Anna Price

Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition affecting 5–7% of children/adolescents and 2–5% of adults. It is characterised by inattention, hyperactivity and impulsivity, impacting functioning across multiple domains with linked social and economic burden. Despite effective treatments that reduce the risk of negative outcomes, the UK is currently failing to provide equitable access to healthcare for people with ADHD. Young people with ADHD are at a vulnerable life-stage, facing multiple transitions such as moving educational settings, starting work or leaving home. They frequently experience barriers to accessing care, including unsupported healthcare transitions, service gaps and attentional/organisational difficulties. A co-developed digital health application (app) could provide cost-effective psychoeducation and self-management tools for young people aged 16–30. This includes support at key times when standard services may not be available, providing trusted healthcare information and helping them to navigate care pathways, ‘wait well’ for referral/assessment or their next appointment and manage this long-term condition. This mixed-methods study aims to co-develop, initially evaluate and plan the implementation of a digital health intervention (the SmartADHD app) for young people with ADHD. Methods and analysis This mixed methods research will follow the Person-Based Approach to co-develop, iteratively adapt and feasibility test a prototype digital health intervention, informed by a critical realist stance. An interdisciplinary team, comprising experts by lived experience, health and social care professionals and digital experts, will follow co-production and engagement methodologies to develop theory, prioritise content and co-design a simple prototype (V. 0). Work Package 1 will trial and refine the prototype with 20 young people via community settings to establish usability and acceptability (V.1). Work Package 2 will feasibility test the refined prototype with 30 young people and eight healthcare professionals in National Health Service (NHS) settings (V.2). Data will be collected via think-aloud interviews, semi-structured interviews and pre- and post-surveys to iteratively improve and initially evaluate the prototype. Concurrent workstreams will explore economic models for long-term NHS implementation and address digital inclusion. Ethics and dissemination The protocol has been approved by the Yorkshire and The Humber - Sheffield Research Ethics Committee (26/YH/0101). Recruitment will commence in September 2026. Young people with lived experience of ADHD will be actively involved as co-authors and co-presenters in communicating outputs. All participants will provide informed consent prior to participation. Findings will be disseminated via research articles in peer-reviewed journals, conference presentations, public involvement events, patient groups and media releases. A summary of study findings will be shared with participants at the end of the study. Trial registration number ISRCTN26360329.

Summary: When thoroughly assessed, the prevalence of attention-deficit hyperactivity disorder (ADHD) in children/adolescents is estimated at 5%. There is no evidence that ADHD is over-diagnosed in the UK. Indeed, available data point to under-diagnosis, even though rigorous updated post-COVID-19 pandemic data are not available. Some cases may be misdiagnosed due to low-quality assessment, poor adherence to national guidance or inappropriate differential diagnosis. Beyond the controversy around over- or under-diagnosis and over-medicalisation of ordinary behaviours or emotions, the main issue is that UK clinical services cannot adequately support individuals with ADHD who need help. There is a risk that the narrative claiming ‘ADHD is over-diagnosed’ could be used to deny people with properly-diagnosed ADHD the care they deserve.

