of which can manifest in behaviours which try to communicate what the child can not articulate because they dont have the self awareness or the language skills. Anxiety and depression are much more common in children than we as a socety would perhaps like to admit. How we parent and educate our children is an emotive issue – because we all recognise how important it is that we get it right!

Untreated and unsupported ADHD Age:6 10 14 Criminal behaviour School exclusion Substance abuse Teenage pregnancy Conduct disorder Lack of motivation Disruptive behaviour Poor social skills Learning delay Challenging behaviour ODD ADHD only–low self esteem Treated and supported ADHD will remain just as ADHD; without the right support ADHD is likely to develop into other difficulties. (G. Kewley 2002) Dr. Geoff Kewley Consultant Paediatrician and consultant representative of ADDISS (Attention Deficit Disorder Support Services) 3 (c) Liverpool ADHD Foundation 2009 3

NICE Guidance 2010 ”The consequences of severe ADHD for children, their families and for society can be very serious. Children can develop poor self esteem, emotional and social problems and their educational attainment is frequently severely impaired. The pressure on families can be extreme”. 4 (c) Liverpool ADHD Foundation 2009

– where are the rest? Youth Justice System? We now know that …….. Prevalence of ADHD: affects between 3-5% of children/young people both nationally and internationally (NICE guidelines). Diagnosis in Liverpool is approx 1.4% of the 92,300 children in Liverpool Sefton is approximately 1% – where are the rest? Youth Justice System? The NEET figs for Liverpool are 15,814 known to Connexions of which 1,640 are NEET = 10.4% The NEET figs for the North West are 249,913 known to Connexions of which 19,440 are NEET = 7.8% 5 (c) Liverpool ADHD Foundation 2009

ADHD is a lifelong condition (International Consensus Statement on ADHD 2002) Increased risk of – Anxiety , Depression, (Laitinen-Krispijn 1999) Mental Health Problems (Kalttialala-heino et al 2003) Alcohol and substance misuse (Barklay et al 1997) (Green & Chee 1997) Reduced economic independence (Beiderman & Farraone 2006) School failure Early onset cardiovascular disease + increased health care costs throughout life (Chan et al 2002) (Lynch 2000) The research on the developmental trajectory of children with ‘ADHD’ is alarming. ADHD often remains but impulsivity is reduced as a result of the development of the pre frontal cortex in adolescence – inattention and inability to concentrate are often still in evidence in young adults. However, the brains ability to grown not only new synaptic connections but also new neurons means that the brain can be trained to function more efficiently – both cognitively and in relation to behavioural impulse.

Conclusion Early intervention significantly reduces the severity of ADHD Intervention needs to be multi modal Intervention should have a ‘think family’ approach (why?) With substance misuse explore how some young people ‘self medicate’ with cannabis or amphetamines – would psychostimulants such as Ritalin be the answer? Research suggests using Ritalin reduces substance misuse (Beiderman 1999) (self medicating linked to acquisitive crime?) De stigmatise ADHD – many with this condition experience a sense of relief that they are not ‘mad or bad’ but rather misunderstood. It is a neurobiological condition not a cultural construct or a synonym for anti social behaviour. Children & young people can be taught to self manage the condition

What we offer Information Advice and Guidance / Assessment Sessions for parents Information Advice & guidance sessions for young people (12yrs – 19yrs) ‘CBT based ADHD Skills Building’ training for parents ‘ADHD Skills Building’ training for children 5-12 years ‘ADHD Skills Building’ training for young people 12-19 years Counselling ADHD Brief Solution Focussed Therapy for 12-19 years Counselling Family Therapy Childrens Therapy (5-12 years) from - Spring 2013 Stress Management and Sleep Clinics from - Autumn 2013 Facilitated Parents Peer Support Groups – Monthly from April 2013 Neurofeedback Clinic – September 2013 8 (c) Liverpool ADHD Foundation 2009

Referral Pathway G.P. Education Psychologist? Alder Hey NHS Trust Paediatricians & Psychiatrists SPA ADHD Counselling Service (12-18) Family Therapy Stress Management & Sleep Clinic (Spring 2013) Referral to the ADHD Foundation Information Advice & Guidance Service user Engagement Activities: à Trustee à Youth Board à Parents Support Group à ADHD Accredited training à Participation events à Volunteering opportunities Invited to Parent ADHD Skill Building Group 11—19 Youth Activity Service promoting positive outcomes for Young People with ADHD Children (5-11) and Young Persons (12- 18)Skill Building Group