Conceptualizing professionals' strategies in care pathways for neurodevelopmental disorders

Abstract: Neurodevelopmental disorders (ND), are complex neuropsychological functional impairments. About 3-5% of all children meet criteria for attention deficit and hyperactivity disorder (ADHD), and about 1% for autism spectrum disorder – along with intellectual developmental disorder the most common ND diagnoses. Degree and type of functional impairment vary greatly within and between patients, necessitating multi-professional assessment and treatment. Using classic grounded theory (Glaser), this thesis offers a new theory of professionals’ practices in care pathways for ND. It also contains a pilot evaluation of a new, tablet-based, clinical test of attention.Study I shows that care pathways for ND are characterized by social dilemmas. What is rational for an individual professional, team or clinic, is not always rational for the care pathway as a whole. Collective action therefor requires development and sustainability of inter-professional trust. The study highlights strategies used by professionals to decide on whether to act collectively or unilaterally. Such trust testing strategies are couched in the frameworks of social dilemma-theory and game-theory.  Study II emphasizes the importance of professional control over strategies, structures and methods in the care pathway for ND (unpacking control) to deal with ND-related complexity. Lack of such control can short-circuit the ability to work successfully as a professional. Unpacking control is understood mainly in the light of professions theory.Study III evaluates the new MapCog Spectra test as a rapid method to detect and assess clinical problems of attention. Four groups of children and adolescents took the test. Two groups were comprised of patients with either ND or other psychiatric problems. Two groups were comprised of school children without known clinical conditions. The MapCog Spectra test separated clinical from non-clinical groups with good precision.In the thesis, concepts from studies I and II are integrated and extended to form a unified theory about professional practices in care pathways for ND. The latters are suggested to be a particular form of commons, which can be collectively managed by professionals in more or less successful ways. A quantitative model for the dynamics in the care pathways is presented.