Digital technologies are becoming an important part of health care, including for individuals with attention-deficit/hyperactivity disorder (ADHD). Digital health innovations present valuable opportunities to provide flexible and tailored support for their diverse needs, along with significant challenges. Attentional, organizational, and motivational characteristics associated with ADHD may affect how individuals engage with digital tools. Potential risks include additional access barriers, the exclusion of underserved groups, and diminished quality of care. To help reduce these risks, the development, evaluation, and implementation of digital tools must be person-centered and guided by a comprehensive understanding of the diverse needs of all stakeholders. To advance research in this area, a multidisciplinary panel of ADHD specialists, technology experts, and individuals with lived experience of ADHD was formed. The panel worked together to agree on key priorities and considerations for developing, evaluating, and implementing digital technologies for ADHD. The recommendations are designed to be shared with the wider research community and to guide innovations in ADHD digital health to improve care. A modified Delphi approach was used to develop consensus. Key statements were drafted, building on discussions held during the European Network for ADHD (EUNETHYDIS) Special Interest Group meeting in 2024. An expert panel that included additional key stakeholders was convened. Draft statements were shared with panel members via a 2-round Delphi survey and discussion meetings, with final statements coproduced by the panel. Insights from multiple perspectives were incorporated, and consensus agreement was sought. Refined statements were shared with EUNETHYDIS members for ratification. Panel members were invited to contribute as coauthors. An expert panel of 28 members (21 EUNETHYDIS Special Interest Group members, 7 invited experts) coproduced 30 consensus statements on ADHD and digital health. Agreement ranged from 78.6% (22/28) to 100% (28/28) for the first round (19 statements) and from 92.6% (25/27) to 100% (27/27) for the second round (30 statements). Final statements covered 4 topic areas: Opportunities and Aspirations, Development and Evaluation, Implementation, and Risks and Unintended Consequences. These were ratified in September 2025 by the EUNETHYDIS. This consensus process provides the first comprehensive set of key considerations for digital health care for people with ADHD and demonstrates the feasibility of achieving expert agreement on complex, rapidly evolving topics, such as digital health. Future work should focus on translating these considerations into more specific and practical implementation frameworks, identifying priorities, and connecting them to real-life stories and empirical evidence.

BACKGROUND Though attention deficit hyperactivity disorder (ADHD) is thought to be the most prevalent neurodevelopmental disorder in young people worldwide, there are inequalities in access to psychoeducation and health care support. One way to improve access, potentially increase engagement, reduce health care inequalities, and enhance care is by co-developing digital responsive interventions. These have the potential to support long-term condition management and to act as an adjunct to usual care. Virtual assistants that use large language models can provide information in response to questions and learn to tailor communication to suit an individual user’s needs. This can be especially valuable for people with ADHD who often struggle to regulate attention and can experience communication challenges. Involving people with lived experience in the co-design process is crucial for the development of effective digital interventions. Therefore, this article explores the views and preferences of young people with ADHD and their supporters from the United Kingdom who collaborated with researchers to co-design a prototype chatbot. OBJECTIVE This study aimed to co-develop an evidence-based chatbot prototype, intended to help young people with ADHD thrive through improved access to health care information, psychoeducation, and self-management strategies. METHODS An interdisciplinary team was established, including researchers, software developers, clinicians, and lived experience collaborators. Research advisory and working groups were set up in ways that facilitated flexible involvement. Following the person-based approach, guiding principles were established, and workshops were held with young people with ADHD and supporters of young people with ADHD to co-develop an early prototype. Feedback was sought via think-aloud interviews with lived experience collaborators. RESULTS In total, 9 experts by lived experience and 3 health care professionals chose to engage in workshops, and this feedback informed the development of a SmartADHD chatbot prototype. An off-the-shelf chatbot (GPT-4o hosted on Convai) was trained using resources from the National Health Service (NHS). Overall, 6 experts by lived experience engaged with think-aloud interviews, providing feedback on the prototype conversational flow and feel, the avatar, the text-to-speech, the chatbox feature, and the content of the messages. Seven recommendations are made for future development, which will inform the SmartADHD program of work. CONCLUSIONS These findings provide rich data on the preferences of people with ADHD. Specific recommendations for a chatbot for young adults with ADHD have not been investigated before with young people, making this study a novel contribution to the field. These findings provide an excellent foundation for chatbot development for this group and may be relevant for those developing digital tools for people with ADHD across the lifespan and other neurodevelopmental conditions. Further work is required to elucidate the views of health care professionals and identify the limits of the technology before subsequent evaluation. CLINICALTRIAL

