Neurodevelopmental disorders corresponding to attention deficit hyperactivity disorder (ADHD) and autism approximately one in ten children. These conditions affect learning, behavior and development.

Executive function delays are at the center of the challenges faced by individuals with neurodevelopmental disorders. This includes skills corresponding to being attentive, switching attention, impulse control, planning, organizing and problem solving.

These skills are necessary for learning and long-term development. They have been linked to future skilled, social, academic and mental outcomes. Children with higher executive skills and support for these skills do higher in the long run.

Decades of research describe the causes of difficulties with attention and impulse control ADHD. Meanwhile, difficulties with switching attention and flexibility of considering have been proposed as the premise autism.

As a result, various supports and interventions designed for different neurodevelopmental conditions goal these skills. It creates a system during which a diagnosis is first made and then a set of support is provided based on it.

But our latest study published in Nature Human Behaviorshows that problems with executive functions are similar across neurodevelopmental conditions. Understanding these common needs could lead on to raised access to support before waiting for a particular diagnosis.

Our study found more similarities than differences

We checked out 180 studies conducted over 45 years that compared executive function skills in two or more neurodevelopmental conditions.

We combined research on all neurodevelopmental conditions defined in diagnostic manuals, including ADHD, Tourette’s syndrome, communication disorders and mental disabilities.

Surprisingly, we found that most kids with neurodevelopmental disorders showed very similar delays in executive skills.

For example, children with ADHD showed difficulties with attention and impulse control, but additionally children with autism, communication and specific learning conditions.

There were only a few differences between each neurodevelopmental condition and the kind of executive function delay.

This suggests that executive function delay is best considered a typical difficulty in all children with neurodevelopmental disorders. All of those children may gain advantage from similar support to enhance executive functioning skills.

But the supports have been silenced

The research has been happening for several many years didn’t integrate ends in various conditions. This has led to the separation of research and practice into the education, health and disability sectors.

Our data showed a gradual change within the forms of conditions that have been studied since 1980. In earlier days, a much greater percentage of research was conducted on tic disorders corresponding to Tourette’s syndrome. Over the last ten years, autism has turn out to be a subject of increased attention.

This means that research and practice also turn out to be separated from one another, based on a concentrate on funding and community interest. Some groups lose good science and practice as they turn out to be less visible within the political landscape.

This has led to a skewed support system during which specific interventions can only be offered to children with a particular diagnosis. It also limits access to support if families would not have access to diagnostic services, which might be particularly difficult in regional and rural communities.

Thanks to diagnosis-based research practices, there are now assessment services, guidelines, and treatments really helpful for autism. These are normally stand-alone and are not offered to children with ADHD, Tourette’s syndrome, communication disorders or mental disabilities, despite significant overlap in kid’s needs.

How does this affect access to support?

It is commonly difficult for families to get the assistance they need. They often describe the assessment and support process as confusing, with long waiting times and plenty barriers.

We have shown earlier Carers often use assessment and support services for a wide selection of needs, but many needs are left unaddressed.

Last national child mental health, autism AND ADHD the rules call for more integrated support for children. However, most services are not well configured for this. If that is to be achieved, such a system change will take time to implement.

Why we’d like integrated research

More integrated research will result in more coherent education, health and disability support systems for all children in need.

Research shows, for example, that many risk aspects (genetic and environmental) are common to all neurodevelopmental conditions. These include a large overlap of risk genes that are the identical across conditions, and common environmental aspects that influence development within the womb, corresponding to the usage of certain medications, stress and a big immune response.

Other research shows that most kids diagnosed with one neurodevelopmental disorder can even be diagnosed with one others.

But gaps remain. While we all know that some stimulant medications can work well for ADHD, for example, we now have less details about how they will help children with other neurodevelopmental conditions and attention difficulties.

Contrary to what we find out about social support for children with autism, we do not do much research on how we will help children with ADHD meet their social needs.

We should take a broader take a look at kid’s needs

It is essential for families to remember that if their child meets criteria for one neurodevelopmental condition, it is extremely likely that their child will meet criteria for other neurodevelopmental conditions. They will likely have many needs related to other conditions.

It is value asking clinical services about needs broader than diagnosis. This should have in mind developmental, mental and physical health needs.

