Recognising possible ADHD in your patients
An assessment for ADHD may start before the patient enters the room. Patients who are chronically late or forget to turn up would trigger a red flag. A GP’s keen observation skills, and hopefully longstanding knowledge of their patients, may identify some behaviours and presentations that suggest the presence of ADHD, particularly if there is a cluster of such behaviours (Box 1). A life transition (e.g. moving from year 11 to year 12, being promoted at work, getting married, having a baby) may increase cognitive and executive function demands to a point where ADHD symptoms become significantly more problematic, leading to the person feeling overwhelmed and seeking help.
A GP’s keen observation skills, and hopefully longstanding knowledge of their patients, may identify some behaviours and presentations that suggest the presence of ADHD.
Assessing for ADHD
In a patient with suspected ADHD, a brief rating scale such as the six-item Adult ADHD Self-Report Screening Scale for DSM-5 (Box 2) is quick to administer and score.5 A score of 14 or above detects about 84% of cases of ADHD in the general population with a false-positive rate of about 10%. The slightly longer Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist is another good option that GPs might ask patients to fill in during a long consultation, or at the end of the consultation if the session is short.8 Feedback can be provided at a follow-up appointment. Patients with ADHD often forget to return paperwork so it is best to ask them to complete the scale in the waiting room before they leave the practice. These scales are not diagnostic but are a helpful guide to assessment.
If a patient scores 14 or more on the six-item screening scale, feedback should be provided and enquiries made about any history suggestive of ADHD in childhood.
- Was ADHD ever suggested or diagnosed in your childhood?
- Did you rely too heavily on parental support to remain organised?
- Did your parents ever do your homework for you or sit with you to get it done?
- What sorts of comments did teachers make in school reports and parent–teacher interviews?
- Do you feel you have persistently had problems reaching your potential?
- Do any family members have ADHD?
- Some medical conditions might lead to symptoms that mimic ADHD.