Practice Based Public Health ADHD Project: Bexley Borough, UK

This project delves into the issue of Attention Deficit Hyperactive Disorder (ADHD) among Black minority ethnic (BME) children aged 5-11 in Bexley Borough, UK. It examines ADHD as a public health concern, emphasizing the need for early interventions. The project explores the rationale, background, and social determinants contributing to ADHD in the target group, including demography, social and economic deprivation, culture, ethnicity, education, and health inequalities. It analyzes existing healthcare interventions in Bexley, such as behavioral, meditation-based, dietary, and school-based programs, parenting programs, and novel strategies. The project aims to identify effective early intervention strategies, assess current interventions, and propose suitable interventions to reduce, minimize, and prevent ADHD, ultimately contributing to reduced health inequalities. The methodology includes a detailed stakeholder analysis, timeline, and data collection methods. The project concludes by suggesting tailored interventions to promote health and well-being among the BME children affected by ADHD.

Running head: PRACTICE BASED PUBLIC HEALTH AND HEALTH PROMOTION
PROJECT
Assignment 3: Practice Based Public Health and Health Promotion Project
Name of the Student:
Name of the University:
Author Note:

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PRACTICE BASED PUBLIC HEALTH AND HEALTH PROMOTION PROJECT
Table of Contents
Introduction......................................................................................................................................3
Public health area and scope of project.......................................................................................3
Rationale and Background...........................................................................................................3
Target group.................................................................................................................................4
Aims.............................................................................................................................................5
Objectives....................................................................................................................................5
Identified need.................................................................................................................................5
Background and Social Determinants Cause of ADHD in Bexley Borough..............................5
Demography of the Baxley borough............................................................................................6
Social and economic deprivation.................................................................................................7
Culture and Ethnicity...................................................................................................................7
Education and Parents..................................................................................................................8
Health inequalities.......................................................................................................................8
Access to health services.............................................................................................................9
Evidence........................................................................................................................................10
Healthcare interventions in Baxley borough.............................................................................10
Behavioral interventions............................................................................................................10
Meditation-based intervention...................................................................................................11
Dietary interventions.................................................................................................................11
Early diagnosis & school-based interventions...........................................................................11
Parenting programs....................................................................................................................12
Behavioral interventions & CBT...............................................................................................13
Exercise interventions................................................................................................................13
Novel strategies.........................................................................................................................14

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Intervention....................................................................................................................................17
Method to be used......................................................................................................................17
Key activities.............................................................................................................................17
Setting........................................................................................................................................18
Data Collection..........................................................................................................................18
Equipments to be used...............................................................................................................18
Finance.......................................................................................................................................19
Stakeholder Analysis.................................................................................................................19
Time frame for intervention.......................................................................................................19
Conclusion.....................................................................................................................................19
References......................................................................................................................................21

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PRACTICE BASED PUBLIC HEALTH AND HEALTH PROMOTION PROJECT
Topic: Attention Deficit Hyperactive Disorder (ADHD) in black minority ethnic (BME) children
living in Bexley Borough
Introduction
Public health area and scope of project
In the current project, discussions will be carried out with respect to the novel
interventions that are available and may be utilized in the context of tackling the Attention
Deficit Hyperactive Disorder (ADHD) in Black minority Ethnic (BME) children aged between 5
to 11 years and living in the Bexley Borough. ADHD is considered as a public health issue
affecting children mainly; whereas, early appropriate interventions have been found to offer
resort to such nagging problems and in ameliorating the symptoms associated with ADHD.
Adequate attention must be given to this problem to help in coping up with this issue in the
affected children, thereby ensuring a healthy and positive future for them. Critical analysis of the
available interventions and their drawbacks will enable the healthcare practitioners to formulate
plan that will be effective in combating ADHD in the intended group of audience. The various
needs identified in case of the target group will be discussed to understand better their condition.
Therefore, based on practice-based evidence, suitable interventions will be suggested to provide
respite to the ADHD affected children in the intended population. Thus, most appropriate and
relevant solution may be streamlined in keeping with the demands of the target group that in turn
will serve to promote health and wellbeing of the intended group. Information retrieved will be
helpful in promotion of health in target population.
Rationale and Background
Attention Deficit Hyperactive Disorder (ADHD) refers to a chronic condition whereby
the victim shows the cardinal symptoms of difficulty in paying attention, hyperactivity and
impulsiveness. The affected person often exhibits the symptoms of being hyperactive or being
active constantly (Weiss & Hechtman, 1993). It has been found that although ADHD is more
pronounced in childhood days, but may continue through adolescence and adulthood (Polanczyk
et al., 2007). In order to comprehend and sufficiently understand the modality of ADHD, it is
imperative to study the community health status, health inequities and social determinants of
health concerning this pressing issue. Epidemiological data may be perused in this regard to deal

