ARTICLES
Use of Health and School-Based Services in Australia by Young People With Attention-Deficit/Hyperactivity Disorder

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ABSTRACT

Objective:

To examine use of health (including psychiatric) and school-based services by children and adolescents who met symptom criteria for attention-deficit/hyperactivity disorder (ADHD), the factors associated with service use, and barriers to service access.

Method:

The relationship between parents’ perceptions of children's need for professional help, the impact of children's problems on children and parents, and services used during the previous 6 months were examined in a national sample of 398 children and adolescents with ADHD symptoms aged 6 to 17 years (70% response rate). Information was obtained from parents who completed the Diagnostic Interview Schedule for Children Version IV and standard questionnaires. Data collection took place between February and May 1998.

Results:

Only 28% of those with ADHD symptomatology had attended health or school-based services. Among these, 41% had attended both health and school-based services, 39% had attended only health services, and 20% had attended only school-based services. Sixty-nine percent of parents attending health services wanted additional help. Parental perceptions that children needed professional help, children's functional impairment, the impact of problems on parents, and comorbid depressive or conduct disorders had a significant and independent relationship with service use.

Conclusions:

A minority of children and adolescents with ADHD symptomatology receives professional help for their problems in Australia. Counseling is the most frequent help provided, with many parents wanting additional help beyond that already provided. Factors other than children's ADHD symptomatology have a significant relationship with service attendance. Practical issues, including the cost of services and waiting lists are the most common barriers cited by parents as hindering access to services.

Section snippets

Participants

The participants were 398 children of the 3,597 children aged 6 to 17 years who were recruited for the Child and Adolescent Component of the National Survey of Mental Health and Well-Being in Australia and who met DSM-IV symptom criteria for ADHD. The survey methodology has been described in detail elsewhere (Sawyer et al., 2000). In brief, the survey used a multistage probability sample of 4,509 households to select a representative sample of Australian children aged 4 to 17 years (for

Characteristics of Children

The characteristics of children with each ADHD subtype are shown in Table 1. Overall, 70.1% were males, 64.6% were aged 6 to 11 years, and 25.4% lived in single-parent families. Compared with other children in the survey, children with ADHD symptomatology were significantly younger (ADHD = 10.2 years, non-ADHD = 11.6 years, t = 7.8, df = 1,3559, p < .001), more frequently male (ADHD = 70%, non-ADHD = 47%; χ2 = 73.9, df = 1, p < .001), and more often living in single-parent households (ADHD =

DISCUSSION

Only a minority of children with ADHD symptoms had received help from professional services during the 6 months before the survey. Family doctors and pediatricians played a key role in the provision of these services. Dulcan et al. (1990) have drawn attention to the role of pediatricians as gatekeepers to mental health services in the United States. In other countries such as the United Kingdom and Australia, family doctors provide primary health care for children, with pediatricians having a

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This work was funded by the Commonwealth Department of Health and Aged Care and supported by a national collaborating group of researchers in Australia. The authors thank Jo Carbone for her help with data analysis.

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