Dr. Kate Carr-Fanning:

I thank the Chair and members for the invitation to appear today. We welcome the attention being given by the committee to this important issue of mental health and ADHD. Who are ADHD Ireland? We are a national representative organisation for those with this condition. Our mission is simply to make life better for all those affected by ADHD. This year, we will deliver more than 400 activities to support our community. We will receive more than 6,000 contacts from members of the public. Our website will have more than 250,000 visits, all delivered by ten exceptionally motivated and passionate staff, consisting of six whole-time employees and our board and volunteers. As a section 39 organisation, we receive more than 80% of our funding through the HSE.

ADHD stands for attention deficit hyperactivity disorder. It is a neurodevelopmental condition which means the brain has developed differently. Currently, more boys than girls are diagnosed, with prevalence somewhere between 2% and 7%, decreasing with increasing age. In Ireland, there is no guidance for clinicians working with those with ADHD on what good ADHD assessment or intervention looks like.

Regarding child services, ADHD diagnosis falls under the remit of the child and adolescent mental health services, CAMHS. This is a service for both ADHD and those with moderate to severe mental health concerns. Using data from my own service, Lucena Clinic CAMHS, there was a 54% increase in referrals between 2006 and 2021. For ADHD, this is likely to be driven by parents noticing differences when home-schooling their children during the Covid pandemic. It is also from young people themselves self-identifying after viewing content on social media and following increased awareness and acceptance of the condition.

A limitation of having ADHD under the remit of CAMHS is that of waiting list prioritisation. CAMHS waiting lists are largely populated by children awaiting ADHD assessment, due to the fact that urgent mental health issues are of course prioritised. The HSE has recently been funding waiting list initiatives. These are advertised as temporary contracts, making suitable recruitment difficult and retention of any gains difficult. In addition, although children on waiting lists have benefited from speedier assessment as part of these initiatives, the use of the waiting lists as a key metric by the HSE for how CAMHS teams are functioning is an ongoing issue. Once these children have been assessed, they then require supports, and demand for intervention within CAMHS far exceeds capacity.

All disciplines are understaffed on CAMHS teams nationally when compared with the recommendations in the A Vision for Change document. Social workers staff in Lucena Clinic CAMHS is at 37% on average across the teams. Despite this, I note from data available from my CAMHS that those with ADHD were 5.5 times more likely than those without to have a referral to Tusla. Psychology staffing in Lucena is at 40.5%, and that ranges from 23% to 53% across teams. This means there is reduced access to ADHD assessment and intervention.

Children with moderate to severe mental health concerns like depression, anxiety, obsessive-compulsive disorder, OCD, psychosis and eating disorders will be prioritised for intervention over the ADHD cohort. It is common that only medication is available to ADHD children in Ireland.

Of note is the assessment, diagnosis, management initiation, research and education, ADMiRE, team in Linn Dara CAMHS, which is a separately staffed ADHD-specific team in CAMHS. Consideration should be given to extending this model across services. CAMHS provides intervention for moderate to severe ADHD only. There is a lack of clarity on where those with mild presentations should be supported, with many of these children falling between services.

A further issue with current service provision is the segregation of child services in Ireland, with each having different remits. The co-occurrence rate is high between neurodivergences. For example, 30% of those with ADHD also meet the criteria for autism. This means that children currently need to access multiple services nationally and clarity on the presence of other diagnoses is very often needed before ADHD can be considered. This means that CAMHS relies on other services like the children's disability network team, CDNT, and the National Educational Psychological Service, NEPS, to provide assessment that falls outside its remit. Children are often on multiple waitlists at the one time, and are not receiving holistic care in Ireland.

In the UK, there are pilot neurodivergence teams established by the NHS, providing assessment and intervention for neurodivergence more generally. Strong consideration should be given to the establishment of similar teams nationally.

Of note regarding children’s services is the high prevalence of private assessment as a direct consequence of families being unable to access CAMHS in a timely way. Private assessment is currently unregulated in Ireland and the quality of these assessments varies considerably.