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Feature Article

Could it be ADHD? Recognising ADHD in youth and adults

HEIDI J. SUMICH, HUGH MORGAN
OPEN ACCESS

What is the GP's role in the management of ADHD?

GPs are ideally placed to identify potential cases of ADHD among their adult patients and to refer them to specialists as needed. They can determine whether cardio­vascular (or other) examinations or ­investigations are warranted, anticipating treatment with stimulant medication. In fit healthy adolescents or younger adults without a medical or family history of cardiovascular disease, it is not necessary to routinely perform investigations such as an ECG. Routine baseline blood pressure, pulse rate and weight are recommended. In those patients with cardiovascular disease or other medical problems, it is worth ensuring they are medically fit to have stimulant medication. GPs can also take an active role in psychoeducation about ADHD and help decrease stigma for these patients. 

It helps to remind patients that ADHD is not all bad. ADHD is associated with being more spontaneous and adventurous and it may be that explorers or entrepre­neurs are more likely to have ADHD. People with ADHD are often big picture people and may be better at lateral thinking. 

GPs can reinforce the importance of developing healthy sleep–wake behaviours, obtaining adequate exercise and good nutrition. These are the building blocks on which other treatment is based. For patients who are taking stimulant medication, it is helpful if the GP continues to monitor their blood pressure given that stimulant medication may cause elevation. Once a patient has been stabilised on medication for ADHD, the psychiatrist may refer the patient back to the GP for ongoing prescribing in line with state-based guidelines.15 However, in most states and territories, the GP is not granted permission to alter the dose.

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Conclusion

ADHD is a common disorder that responds very well to treatment with stimulant medication. Initiation of ­treatment requires referral to a specialist but long-term management may be returned to the GP. The involvement of clinical psychologists is helpful for ­assisting patients to cope more effectively with their disorder, and for treating comorbid conditions. ADHD coaches can help address deficits in organisational skills. 

ADHD is a rewarding disorder to diagnose and treat due to its high response rate to stimulant medication and the beneficial impact of greater self-awareness and self-acceptance. GPs play an important role in helping to identify ADHD in their patients and to assist them to obtain life-changing treatment. By ­talking about ADHD, referring patients for treatment and managing the continuation of prescribing, GPs are also well placed to help reduce the stigma regarding this ­treatable and common condition.     MT

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COMPETING INTERESTS: Ms Sumich has received sponsorship from Shire for travel, accommodation and dinners to attend various ADHD educational meetings. Dr Morgan is on the Shire national and international advisory boards for Vyvanse (lisdexamfetamine dimesilate), has received speaker honorarium from Shire, is a past consultant for Janssen-Cilag (Concerta) with regards to their ADHD training program for health professionals and is on the Eli Lilly Advisory Board for Strattera (atomoxetine).

 

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Ms Sumich is a Consultant Clinical Psychologist; and Director of Mindcare Centre, Sydney. She is also a founding co-author of the first edition of the WHO textbook, Management of Mental Disorders. Dr Morgan is a Consultant Psychiatrist; Director of Mindcare Centre, Sydney; Senior Clinical Lecturer, The University of Sydney, Sydney, NSW; and is a committee member of The Royal Australian and New Zealand College of Psychiatrists Section of Youth Mental Health.