Mixed method exploration of Attention Deficit Hyperactivity Disorder (ADHD) in co-occurring adult autism and ADHD in First Episode Psychosis

Background: The UK is facing service provision challenges in neurodevelopmental conditions and First Episode Psychosis (FEP). This is due to diagnostic overshadowing and underestimated prevalence of Autism Spectrum Condition (ASC) and Attention Deficit Hyperactivity Disorder (ADHD) in individuals experiencing FEP. ASC and ADHD frequently co-occur. My preliminary work revealed that individuals with FEP, affected by neurodevelopmental conditions, utilise emergency mental health services more than individuals unaffected by neurodevelopmental conditions. They have longer mental hospital stays and experience FEP at a younger age. Research question: What role does Attention Deficit Hyperactivity Disorder (ADHD) play in autistic ADHD individuals experiencing First Episode Psychosis (FEP)? Aims: The proposed project aims to investigate the intricate relationship between ADHD, ASC, and FEP. This will enhance understanding and drive practice change, improving outcomes for this vulnerable population. My research aims align with the strategic objectives of the NIHR and the priorities of the James Lind Alliance Priority Setting Partnership and the NHS Long Term Plan. Objectives: Conduct a comprehensive scoping review of existing evidence regarding the impact of ADHD in individuals with neurodevelopmental conditions and FEP. Investigate how ADHD affects FEP in autistic ADHD individuals experiencing psychosis. Explore the perspectives of clinicians, commissioners, and service users regarding necessary changes to improve services for individuals with ADHD, ASC, and FEP. Methods: The project will include 3 phases: Scoping review (months 1-6) A comprehensive exploration and synthesis of published research and grey literature will be undertaken, to identify symptomology overlaps between ADHD, ASC and FEP. Quantitative observational study (months 7-19) Using a quantitative cross-sectional comparative study, I will investigate a total of 224 individuals across 4 groups to delineate if and how ADHD impacts FEP in autistic ADHD people experiencing FEP. Participants will be recruited from 4 NHS mental health sites. Data collections will take place in two phases. Phase 1: Administration of questionnaires to participants in order to measure ADHD and ASC characteristics, and quality of life. Phase 2: Information related to FEP outcome measures will be collected from participants' health care records. The complete dataset will be analysed descriptively and inferentially. The analysis results will provide answers to the research question, which will serve as the foundation for the qualitative exploration in the final study. Qualitative focus groups (months 20-26) Three focus groups of maximum 30 participants will be formed, consisting of commissioners, clinicians and service users respectively. Each group will discuss study 2 findings, implication on current practice, need for change and ways to facilitate required change. I will analyse transcriptions to identify patterns and perspectives, refining themes and formulating the research response. Anticipated impact and dissemination Key outputs will include publications of findings in peer-reviewed journals, press releases, presentations at conferences, social media posts, and local media interviews. Project recommendations will be embedded in multidisciplinary clinical training programmes to improve outcomes of individuals affected by neurodevelopmental conditions and FEP. This fellowship will be a platform to establish a dedicated clinic and improve access to assessments of neurodevelopmental conditions in individuals with FEP postdoctorally.