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Clinicians working in UK child mental health services are faced with several challenges in providing accurate assessment and diagnosis of attention deficit hyperactivity disorder (ADHD). Within the South London & Maudsley (SLaM) NHS Trust, community Child & Adolescent Mental Health Services (CAMHS) are developing structured pathways for assessing and diagnosing ADHD in young people. To date, these pathways have not been formally evaluated. The main aims of this evaluation are to evaluate all ADHD referrals made to the service in an 18-month period, including the number of completed assessments and proportion of children diagnosed with ADHD; and investigate adherence to the National Institute for Clinical Excellence (NICE) guideline for diagnosing ADHD in children and young people.

Retrospective data analysis was performed using service databases and electronic patient records. Adherence to the clinical guideline was measured using the NICE data collection tool for diagnosing ADHD in children and young people. All completed ADHD assessments were compared to four key recommendation points in the guideline.

Within the time frame, 146 children aged 4-17 years were referred and accepted for an ADHD assessment. Of these, 92 families opted in and were seen for an initial appointment. In total, 36 ADHD assessments were completed, of which 19 children received a diagnosis of ADHD and 17 did not. Aside from structured recording of ADHD symptoms based on ICD-10 criteria (69%) and reporting of functional impairment (75%), adherence to all guidance points was above 90%. The study also found that although a greater proportion of children referred to the service were male and identified as White, these differences narrowed upon receipt of ADHD diagnosis.

Relationship to the existing literature is discussed in relation to the assessment process, demographic characteristics and rates of co-occurrence.

The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families.

This article is unique in that it is, to the best of the authors’ knowledge, the first to describe and report clinician-adherence to a structured pathway for diagnosing ADHD in young people within a community CAMHS service in South London.

The paper aims to provide an overview of the current situation with diagnosis and assessment in autism spectrum disorders (ASD).

The paper is a review of literature combined with personal observation of practice.

Diagnosis cannot be determined by any one tool. It is a clinical judgement. A solo experienced clinician can make a diagnosis. Wider assessment is needed post diagnosis and needs a team.

Specialist multidisciplinary teams to assess people with ASD should be set up for adults as well as for children.

The paper is of value to those who are designing and providing diagnostic and assessment services. It provides a new review, covering a wider area.

Servitization of manufacturing is characterized by very complex decision processes within strongly unstable and uncertain decision contexts. Decision-makers are face situations of lack of internal and external information. The purpose of this paper is to develop a decision aid approach to support the management of servitization decision-making processes.

The scientific orientation of this research consists in working at improving the efficiency of the servitization decision-making process, by identifying factors of non-reliability, in order to propose remediation actions for the whole process. Improving the final decisions taken by the managers is considered as a consequence of the improvement of the decision-making process reliability. The method, based on modeling and evaluation, requires the specification of a decision process model for servitization, used as a basis to assess decision process reliability and diagnose the enterprise’s servitization decision system. Improving the final decisions made by the managers is considered as a consequence of the improvement of the decision-making process reliability.

Key added values: first, to formalize a servitization decision-making reference model; second, to specify a reliability assessment applied to the decision system; and third, to define a decision process reliability diagnosis procedure for servitization, illustrated in a case study.

A direct perspective is to complete the focus on procedural reliability, by taking into consideration the subjective rationality of decision-makers in the reliability assessment procedure. Additionally, this reliability assessment method and diagnosis could become the basis of a larger risk management approach for servitization.

The diagnosis procedure proposed in the paper is dedicated to generating practical results for enterprise decision-makers, consisting in recommendations for decision process improvements, in the context of servitization. The approach is illustrated through an industrial SME case study. The practical implications are highly contextualized.

The key originality of this research is to tackle servitization complexity with a decision system modeling and diagnosis orientation, including the formalization of the notion of “decision process reliability,” and the specification and implementation of a quantitative assessment procedure.

People with Down's syndrome are at increased risk of developing early onset Alzheimer's disease. It has been recommended that all adults with Down's syndrome receive baseline neuropsychological testing for dementia. In certain areas prospective screening of people with Down's syndrome takes place to ensure the early diagnosis of the condition. However, little has been published on the value of this type of screening. The purpose of this paper is to report on a prospective screening programme and asks whether the programme is effective in identifying dementia-related changes in people with Down's syndrome and whether the current screening intervals are appropriate.

