Shared care for ADHD in Youth: Sharing Canadian & Chinese Experiences

Background

China has a population of 1.36 billion, 302 million of which are children under the age of 15. The rapid economic development and social reforms that have taken place in the last decades have all greatly influenced child and adolescent mental health.

The One Child Policy was successful in maintaining a stable population, but also resulted in new challenges. The 4-2-1 family structure (4 refers to the grandparents, 2 to the parents, and 1 to the child) put a stressful responsibility on the parents and a tremendous amount of pressure on the single child to perform at high levels in all academic subjects.

Students often get out-of-hours private tuition to prepare for the National Higher Education Entrance Examination, commonly known as Gaokao. This examination determines one’s place at university, and indeed in life.

Years of schooling and constant stress takes a toll on Chinese children’s mental health. Prevalence of suicidal ideations is high among college students in China. A stressful psychosocial school environment in terms of effort-reward imbalance predicts depressive symptoms, suicidal ideation and attempts in adolescence, especially in low socio-economic families.

Poor academic performance predicts higher level of depression, externalized problems, and suicidal ideations, especially when child-parent relationship becomes more conflictual. Therefore, children with neurodevelopmental challenges, especially with externalized behaviours (most often with a diagnosis of Attention Deficit Hyperactivity Disorder or ADHD), represent a very vulnerable group in the context of modern China.

Aims

The project will implement a four step ADHD pathway, learning from lessons in Canada, based on shared experience and the description of other published ADHD care pathways. We will adapt the Canadian shared care model for ADHD to the Chinese context. To test its flexibility, it will be implemented within the pediatric care system in two districts of Shanghai and within the mental health care system in one district of Beijing.

Project plan

We will first assess how ADHD guidelines are used, and the existing collaboration between GPs and specialists. After a Consensus Conference, we will implement a shared care pathway and we will produce actionable findings in a formative evaluation to improve implementation. At the end of the setup phase, we will assess the use of guidelines, the deviation from the intended protocol, how its members evaluate the care process, examine the effectiveness with regard to ADHD outcome, and functioning of the pathway, in terms of patient flow and timing.

Once the shared care model is functionally implemented, we will scale up the care system horizontally by linking it progressively with schools selected randomly in the target districts. Using already established collaborations with the educational psychologists, we will first survey the knowledge and perceived needs of teacher, then implement a screening strategy for ADHD problems in the schools, as well as web-based effective strategies to educate parents and teachers about ADHD and mitigate its impact. We will assess the effectiveness of the intervention, and how it changes the perception of ADHD and the helpseeking process, as well as the rate of referrals into the shared care system. These two steps will allow defining the scalable unit that could be used in further implementation of the model. A cost-effectiveness analysis is integrated in the project in order to support its scalability.

Funding organisations

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