The Times Australia
The Times World News

.

GPs could improve access to ADHD treatment. But we still need specialists to diagnose and start medication

  • Written by Adam Guastella, Professor and Clinical Psychologist, Michael Crouch Chair in Child and Youth Mental Health, University of Sydney
GPs could improve access to ADHD treatment. But we still need specialists to diagnose and start medication

Attention deficit-hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects 2.5–5% of people[1]. Less than half[2] of people with ADHD have been diagnosed and treated – though more and more people are presenting[3] for help.

Like other neurodevelopmental conditions, there are long delays[4] to diagnosis. The current pathways to diagnosis and care can involve multiple assessments[5] from different professionals who are in short supply, making the process confusing, expensive and time-consuming.

Yet many Australians have a GP on local clinic they can access. That’s why some medical groups are advocating[6] for GPs to have a role in the diagnosis and management of ADHD.

But while GPs should have an expanded role in the ongoing management of ADHD, it’s important for specialists to diagnose and initiate treatment.

Read more: Myths and stigma about ADHD contribute to poorer mental health for those affected[7]

What is ADHD?

ADHD is associated with inattention, or difficulty holding and sustaining concentration over periods of time, particularly on tasks that are less interesting or require significant mental effort.

It is also often associated with hyperactivity and high levels of impulsivity and arousal, and difficulty planning, coordinating and remaining engaged in tasks.

In order to meet criteria for ADHD, these difficulties must be present over a long period and have a negative impact on a person’s day-to-day life. This is why an ADHD assessment requires a clinical interview from specialists, and should never be done by questionnaires alone.

ADHD assessments are performed by psychiatrists, paediatricians and clinical and neuropsychologists with specialist training.

Man helps young child with a puzzle
To meet the criteria, difficulties must impact on day to day life over a long period. Shutterstock[8]

An ADHD assessment must be comprehensive enough that if a diagnosis is made, it can be followed up with a management plan that:

  • addresses the person’s individual needs
  • is culturally appropriate for them and their circumstances
  • takes into consideration all of the issues identified.

When a diagnosis of ADHD is made, medication is often part of the management plan. Stimulant medications are usually the first-choice medication. Psychological therapies may also be recommended.

Treatment can ease some of the struggles

ADHD increases the risk for poor academic, occupational, social and mental health outcomes, and has even been associated with higher rates[9] of accidental injury and death.

However, these risks decrease when ADHD is effectively treated[10]. One front-line treatment, stimulants, have about a 70% efficacy rate[11] for managing symptoms. Research shows stimulants can effectively reduce[12] many of the adverse impacts of ADHD.

Stimulants have a good safety profile, with relatively few serious side effects[13] in most children and adults[14].

However, stimulants can be very hard to access. States and territories have different laws about stimulant prescribing[15], and your prescription from one state may not be honoured in another.

Why are medications difficult to access?

Stimulants are tightly regulated because they have been assessed as having the potential for abuse. Prescribing or supplying them requires prior authorisation by the state authorities and must be in accordance with criteria set out by each state.

While GPs and nurse practitioners can apply for authorisation in some situations in some states, the legislation generally identifies specialists (paediatricians and psychiatrists for children and adolescents, and psychiatrists for adults) as the main prescribers.

Currently, there are too few specialists, in both rural and urban areas of Australia, to ensure access to ADHD medication.

As our recognition of ADHD increases, especially in adults, alternative approaches are needed, since this skills shortage is unlikely to resolve soon.

Woman holds drink of water
Medication is often part of an ADHD management plan. Pexels/Lisa Fotois[16]

So what role should GPs have in managing ADHD?

We advocate for a “collaborative care” model, with GPs playing a greater role in managing patients’ ongoing ADHD care, including prescribing and monitoring medication.

However, it’s important for specialists to perform the initial diagnosis and identify the right treatment for the patient. Diagnosing ADHD can be complex – other psychiatric[17] and medical conditions may need to be ruled out. And it can be difficult[18] to match patients with an appropriate treatment.

GPs are specialists in chronic disease management and already provide ongoing care for many chronic physical and mental health conditions. GPs are generally easier and cheaper to access than other specialists, know their patients well and are embedded in their communities. Models of collaborative care for ADHD are already common[19] in many other countries including the United Kingdom and United States.

A collaborative care model would also allow specialists to spend more of their time on initial consults and the management of complex cases, rather than the ongoing management of less complex cases.

For collaborative care models to work, national programs will be required that can train and register GPs in ADHD management, to meet the needs of their patients with ADHD and, most importantly, improve patient outcomes.

Resources and support will be needed to ensure practitioners are supported[20] to deliver shared care for ADHD. If GPs don’t receive adequate support, fewer may be willing to provide this care.

Ultimately, the model could transform access to effective treatment for people with ADHD and their families.

