Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that starts in childhood and continues into adulthood in most cases. Many young people and adults with ADHD remain undiagnosed and significantly impaired by their symptoms particularly problems with day-to-day responsibilities. GPs are well placed to identify patients with ADHD and refer for specialist treatment. Effective treatment can be life changing.
- Attention deficit hyperactivity disorder (ADHD) is a common and serious mental disorder, associated with a twofold increase in mortality rate and significant impairment in quality of life.
- ADHD is associated with substantial mental and physical comorbidities, and much stigma.
- ADHD runs in families and affects the whole family unit.
- Patients often describe treatment with stimulant medication as being ‘life changing’.
- Effective treatment decreases mortality and comorbidities, and improves quality of life.
- The risk of stimulant dependence is very low with careful prescribing.
Most healthcare professionals poorly understand attention deficit hyperactivity disorder (ADHD) despite it being one of the most widely researched mental disorders. Half of adults with ADHD have sought help from mental health professionals, yet four out of five of those who present for treatment are not identified as having ADHD.1 ADHD is a persistent neurodevelopmental disorder characterised by difficulties with inattention, hyperactivity and impulsivity. The heritability of ADHD is about 79% (similar to that for height), so ADHD typically affects several family members.2
Sceptics commonly claim that the symptoms of ADHD are observable in most people. However, they fail to acknowledge that ADHD is only diagnosed if the severity of symptoms causes significant impairment in everyday activities. We ‘all have a bit of ADHD’, but most of us are not persistently disabled by it. There are claims that all of us are likely also to perform better if we take stimulant medication. Although many of us may detect a slight improvement in performance, adults with ADHD often describe stimulant medication as ‘life changing’.
Contrary to common belief, ADHD is not just a disorder of childhood. At least 40 to 50% of children with ADHD will continue to meet criteria in adulthood, with ADHD affecting about one in 20 adults.3,4 ADHD can be masked by many comorbid disorders that GPs are typically good at recognising such as depression, anxiety and substance use (Table 1). In patients with underlying ADHD, the attentional, hyperactive or organisational problems pre-date the comorbid disorders and are not episodic as the comorbid disorders may be. GPs are encouraged to ask whether the complaints are of recent onset or longstanding. Collateral history can be helpful for developing a timeline of symptoms (e.g. parent or partner interview, comments in school reports). Diagnosis of underlying ADHD in these patients will significantly improve their treatment outcomes, general health and quality of life.
GPs who are familiar with their patients play a crucial role in helping to detect this often hidden disorder and to make an appropriate referral to a specialist. In the longer term, the GP is also well placed to continue ongoing management and prescription of stimulant medication once stabilised by the psychiatrist. This article will assist GPs to better identify ADHD in their adolescent and adult patients and to optimise their assessment, referral and long-term management in general practice.