Impact case study database

Impact of evidence synthesis on national and international clinical guidelines

Due to its methodological rigour and comprehensive nature, the evidence synthesis on ADHD treatments has been influential to inform national and international clinical guidelines/policies. At the national level, in line with the evidence synthesis conducted by the EAGG [ 3.3], the NICE 2018 guidelines for ADHD [ 5.1] changed their recommendations, indicating parent training as an intervention for problems with oppositional behaviours associated with ADHD, rather than for ADHD core symptoms, as it was reported in the previous NICE guidelines. The 2018 network meta-analysis on ADHD medication [ 3.1] was selected by the NIHR as an “NIHR Signal” publication, which highlights research considered to contain the evidence most valuable to decision makers [ 5.2]. At the international level, this network meta-analysis has been crucial for a number of guidelines, such as those from the European ADHD adulthood network [ 5.3], the German guidelines (estimated to influence the practice of 20,000 professionals [ 5.4]), and the Danish guidelines, with the Danish Health Authority [letter, 5.5] stating: “ Without this valuable input, formulation of a recommendation had not been possible”. The guidance paper on the management of side effects of ADHD medications [ 3.2] has informed the recent Guidelines on ADHD management by the American Academy of Pediatrics (67,000 members) [ 5.6]. Recently, The New England Journal of Medicine invited Cortese to summarise the evidence synthesis on ADHD in a review article, which in less than 3 months from its publication, has been viewed by more than 25,000 readers [ 5.7].

Impact of the New Forest Parenting Programme (NFPP)

The NFPP has shown tangible outcomes in randomised controlled trials (RCTs). In a RCT conducted in 2013 [ 3.4], the NFPP for parents of pre-schoolers was shown to be as efficacious as another commonly used treatment ( Incredible Years) but significantly less expensive. NFPP was cheaper than group-based interventions for ADHD (IY) recommended by NICE (GBP1,591 vs. GBP2,103 per parent). In a RCT carried out in 2018, NFPP was superior to intensive treatment-as-usual within routine care in Denmark [ 3.6]. NFPP has been widely disseminated and implemented. The self-help book on NFPP has been purchased by over 3,429 parents since it was launched in 2014, with the Danish, Hebrew and Czech versions of the book being launched in the same year. The book is available for sale on Amazon and currently has 40 reviews and 4.5 out of 5 stars, with 71% reviews scoring 5/5 [ 5.8]. The number of therapists trained nationally and internationally continues to grow. Nationally, the Southampton team has trained groups of trainers in Nottingham, and then Newcastle, Mansfield, Richmond, Bromley, North Staffs, Isle of Wight, Jersey, Guernsey, which are adopting Nottingham city’s approach to embed the work in the community out of the CAMHS. 75% of the foster carers trained in Nottinghamshire stated that the “group changed the way they support your child” [ 5.9]. The NFPP is also endorsed by the Early Intervention Foundation [ 5.10]. Internationally, training took place in Denmark and Japan [ 5.11] and, more recently, in China and soon Iceland. Furthermore, the NFPP is endorsed in the recent Guidelines on ADHD management by the American Academy of Pediatrics [ 5.6]. Additionally, NFPP set the groundwork to develop an online programme for parents of children with disruptive behaviours (PI: Prof. Sonuga-Barke, currently at Kings’ College London) [ 5.12].

Overall impact of the Southampton ADHD group research activity on professionals and patients

The ADHD research activity in Southampton has been crucial to raising awareness of evidence-based practices among professionals, alongside families of children with ADHD and teachers, at the national and international level and has been defined as “highly influential in the field” by the Chair of the European Network for Hyperkinetic Disorders (Eunethydis) [ 5.13]. In an international survey of 103 professionals on the guidance for management of ADHD during the Covid-19 pandemic, 60% considered the Southampton-led European guidance as “very helpful” and 45% stated the guidance was endorsed/used by their work institution [ 5.14]. The President of ADHD Europe, a European network of 28 national associations of families with children with ADHD, stated the guidance “proved to be a very helpful resources and has been circulated to all our members” [ 5.15].