Read more: You might have heard ADHD risks being over-diagnosed. Here's why that's not the case[21]

References

  1. ^ 2.5–5% of people (www.ncbi.nlm.nih.gov)
  2. ^ half (www.tandfonline.com)
  3. ^ presenting (www.abc.net.au)
  4. ^ long delays (bmjopen.bmj.com)
  5. ^ involve multiple assessments (theconversation.com)
  6. ^ advocating (www.racgp.org.au)
  7. ^ Myths and stigma about ADHD contribute to poorer mental health for those affected (theconversation.com)
  8. ^ Shutterstock (www.shutterstock.com)
  9. ^ higher rates (pubmed.ncbi.nlm.nih.gov)
  10. ^ effectively treated (pubmed.ncbi.nlm.nih.gov)
  11. ^ 70% efficacy rate (pubmed.ncbi.nlm.nih.gov)
  12. ^ reduce (pubmed.ncbi.nlm.nih.gov)
  13. ^ few serious side effects (pubmed.ncbi.nlm.nih.gov)
  14. ^ adults (pubmed.ncbi.nlm.nih.gov)
  15. ^ different laws about stimulant prescribing (aadpa.com.au)
  16. ^ Pexels/Lisa Fotois (www.pexels.com)
  17. ^ psychiatric (theconversation.com)
  18. ^ be difficult (pubmed.ncbi.nlm.nih.gov)
  19. ^ already common (bmcpsychiatry.biomedcentral.com)
  20. ^ supported (ncbi.nlm.nih.gov)
  21. ^ You might have heard ADHD risks being over-diagnosed. Here's why that's not the case (theconversation.com)

Read more https://theconversation.com/gps-could-improve-access-to-adhd-treatment-but-we-still-need-specialists-to-diagnose-and-start-medication-210803

Times Magazine

DIY Is In: How Aussie Parents Are Redefining Birthday Parties

When planning his daughter’s birthday, Rich opted for a DIY approach, inspired by her love for drawing maps and giving clues. Their weekend tradition of hiding treats at home sparked the idea, and with a pirate ship playground already chosen as t...

When Touchscreens Turn Temperamental: What to Do Before You Panic

When your touchscreen starts acting up, ignoring taps, registering phantom touches, or freezing entirely, it can feel like your entire setup is falling apart. Before you rush to replace the device, it’s worth taking a deep breath and exploring what c...

Why Social Media Marketing Matters for Businesses in Australia

Today social media is a big part of daily life. All over Australia people use Facebook, Instagram, TikTok , LinkedIn and Twitter to stay connected, share updates and find new ideas. For businesses this means a great chance to reach new customers and...

Building an AI-First Culture in Your Company

AI isn't just something to think about anymore - it's becoming part of how we live and work, whether we like it or not. At the office, it definitely helps us move faster. But here's the thing: just using tools like ChatGPT or plugging AI into your wo...

Data Management Isn't Just About Tech—Here’s Why It’s a Human Problem Too

Photo by Kevin Kuby Manuel O. Diaz Jr.We live in a world drowning in data. Every click, swipe, medical scan, and financial transaction generates information, so much that managing it all has become one of the biggest challenges of our digital age. Bu...

Headless CMS in Digital Twins and 3D Product Experiences

Image by freepik As the metaverse becomes more advanced and accessible, it's clear that multiple sectors will use digital twins and 3D product experiences to visualize, connect, and streamline efforts better. A digital twin is a virtual replica of ...

The Times Features

Long COVID is more than fatigue. Our new study suggests its impact is similar to a stroke or Parkinson’s

When most people think of COVID now, they picture a short illness like a cold – a few days of fever, sore throat or cough before getting better. But for many, the story does...

What Makes Certain Rings or Earrings Timeless Versus Trendy?

Timeless rings and earrings are defined by designs that withstand the test of time, quality craftsmanship, and versatility. Trendy pieces, on the other hand, often stand testimony ...

Italian Street Kitchen: A Nation’s Favourite with Expansion News on Horizon

Successful chef brothers, Enrico and Giulio Marchese, weigh in on their day-to-day at Australian foodie favourite, Italian Street Kitchen - with plans for ‘ambitious expansion’ to ...

What to Expect During a Professional Termite Inspection

Keeping a home safe from termites isn't just about peace of mind—it’s a vital investment in the structure of your property. A professional termite inspection is your first line o...

Booty and the Beasts - The Podcast

Cult TV Show Back with Bite as a Riotous New Podcast  The show that scandalised, shocked and entertained audiences across the country, ‘Beauty and the Beast’, has returned in ...

A Guide to Determining the Right Time for a Switchboard Replacement

At the centre of every property’s electrical system is the switchboard – a component that doesn’t get much attention until problems arise. This essential unit directs electrici...