It can also be necessary to contemplate that there are a lot of them interventions has the potential to support all children with neurodevelopmental disorders.

This is a very important issue for the federal government. Reviews into supporting the needs of individuals with autism, intellectual disability AND ADHD.

It is time to ascertain more integrated systems, supports and strategies for all individuals with neurodevelopmental disorders at home, school, play and work.

Pharmacist financing decision continuous glucose monitoring and automatic insulin delivery systems for the roughly 18,000 people currently living with type 1 diabetes in Aotearoa New Zealand are excellent news.

The decision got here after years of pressure from patient groups and doctors.

However, there are problems in the broader system – particularly around labor shortages – which mean it will likely take years for patients to totally access insulin pump training.

Failure to handle these issues will also perpetuate health inequalities amongst Māori and Pacific people who have been less more likely to use the monitor and pump in the past and should have to attend longer for training. These delays may undermine the positive impact of Pharmac’s financing decisions.

Complex balance

Type 1 diabetes is an autoimmune disease that causes the pancreas to stop producing insulin. This extremely essential hormone is needed to maneuver glucose to each cell in the body.

Without insulin, cells (and humans) “starve to death.” Although the current approach to treating type 1 diabetes – pricking fingers to envision blood glucose levels and injecting insulin – is effective, it’s complex.

Inject an excessive amount of insulin and also you will experience low blood sugar (hypoglycemia). This causes an individual with Type 1 to feel shaky and weak, and should even fall right into a coma. Do not inject enough medicine, which will cause persistently high blood sugar levels (hyperglycemia). This results in long-term health complications.

Determining the correct quantity of insulin is elusive. Needs are consistently changing depending on the time of day, weight loss plan, exercise, illness, caffeine, alcohol, stress and other aspects. This may cost you psychologically and physiologically.

Modern solutions

Continuous monitors measure blood glucose levels 24 hours a day using a sensor placed under the skin, replacing finger prick testing. They are widely financed and used abroad.

Monitors alert users to low blood glucose levels, and so they have significantly reduced variety of hospitalizations for people with type 1 diabetes.

Combining monitors with a pump and an appropriate algorithm automates insulin delivery when glucose levels rise above the patient’s goal range – significantly reducing the burden of every day therapy.

But continuous monitors and insulin pumps are expensive.

Before Pharmac’s decision, the monitors were completely out of funding. Prices ranged from NZ$2,600 to NZ$4,800 per yr. Insulin pumps were funded, but only for a small group of people.

This has created an ever-widening capital gap. Māori and Pacific people with type 1 diabetes were less more likely to have access monitors AND patent shoes. They were also more more likely to have them repeated hospitalizations for diabetes-related events.

Labor shortage

Compared to other countries, New Zealand is slow to fund monitors.

Unfortunately, in comparison with international guidelines, there are also significant staff shortages amongst diabetes staff.

There is a shortage of all qualified health professionals dealing with type 1 diabetes, including endocrinologists, nurses, diabetes nurses, dietitians, psychologists, social staff and podiatrists.

To meet international recommendations, New Zealand would want to greater than double its clinical workforce.

Most people with type 1 diabetes will find a way to access monitors quickly because each GPs and diabetes specialists can prescribe them. However, insulin pumps and automatic insulin delivery will only be available to specialists.

Although insulin pumps offer benefits in controlling glucose levels, learning methods to use the device takes time and support out of your physicians. This is more likely to be an issue, particularly for those that already struggle to access healthcare services in the country.

The issue of equity

Māori and Pacific people have a lower risk of developing type 1 diabetes current users of insulin pumps. This means there’s a transparent risk of labor shortages, with those that would profit most from automated insulin delivery being amongst the last to have access to it.

Increasingly, evidence of continuous glucose monitors AND automatic insulin delivery shows that they improve type 1 diabetes control for everyone.

Monitor use has been shown to cut back differences in glucose control between Māori and non-Māori children with type 1 diabetes.

Automatic insulin delivery might also be an efficient tool for children and adolescents at very high risk of glycemia.

Thank you, Pharmac. Funded devices are a game changer. New Zealand has moved from an outdated, unfair funding system for technology to treat type 1 diabetes to 1 that’s progressive and fair. However, far more must be done to support all those affected by this disease.

(*30*)