Background: Though attention deficit hyperactivity disorder (ADHD) is thought to be the most prevalent neurodevelopmental disorder in young people worldwide, there are inequalities in access to psychoeducation and health care support. One way to improve access, potentially increase engagement, reduce health care inequalities, and enhance care is by co-developing digital responsive interventions. These have the potential to support long-term condition management and to act as an adjunct to usual care. Virtual assistants that use large language models can provide information in response to questions and learn to tailor communication to suit an individual user’s needs. This can be especially valuable for people with ADHD who often struggle to regulate attention and can experience communication challenges. Involving people with lived experience in the co-design process is crucial for the development of effective digital interventions. Therefore, this article explores the views and preferences of young people with ADHD and their supporters from the United Kingdom who collaborated with researchers to co-design a prototype chatbot. Objective: This study aimed to co-develop an evidence-based chatbot prototype, intended to help young people with ADHD thrive through improved access to health care information, psychoeducation, and self-management strategies. Methods: An interdisciplinary team was established, including researchers, software developers, clinicians, and lived experience collaborators. Research advisory and working groups were set up in ways that facilitated flexible involvement. Following the person-based approach, guiding principles were established, and workshops were held with young people with ADHD and supporters of young people with ADHD to co-develop an early prototype. Feedback was sought via think-aloud interviews with lived experience collaborators. Results: In total, 9 experts by lived experience and 3 health care professionals chose to engage in workshops, and this feedback informed the development of a SmartADHD chatbot prototype. An off-the-shelf chatbot (GPT-4o hosted on Convai) was trained using resources from the National Health Service (NHS). Overall, 6 experts by lived experience engaged with think-aloud interviews, providing feedback on the prototype conversational flow and feel, the avatar, the text-to-speech, the chatbox feature, and the content of the messages. Seven recommendations are made for future development, which will inform the SmartADHD program of work. Conclusions: These findings provide rich data on the preferences of people with ADHD. Specific recommendations for a chatbot for young adults with ADHD have not been investigated before with young people, making this study a novel contribution to the field. These findings provide an excellent foundation for chatbot development for this group and may be relevant for those developing digital tools for people with ADHD across the lifespan and other neurodevelopmental conditions. Further work is required to elucidate the views of health care professionals and identify the limits of the technology before subsequent evaluation.

Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that can have poor long-term outcomes when unmanaged. Young people aged 16–25 years with ADHD are often unable to access specialist health care as recommended by UK guidelines because of gaps in services, poor transitional support between child and adult services, and long waiting lists. Healthcare information, which is important for condition management, may help mitigate service gaps and support thriving in people with ADHD; however, little is known about provision via primary care. Aim: To investigate experiences of information provision supporting management of young people with ADHD in general practice and explore the potential of digital resources. Design and setting: This qualitative study comprised interviews with young people with ADHD, their supporters, and primary healthcare professionals from sites across England. Method: Participants were recruited from five purposively sampled general practices, varying by local area characteristics. Semi-structured interviews included questions about information provision, healthcare information needs, and digital resources. Themes were generated using reflexive thematic analysis, within a critical realist framework. Results: In total, 20 participants were recruited (11 healthcare professionals and nine people with lived experience). Four themes were generated: lack of ADHD-specific resources, supporting patients with condition management, dedicated resources for clinicians, and digital resources enhancing care . Conclusion: People with lived experience and healthcare professionals want better healthcare information about ADHD in general practice, including co-produced resources to support understanding and self-management. Digital resources represent a potentially cost-effective and accessible solution that is currently underutilised.

Background: Evidence and Gap Maps (EGMs) are a visual representation of the available evidence relevant to a specific research question or topic area. They are produced using similar methods to systematic reviews, however, there is little guidance on which databases to search and how many. Information Specialists need to make decisions on which resources to search, often for a range of study designs within a broad topic area to ensure comprehensiveness. Case Presentation: This case study presents two search summary tables (SSTs) from an evidence and gap map on peer support interventions. The first search summary table presents the findings of the search for systematic reviews and the second for randomised controlled trials. Different databases and different searches were undertaken for the two different study types. Conclusion: The two SSTs indicated that MEDLINE and PsycINFO were key databases required for the identification of both systematic reviews and randomised controlled trials of peer support interventions, with the addition of CINAHL for systematic reviews, and CENTRAL for randomised controlled trials. For both study types, forward citation searching found additional included studies although it was more lucrative for identifying additional randomised controlled trials. Search summary tables are a simple way to share the effectiveness of the search methods chosen for a specific evidence synthesis project. The more SSTs we have, the more data we will have to inform evidence-based decisions on our search methods.