All adults with Down's syndrome in Plymouth (UK) are identified and offered a comprehensive test battery at baseline at the age of 20 and then have testing biennially from 40 to 50 and annually after 50. All individuals diagnosed with dementia between 2001 and 2013 were identified and their case notes examined. The symptoms at the time of diagnosis were identified and whether these symptoms had been identified through the screening programme or by other routes were recorded. Prevalence data and age at diagnosis were also recorded.

In total, 26 people were diagnosed with dementia during the study period. Of these, the diagnosis of dementia followed concerns being identified during the routine screening programme in 54 per cent of cases. In the younger age group (age 40-49) 63 per cent of people were identified through the screening programme. At the time of diagnosis a mean of 5.5 areas of concern were in evidence.

Limited by small sample size, however service development not original research. Implications for the use of prospective dementia screening in people with Down's syndrome.

Implications for how services choose to run their Down's syndrome and dementia screening programmes, including the frequency of screening.

The paper adds to a growing evidence base around the value of prospective dementia screening in people with Down's syndrome. It is also one of a few studies exploring the frequency of screening. Additionally, it adds further data about prevalence of dementia in people with Down's syndrome.

The purpose of this paper is to explore the experience and possibilities for misdiagnosis of women with ASD in secure and forensic hospitals, via the medium of a lived experience case study. To consider the clinical value of the patient perspective of and insight into their disorder. The case study is supplemented by relevant associations to the MHA Code of Practice, the CQC report, Monitoring the Mental Health Act (MHA) 2016–2017, published on 27 February 2018 and current research findings in the fields of service provision, quality of care and treatment of female patients with a diagnosis of ASD.

A review and commentary of the author’s lived experience of a formal diagnostic assessment for ASD as a female patient in a secure and forensic hospital. In reviewing aspects of the author’s clinical assessment, the author has made contextual reference to the MHA Code of Practice, the CQC report, Monitoring the MHA 2016–2017, published on 27 February 2018, and current research findings. The account focuses on aspects of the author’s recent experience assessment and treatment for ASD which the author believes may be of use in informing clinical practice.

Open-ended exploration of a lived experience account/case study of a diagnostic assessment of an adult female patient for ASD, demonstrating the possible ambiguity of responses to questionnaire-based assessment tools and other deficiencies inherent to the assessment process and care and treatment of adult female ASD sufferers in secure and forensic hospitals.

The author uses the lived experience as a patient to review and provide commentary on the clinical assessment for ASD. This review is, therefore, informed by an authentic patient perspective and not clinical perspectives. This paper highlights the need for further research into the diagnostic assessment of females for ASD in a secure and forensic hospitals.

First, to encourage practitioners to extend their range of thinking to be more inclusive of the patient perspective when performing a diagnostic assessment. Second, to increase practitioner awareness of the deficiencies in the current service provision for adult female patients diagnosed with ASD in secure and forensic hospitals.

To improve patient experience of diagnostic assessment for ASD and the quality of the assessment and patient outcomes in secure and forensic hospitals.

The paper is original in concept in that it considers the inclusion of patient experience/views in assessment and formulation and links them to wider social policy and practice guidance. The case study is an authentic patient account informed by the author’s experience of secure and forensic psychiatric hospitals. The value of the paper may be determined by the extent to which the paper encourages practitioners to consider the patient perspective and experience of the diagnostic assessment and how this and subsequent care and treatment may affect the adult female patient in secure and forensic hospitals.

The assessment for and diagnosis of personality disorder (PD) continue to be contentious, with many prominent practitioner psychologists arguing against this specific label and providing a credible alternative framework to psychiatric diagnosis more generally. This paper aims to summarise the literature and support practitioners identifying PD in people with intellectual disabilities (ID).

Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide a service position on the assessment and diagnosis of PD in people with ID.

For people with intellectual disabilities, the PD label can be even less robustly applied and may be even more pejorative and obstructive. That said, there are people for whom a PD diagnosis has clear clinical utility and opens access to suitable specialist services.

Evidence suggests that a diagnosis of PD can be both facilitative and obstructive, and the assessment and diagnosis process should, therefore, be undertaken with caution.

This paper presents an account of NICE guidance and evidence on the assessment and diagnosis of PD in people with intellectual disabilities.

The purpose of this paper is to discuss the findings of a service evaluation project of the Specialist Memory Clinic for people with intellectual disabilities in South Wales using the Dementia guidelines published by the British Psychological Society and the Royal College of Psychiatrists (BPS/RCPsych, 2015).