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with the ensuing situation effectively. Numerous pertinent data from the repertories as well as
reports in newspaper media have indicated the prevalence of ADHD in UK across various age
groups and ethnicities (Horton-Salway, 2011). The commonest behavioral disorder in United
Kingdom (UK) at present is ADHD (McCarthy et al., 2012). Reports from various sources like
that of the Royal Colleges of psychiatrists, Bexley Borough and Public Health England reveals
that about 3% of the entire population and 8% of the BME children aged between 5 to 11 years
are affected with ADHD as proven through proper diagnosis (Barkley, 2010). Further, reports
acquired from parents suggest that ADHD is on the rise among BME children (Birley, 2013).
Therefore, access to the most suitable intervention for the children who are at the risk of
developing ADHD or already diagnosed with ADHD has the potential of correcting, preventing
or reducing the prevalence of the disorder among the intended group of BME children aged 5 to
11 years.
Target group
Schoolchildren are the worst hit due to ADHD and seem to have a pervasive interference
across many aspects of life. They tend to suffer from attention deficiency, poor academic
achievement. Moreover, they are unable to comprehend completely the repercussions associated
with their faulty behaviors that in turn again lead to confrontation with the legal systems and
proceedings (Scahill and Schwab-Stone, 2000). Further, it has been reported that children
diagnosed with ADHD are most likely to lag behind in terms of their educational achievement in
contrast to their peers of the same age and in same class (Loe and Feldman, 2007). Thus, these
children are encountered with more challenges that seem to come in the way of their sharing
responsibilities and functioning in school as well as home (Loe and Feldman, 2007). Study by
Russell et al., (2014) supports that the cases of ADHD among BME children is on the rise in
UK. Outcomes of such prevalence is often noted in the form of difficulty in maintaining
attention, control of coordination and impulse among the ADHD affected children apart from
negative impacts on classroom organization, poor educational performance in addition to
complicated relationships (Russell et al., 2014). Therefore, in the light of this knowledge, it is
justified to carry upon the intended project focusing on the schoolchildren aged 5-11 years who
belong to the black minority ethnic population and are residents of Bexley Borough in UK.

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PRACTICE BASED PUBLIC HEALTH AND HEALTH PROMOTION PROJECT
Aims
The primary focus of this project is to establish certain early intervention strategies for
black minority ethnic (BME) children belonging to the age range of 5 to 11 years, who are at the
risk of or are diagnosed with Attention deficit Hyperactivity Disorder (ADHD), and reside in the
Bexley borough of United Kingdom (UK). Thus, the intended project strives to investigate the
potential of the strategies applicable in order to reduce, correct and prevent the disorder through
interventions such as that of behavioral therapy, health change and parent’s support group
thereby serving the greater purpose of promoting good health.
Objectives
What are the early intervention strategies available to BME children aged 5-11 years old
who are at risk or have been diagnosed with ADHD residing in the Bexley Borough?
The prospective project attempts to address the following objectives:
1. To explore what are the causes of ADHD among Black Minority Ethnic children age 5-11
years old in Bexley Borough.
2. To evaluate the effectiveness of the current interventions in Bexley Borough.
3. To explore the opportunity and suitability of intervention that would reduce, minimize and
prevent ADHD.
4. To examine how the intervention might contribute to a reduction in health inequalities.
Identified need
Background and Social Determinants Cause of ADHD in Bexley Borough
The symptoms of ADHD can be grouped into two classes of behavioral problems, which
in turn are known as inattentiveness and hyperactivities and impulsiveness. Therefore, many of
the children diagnosed with ADHD would either fall into the two categories or have both the
inattentiveness and hyperactivities. However, children with inattentiveness condition and not
with the other condition are known to be suffering from attention deficit disorder (ADD). ADD
may not raise any concern because the symptoms may go unnoticed or less visible (nhs.uk,
2019).

