Aisling Mulligan

Purpose: Gender differences in the presentation of Attention-Deficit/Hyperactivity Disorder (ADHD) are well-documented, yet the interaction between ADHD and female reproductive stages remains underexplored. This study investigates how ADHD impacts menstruation, perinatal experiences, and menopausal symptoms in females. Methods: A cross-sectional study was conducted with 602 females (mean age = 39.52; SD = 10.21), including 377 with self-reported ADHD and 225 without, recruited through ADHD support groups, social media, Volunteer Ireland, and Prolific. Participants reported their menstrual regularity and completed the Premenstrual Symptoms Screening Tool (PSST). Retrospective postpartum depression levels were measured using the Edinburgh Postnatal Depression Scale (EPDS), and peri- and post-menopausal symptoms were evaluated using the Greene Climacteric Scale (GCS). Results: Females with ADHD exhibited significantly higher rates of menstrual irregularity (χ2 = 14.2, p < .001), more severe premenstrual symptoms (χ2 = 204.7, p < .001), elevated postpartum depression levels (t = 7.89, p < .001) with increased risk of unplanned pregnancies and pregnancy-related complications, and greater menopausal symptom severity (t = 9.61, p < .001) compared to their non-ADHD counterparts. Conclusions: These findings highlight a higher prevalence of reproductive-related challenges in females with ADHD, underscoring the need for further research in this area and more in-depth analysis. They emphasise the importance of integrating ADHD considerations into female health research and clinical practice.

Background: This study evaluated the efficacy and acceptability of Ireland’s National Clinical Programme for ADHD in Adults (NCPAA), providing public assessment and supports for adults with ADHD. Methods: Overall, 249 adults (51% women, 42% men, 4% non-binary, 1% other gender) were recruited from three NCPAA services using consecutive sampling. Participants completed the Adult Self-Report Scale (ASRS) and the Weiss Functional Impairment Rating Scale (WFIRS-S) at baseline, 6, and 12 months; service satisfaction was measured with the Service Satisfaction Scale (SSS). Reflexive thematic analysis explored responses to two open-ended questions. Results: Service users presented with high baseline symptomatology and life challenges. Significant improvements were observed in ASRS and WFIRS-S (except education) in the first six months. Improvements were retained at 12 months in ASRS and WFIRS-S domains of work, life skills, self-concept and social. but not family, risk or education. Service satisfaction was high, particularly among those diagnosed with ADHD. Thematic analysis identified three positive themes: feeling affirmed, benefits of supports, and person-centred care; and three improvement areas: access barriers, resource gaps, and need for ongoing support. Conclusions: Engagement with NCPAA services is associated with improvements in ADHD symptoms and life challenges and is acceptable to adults with ADHD in the short term. Service limitations, particularly staffing constraints, warrant attention. Recommendations include strengthening resources, improving communication and appointment systems, and enhancing links to external supports. Given the absence of a control group, findings should be considered preliminary.

Background: Patient‐reported outcome measures place the patient at the centre of his/her care. There are calls to introduce child‐reported outcome measures to mental health services. We aimed to (a) develop an age‐appropriate patient‐reported outcome measure for children's mental health, and (b) validate this in a primary school and Child and Adolescent Mental Health Service (CAMHS). Methods: A list of items to measure children's mental health was proposed (Draft 1) and revised to 14 items following focus group and user consultation (Draft 2). A colourful, cartoon and emoji version was created in consultation with children (Draft 3); a professional cartoon artist created the final ‘My Feelings Form’ (MFF), with usability feedback (Draft 4). The MFF was tested by 317 children aged 4–13 years from one mixed‐gender primary school at two time points in 1 day, and 25 children aged 4–13 years from CAMHS. Results were analysed using test–retest reliability and exploratory factor analysis; a receiver operator characteristic curve was constructed. Results: The CAMHS group scored significantly higher than the school group for the mean total score (23.5 ± 11.3 vs. 16.1 ± 6.2) and for 10 items. Test–retest reliability was acceptable (correlation = 0.74, p < .001). Exploratory factor analysis using 10 informative items identified two factors – emotional factor (Cronbach's alpha = 0.74) and function factor (Cronbach's alpha = 0.59). The revised 10‐item form has a Cronbach's alpha of 0.77; a cut‐off of 12 has a sensitivity of 80% and specificity of 60%, indicating that it correctly identified 80% of those who were attending CAMHS and gave 60% of the schoolchildren a negative result. Conclusions: The colourful MFF was co‐produced with children, and preliminary data suggest that it is a useful patient‐reported outcome measure for children's mental health.

