title: Practitioner Review: Pathways to care for ADHD - a systematic review of barriers and facilitators.
abstract: BACKGROUND
  Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder starting in childhood that may persist into adulthood. It can be managed through carefully monitored medication and nonpharmacological interventions. Access to care for children at risk of ADHD varies both within and between countries. A systematic literature review was conducted to investigate the research evidence related to factors which influence children accessing services for ADHD.
  
  
  METHODS
  Studies investigating access to care for children at risk of ADHD were identified through electronic searches of the international peer-reviewed and grey literature. Databases were searched from inception till 30th April 2012. This identified 23,156 articles which were subjected to three levels of screening (title, abstract and full text) by a minimum of two independent reviewers. Due to the heterogeneity in the study designs, a narrative approach was used to present the findings.
  
  
  RESULTS
  Twenty-seven papers met the inclusion criteria; these were grouped into four main themes, with some papers being included in more than one. These were wider determinants (10 papers); identification of need (9 papers); entry and continuity of care (13 papers) and interventions to improve access (4 papers). Barriers and facilitators to access were found to operate at the individual, organisational and societal level. Limited evidence of effective interventions to improve access was identified.
  
  
  CONCLUSIONS
  This review explored the multilayered obstacles in the pathway to care for children at risk of ADHD and the lack of evidence-based interventions designed to address these issues, thereby indicating areas for service development and further evaluative research.
authors.affiliation: School of Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Wright
authors.affiliation: Specialist Services Directorate, Nottinghamshire Healthcare NHS Trust, Nottingham, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Moldavsky
authors.affiliation: School of Sociology and Social Policy, University of Nottingham, Nottingham, UK.
authors.forename: Justine
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Specialist Services Directorate, Nottinghamshire Healthcare NHS Trust, Nottingham, UK.
authors.forename: Ipsita
authors.initials: I
authors.lastname: Chakrabarti
authors.affiliation: Division of Psychology, Nottingham Trent University, Nottingham, UK.
authors.forename: Janine
authors.initials: J
authors.lastname: Coates
authors.affiliation: Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: David
authors.initials: D
authors.lastname: Daley
authors.affiliation: Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Puja
authors.initials: P
authors.lastname: Kochhar
authors.affiliation: Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Mills
authors.affiliation: Child and Adolescent Psychiatry, Lincolnshire Partnership NHS Foundation Trust, Lincolnshire, UK.
authors.forename: Walid
authors.initials: W
authors.lastname: Sorour
authors.affiliation: Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sayal
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D002648:Child; D006297:Health Services Accessibility; D006801:Humans
keywords: Attention-deficit disorder with hyperactivity; child; continuity of patient care; developmental disability; health service needs and demands