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The condition of ADHD among children is adequately defined; the occurrence usually
starts by or before the age of 6 years old. The behavior can manifest both at home or school.
Children with inattentiveness are characterized with an expression such as forgetfulness, inability
to stay on one task, having a problem with a complex task, unable to keep to instruction and
having difficulties in organizing tasks. However, children with hyperactivity and impulsiveness
are characterized with excessive talking behaviors, being unable to sit still and wait their turn.
Therefore, these symptoms can affect children to fulfill potential, have difficulty to socialize
with peers and have a problem with discipline (nhs.uk, 2019).
The project will identify an area of need in Bexley Borough in regards to the broader
social and geographical environment that affect health concerning ADHD.
The recent special educational needs data shows that children from the low-income
family in Bexley Borough of Bexley, ethnic minority group and urban area like London
(Towerhamlets.gov.uk, 2019).
Therefore, the project will look at the prevalence of ADHD symptoms across social
determinants of health and their impact in Bexley Borough, Southeast England.
Demography of the Baxley borough
As per the data of the census carried out in the year 2011, it has been found that the
population in Baxley comprises of 48% males and 52% females, the average age of its
inhabitants being 39 years. Further, the statistic showed that 84.4% of the people residing in
Baxley were born in England, while 94% of the population speaks in English (Localstats.co.uk,
2019). Thus, it is indicative that the remaining population consists of people who are not English
by birth. It is predicted that by the year 2045, black and minority ethnic groups of Bexley
borough will comprise for an estimated 30% of the population, thus revealing a surge from 18%
as per the 2011 census ("Bexley's population | London Borough of Bexley", 2019).
Hence, the black minority ethnic (BME) children may be considered as part of the
demography of Baxley borough.

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Social and economic deprivation
The study looked at decades and current data of social economy deprivation and the
widespread of ADHD in Bexley Borough in Kent. Families living with social, economic
deprivation are most likely to be a concern with other issues rather than seeking medical help and
diagnosis that could correct the symptoms at the early stage of the condition develops (Bexley
Voice, 2019). 1 in 20 of the parent living in deprived state lack basic knowledge of ADHD
(Bexley Voice, 2019). Most of the children from this deprived area in Bexley Borough, decades
ago were referred by their schools and sometimes the general practitioner, However, in the last
eight years parents in Bexley borough are seeking medical help for their children diagnosis.
Further, as the rate of diagnosis improved, more parents from the deprived area are coming
forward for diagnosis. Therefore, progressively more children from the deprived area are
confirmed to have a higher number of children between 5-11 years old, diagnosed with ADHD in
Bexley Borough (Bexley Voice, 2019).
Culture and Ethnicity
21.6% of the Bexley population constitutes Black and Minority Ethnic (BME) groups,
that is again expected to rise to 27.2% by 2031. The Black African community are the ethnic
group having the highest proportion of residents in Slade-Green, a small town within the Bexley
borough. Towerhamlets.gov.uk 2019 suggested that 1 out of 10 of the minority children are
diagnosed of having a form of special educational needs like ADHD and others. Services must
cater to the needs and respond to the health needs for an increasingly diverse community, that
has been reported of having higher disease prevalence in comparison to other ethnic groups.
Hence, enahncing health and preventing disease shall become a priority of health and social care
services in the near future (Towerhamlets.gov.uk, 2019).
Towerhamlets.gov.uk (2019) reported that women are having longer life expectancy than
men. Difference between males and females in Bexley appears similar since the year 2000-02
while a difference of 4.2 years has been reported in 2011-13. However, since 2000-2002 the
general life expectancy has shot up by 3.1 years by 2011-13 in case of the females and 3.3 years
for males (Bexley Voice, 2019).
Bexley Borough is currently a diversify community compared to a decade ago where the
white ethnic have the majority. However, the demographic distribution current is black African