Clinical audit using case notes of patients attending Memory Clinics during 2011 and 2015 benchmarked against best practice guidelines; carers feedback from Memory Clinic attendance; and evaluation of the training sessions to carers.

Audit findings show full compliance with standards (100 per cent) except for the baseline assessment for people with Down syndrome. Carer’s evaluation and feedback was positive and constructive. Training evaluation indicates improvement in knowledge and positively received sessions.

The small number of people included and possibility of high motivated team may affect the service evaluation result.

It is possible for the Community Learning Disability team to meet the standards published (BPS/RCPsych, 2015) through multidisciplinary working.

Initial service evaluation completed after published guidelines for Dementia care by the BPS/RCPsych (2015).

The purpose of this paper is to explore and highlight the main elements of an autism spectrum disorder assessment in adults. It features significant challenges for the clinical teams responsible to undertake the assessment. This paper aims to explain the importance of the wider needs assessment in accordance to the Autism Act and Autism Strategy.

The paper describes the main symptom domains for an ASD diagnosis, according to the two basic diagnostic manuals. It provides compendious summary of the available diagnostic tools and the significant comorbidities people with ASD present with including other neurodevelopmental disorders, mental or physical health problems, challenging behaviour and risk issues.

The paper proposes that all National Health System professionals should be able to recognise possible signs of ASD and accordingly refer individuals for a comprehensive assessment to secondary services. It highlights the importance of a wider needs assessment as part of a broader approach to addressing the needs of those with suspected ASD.

The paper aims to improve the gaps which remain in the referral and diagnostic process of people affected by ASD.

Through a comprehensive assessment the paper aims to improve the educational, social and personal functioning of people with ASD as well as the quality of life of their parents and carers.

The paper assembles a wide range of relevant considerations in regards to potential ASD in one place, and can be used to inform a comprehensive understanding of the assessment/diagnosis process.

Parents whose children have undergone an autism assessment often describe the process as extremely stressful. This affects how parents engage with services post-diagnosis, meaning less likelihood of using subsequent service support despite struggling to cope. Since parents already report many barriers to accessing services, e.g. long waiting lists, lack of co-ordination and limited resources (Sapiets et al. 2023), negative experiences during assessment should not pose another potential barrier to engagement. This study aimed to address how families’ needs can be better met during the assessment process.

In this qualitative study, the author conducted semi-structured interviews with 11 parents whose child had undergone an autism assessment in the last five years. Thematic analysis determined key themes.

The six themes were: clarity and communication, access to support and resources, aftercare, recognition of parent concerns, personalisation of the assessment process and concerns around the use of personal protective equipment/online assessments. These themes led to criteria to assess the quality of autism assessment services in line with parent perspectives.

These parent-informed criteria could facilitate the consideration of parents’ views into service evaluations of autism assessment services across the UK.

Previous research indicates that the autism assessment experience is often extremely stressful and overwhelming for families (Crane et al., 2016). Despite this, guidance to improve autism services rarely prioritises the opinions and experiences of service-users and their families. The criteria presented here were derived from themes identified by interviewing parents on their experiences of the autism assessment process, thus shifting the focus onto service-users.

The purpose of this paper is to discuss the system approaches and their application for managing IBS building in the context of Malaysian maintenance practice. Currently, the maintenance management method has affected the efficiency of the complex and high-rise industrialised building system (IBS) building maintenance management in Malaysia. Many issues such as poor service delivery, limited budgets, less competent staff and defect repetition emerged because of the usage of conventional method applications (paper-based form). The data revealed that the practice of maintenance management for complex and high-rise IBS buildings needs to be digitalised.

This qualitative research was carried out by conducting literature review and semi-structured interviews. Eight major maintenance organisations were selected based on a conventional method of practice in managing maintenance for complex and high-rise IBS buildings. The computerised system was developed using a data flow diagram and coding. Subsequently, the prototype system was tested.

By having this prototype system, the defect diagnosis and decision-making process become easier, faster and cost-effective in facilitating the maintenance assessment, defect diagnosis and control in relation to IBS building structure components.

In conclusion, the prototype system may improve the effectiveness of maintenance management practices for IBS building structure components in reducing defect design risks such as design calculation error to provide high-quality IBS building structure components for a safe and healthy environment.