MINDS: Intervention for identifying mental health problems in autistic/ADHD adults in primary care

Background: Adult autism and ADHD diagnoses are increasing and around 40% have a diagnosis of both (AuDHD). Three quarters of autistic/ADHD/AuDHD adults experience mental health problems, most commonly depression, anxiety and distress. Presentation of mental health problems in this group resembles traits of autism and ADHD, making identification challenging. Common mental health problems are managed in primary care, and primary care is seen as the gateway for support for autism and ADHD. However primary care clinicians express challenges with identifying overlapping mental health problems, ADHD and autism. Misdiagnosis/missed diagnosis may result, leading to provision of ineffective, possibly harmful treatments. This disproportionately impacts women, diverse genders, and people from minority ethnic groups. Aim: To develop an intervention to support primary care practitioners to better identify and distinguish common mental health problems, autism and ADHD in adults. Methods: Using the Person-Based Approach, we will develop an intervention plan (i.e. Guiding Principles, a Logic Model, planned content mapped against theory and evidence in a Planning Table). These will be developed using qualitative interviews with 30 primary care practitioners (including General Practitioners, Nurse Practitioners, Social Prescribing Link Workers, Mental Health Practitioners, Primary Care Occupational Therapists); four public involvement workshops; a co-production workshop with practitioners, people with lived experience, and their significant others; and triangulation with interview data from a separate study with people with lived experience. Practitioners will be recruited to take part in online interviews via an email circulated by NIHR Research Delivery Networks. Interviews will be transcribed and analysed using thematic analysis to identify barriers and facilitators to identifying common mental health problems within the context of autism and ADHD in adults. Eight people with lived experience of autism/ADHD/AuDHD and common mental health problems will take part in four workshops to inform research plans, data interpretation, and intervention development. A co-production half-day workshop will take place and use creative engagement approaches to co-produce content for the intervention. Inclusion: The research will ensure that the developed intervention deliberately incorporates features that impact the equitable identification and management of mental health problems, autism and ADHD from the perspectives of women, diverse genders and people from minority ethnic groups, as these groups have been historically misdiagnosed. This will be achieved through deliberate exploration of gender and ethnicity in interviews and through inclusion of diverse public contributors. Dissemination and Impact: The primary output is an intervention framework (guiding principles, logic model, theoretical mapping, and planning table) for an intervention to support primary care practitioners to identify and distinguish mental health problems within the context of ADHD and autism in adults. Following optimisation and evaluation, this intervention has the potential to improve early identification of both mental health problems and autism/ADHD, and prevent ineffective, possibly harmful interventions. We will develop an infographic summarising our key findings. This will be disseminated in primary care to provide immediate impact while the intervention undergoes evaluation.