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PRACTICE BASED PUBLIC HEALTH AND HEALTH PROMOTION PROJECT
minority group, Asia minority and White majority group with about 51.3% to 75%, a decade
ago. Most of the white majority knows how social support and education system in Bexley
Borough work has been part of the Bexley Borough development process. While the Black
African minority whom may have migrated few years or months into the country may not have a
full understanding on how social system work or may be going through languages transition and
other factors that affect he or her full integration on how things work and where to ask for help
concerning ADHD children (Bexley Voice, 2019).
Education and Parents
Bartlett et al. (2010) stated that ADHD affects approximately 9% of both children as well
as young people in high schools belonging to the age group of 5-24 years within a population. It
is considered that the disorder will attain an outgrown status once the individual is of a certain
age. However, it has also been cited in valid resources that about 50% of children diagnosed with
such diseases tend to experience the symptom even in their adulthood.
By means of active health promotion and several initiatives spread across its councils,
the Bexley council in Kent County considers these issues seriously. They conduct many parents
awareness health promotions in collaboration with general practice (GP), nursery, hospitals and
primary schools for identification of this range of disorders and simultaneously attempts to look
for a solution that will benefit the parents as well as children living with ADHD
(Bexleylocaloffer.uk, 2019).
Smith et al. (2015) mentioned that it is imperative for most children in school to deliver
academic tasks on time, listen attentively to the teacher’s instruction without distraction and keep
proper attention during lessons. Therefore, children with ADHD are in need of additional time
and planning to fulfill the expectations of school tasks and other related assignments.
Health inequalities
Research has shown that the primary indicators of difficulty in attention and activity level
in case of ADHD although may be attributed to genetic and neurological determinants,
socioeconomic condition also poses an important influence on the etiology. Further, it has been
suggested that the association between the ADHD and socioeconomic situation is mediated by
the parental attachment or family conflict (Russell et al., 2014). It has been cited in valid text that

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the notion of distributive justice in education is endowed with unpredictability due to the
complex nature of the entire system (Gilead, 2019). Data pertaining to UK shows that a bulk
proportion related to the child health outcomes at 11 years of age may be attributable to social
inequity in UK. For condition like ADHD, it has been forecasted that there would have been a
39% reduction, in case all the children had the same outcome equivalent to the highest income
quintile (Spencer, 2018). According to data furnished by Bexley Voice, (2019), 2%-5% of the
school aged children and young people are affected by this most common behavioral disorder
named ADHD in UK. The diagnosis is often made between the ages of 3 to 7 years, although in
some situations, it might be done at a later stage. It is further estimated that 2 out of 3 teenagers
diagnosed with ADHD are most likely to present these symptoms in their adulthood as well
(Bexley Voice, 2019).
Thus, in the intended project, adequate attention must be laid on minimizing these
inequities to harbor optimal benefits for the concerned ADHD affected child.
Access to health services
As part of the Bexley 0 to 19, Children’s Public Health Service intends to extend their
support for the parents and carers in order to render their babies, children and young people with
optimal healthcare facilities conducive for a best start in life. However, the service is restricted to
children aged 0 to 4 years whereby the work is conducted by the Health Visitors (Bexley.gov.uk,
2019). In yet another program related to Children’s family lifestyle program, it offers a 12 weeks
lifestyle and weight management program namely Alive ‘N’ Kicking meant for parents and
children aged 4 to 11 years. The program is targeted for children who are overweight or obese
whereby suitable guidance for a healthier lifestyle and eating habits is provided to the parents or
guardians in a non-judgmental, friendly and supportive manner (Bexley.gov.uk, 2019). Until
now, the services available at the local level are insufficient to meet the demands of the children
with ADHD. The services are mostly restricted to the parents of children with ADHD and they
work as monthly support groups. The choices at the national level is however greater compared
to the local level and accounts for a more holistic approach to treat ADHD involving all the
stakeholders (Bexley Voice, 2019).
Hence, based on the information available, it is quite apparent that behavioral or
childhood disorders like that of ADHD are not included as part of the public health services in