Introduction: It is believed that the COVID‐19 pandemic and associated global school closures may have an adverse effect on children's mental health.Methods: We performed repeated measures of the mental health of children attending one primary school in Ireland before and during the quarantine phase of the first wave of the pandemic. We used the ‘My Feelings Form’, which is a 14‐item colourful self‐report measure which was completed in the classroom in 2019 and via postal survey in 2020.Results: We had an 87% response rate in 2019 and a 35% response rate via postal return in 2020. We found no evidence of a change in mean measures of mental health between 2019 and 2020, in the 35% who responded in 2020.Conclusion: There is a cohort of children who were not adversely affected by the first wave of COVID‐19 pandemic and associated school closures in Ireland.

Difficulty with sustaining attention to a task is a hallmark of ADHD. It would be useful to know which measures of sustained attention best predict a diagnosis of ADHD. Participants were 129 children with a diagnosis of ADHD and 129 matched controls who completed the fixed Sustained Attention to Response Task (SART). The number of commission and omission errors, standard deviation of response time (SDRT), tau, fast and slow frequency variability, d-prime, and mu were able to successfully classify children with and without ADHD. The mean response time, criterion, and sigma were not able to classify participants. The best classifiers were d-prime (0.75 Area Under the Receiver Operated Characteristic), tau (.74), SDRT (0.74), omission errors (0.72), commission errors (0.71), and SFAUS (0.70). This list of the best classifier measures derived from the SART may prove useful for the planning of future studies.

Art therapy and art psychotherapy are often offered in Child and Adolescent Mental Health services (CAMHS). We aimed to review the evidence regarding art therapy and art psychotherapy in children attending mental health services. We searched PubMed, Web of Science, and EBSCO (CINHAL®Complete) following PRISMA guidelines, using the search terms (“creative therapy” OR “art therapy”) AND (child* OR adolescent OR teen*). We excluded review articles, articles which included adults, articles which were not written in English and articles without outcome measures. We identified 17 articles which are included in our review synthesis. We described these in two groups—ten articles regarding the treatment of children with a psychiatric diagnosis and seven regarding the treatment of children with psychiatric symptoms, but no formal diagnosis. The studies varied in terms of the type of art therapy/psychotherapy delivered, underlying conditions and outcome measures. Many were case studies/case series or small quasi-experimental studies; there were few randomised controlled trials and no replication studies. However, there was some evidence that art therapy or art psychotherapy may benefit children who have experienced trauma or who have post-traumatic stress disorder (PTSD) symptoms. There is extensive literature regarding art therapy/psychotherapy in children but limited empirical papers regarding its use in children attending mental health services. There is some evidence that art therapy or art psychotherapy may benefit children who have experienced trauma. Further research is required, and it may be beneficial if studies could be replicated in different locations.

Objectives The Vasarhelyi Method of Child Art Psychotherapy (CAP) is a largely understudied psychotherapeutic modality. This study aims to describe the Vasarhelyi Method of CAP and to describe a stakeholder survey of the views and attitudes of CAP placement supervisors towards CAP among various Child and Adolescent Mental Health Services (CAMHS) teams nationwide. Methods A phone- and letter-based survey of 17 CAP placement supervisors who oversee CAP masters students attached to CAMHS teams was performed. A questionnaire was designed enquiring about their experiences with CAP in their clinic and their thoughts on the validity of CAP in various conditions/patient demographics. Participants received written correspondence and were asked to return the survey by post; this was followed up by a telephone call to complete missing surveys. Results In all, 12 (70.6%) complete surveys were returned. Of the 12 respondents, all considered the CAP student to be a valuable member of the team. In total, 10 respondents (83.33%) stated they would make regular use of the service if it were made available to them. With regard to the therapy itself, nine respondents (75%) believed it was better for internalising symptoms than externalising symptoms. Depression, anxiety, attachment difficulties, trauma, deliberate self-harm and possible psychosomatic illnesses are the conditions viewed as receiving the most benefit from CAP. No gender difference was reported. Conclusion CAP is considered an effective modality and valuable addition to a psychotherapeutic repertoire. Further, more extensive studies are needed in this field.

Background Communication difficulties are associated with oppositional symptoms in young people. We hypothesise that a communication group intervention will reduce oppositional symptoms in young people. Previous research on communication and social skills training in young people with externalising disorders is limited. Aims We aimed to (1) develop and describe a group communication intervention to promote social competence in adolescents with behaviour difficulties, for use in CAMHS with those with attention-deficit/hyperactivity disorder (ADHD)/externalising disorders, and (2) collect pilot data on the effectiveness of this intervention. Methods We developed and delivered a programme of eight sessions to eight adolescents aged 12 to 13 years. We describe the intervention and challenges running the programme. We present pilot study data on pre- and post-oppositional symptoms. Results Our programme was relatively well attended; pilot data indicated a small reduction in oppositional symptoms in all participants. Challenges in running the group were noted. Conclusions Our pilot study data suggest that further research is needed to study the effects of a communication group intervention on oppositional symptoms in a larger number of adolescents.