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Baxley borough. Hence, the prospective project will delve deeper into the situation and attempt
to resolve the ensuing problems through provision of adequate healthcare interventions that are
most suitable.
Evidence
ADHD is a behavioral issue that calls for attention from suitable quarters to deal with the
ensuing problems. Research has illustrated that ADHD may be tackled in a number of ways that
include medications alongside individualized cognitive and behavioral therapy. Amongst the
studies that are carried out in this context, the interventions that are most suitable for children
within the given age group will be discussed thoroughly.
Healthcare interventions in Baxley borough
Data available with respect to the Baxley Borough in London depicts that the healthcare
services available for dealing with ADHD lies with trained and qualified healthcare professionals
such as counselor, psychologist and psychotherapist. Counseling sessions with these
professionals pave path for proper treatment modalities for the affected individuals (London et
al., 2019). Further, results of a survey conducted in the year 2017 on over 350 parents or carers
brought to the forefront that children or young people who are waiting for ADHD assessments
and or are subjected to medication review might sometimes make slower progress at school.
Moreover, the phase after diagnosis is found to be quite challenging, as support and advice are
limited. As per the survey findings, 22% of the children have been identified as having
ADHD/ADD (Bexleylocaloffer.uk, 2019).
Behavioral interventions
Age specific interventions are solicited for any study in order to combat the ensuing
problems more accurately. In a relevant study by Bussing et al., (2016), it has been suggested
that it is crucial to include the adolescents’ perspectives in intervention development for
enhancing the feasibility and negate interventions acceptable to adults, but denounced by the
adolescents. Further, in another study, focus was laid on evaluating the two treatment modalities
concerning ADHD such as behavioral and pharmacological interventions. The study attempted to
evaluate the relative efficacy of the endpoint outcomes depending upon the chronology of
treatment. It was inferred in course of the study that behavioral interventions as compared to the

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medications harbored better treatment outcomes (Pelham et al., 2016). Researchers have also
focused on the utility of exercise interventions to curb the problem of ADHD in children and
adolescents. Study findings revealed that qualitative exercise plays crucial role and has potential
in disseminating long-term health benefits for children and adolescents diagnosed with ADHD
(Neudecker et al., 2019).
Meditation-based intervention
Improvement of mental and physical health of a person is intimately associated with the
practice of meditation-based interventions such as that of mindfulness and yoga. Reviewing
appropriate literatures in this regard did not produce any definite conclusion. The authors
recommended the use of more well defined research for establishing the utility of meditation-
based interventions for recommendations in children with ADHD and their families (Evans et al.,
2018).
Dietary interventions
Another group of researchers explored the effectiveness of diet as interventions to tackle
ADHD in children. It was found that children who are too young or do not respond to medication
might be subjected to few-foods diet (FFD) regime to offer beneficial solution to ADHD,
although polyunsaturated fatty acid (PUFA) supplementation did not emanate any significant
result in such population. However, the underlying mechanisms of food that contribute to such
results need to be investigated for thorough analysis and further recommendations (Pelsser et al.,
2017). In another relevant study, it was highlighted that relationship building skills in addition to
ADHD psychoeducation may be considered as the potential implications in terms of
interventions (Richardson et al., 2015).
Early diagnosis & school-based interventions
Suitable research has emphasized on the importance of timely and accurate diagnosis for
ADHD to avoid repercussions. It has been sated that in case of girls and older children
particularly, the condition often remains both under-recognized as well as under-diagnosed.
However, timely diagnosis in such cases accentuated the potential of improving the long term
outcomes (Sayal et al., 2018). In another interesting study, the efficacy of a sibling-mediated
social intervention has been examined in order to ameliorate negative and enhance positive
social behavior in children with ADHD. The study outcomes indicated that siblings tend to