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What do you think of when you think of ADHD?

Caffeine and contemplation

Dominique Thompson

Monday, 12 November 2018

AdobeStock_177724034.jpegWhat do you think of when you think of ADHD (Attention Deficit Hyperactivity Disorder)?

Do you think of your five-year-old son skipping from one activity to the next, your shy, daydreaming, scatty daughter, your slightly chaotic, middle aged GP partner, who never arrives at meetings on time, or do you think of your patients with known ADHD?

What about those patients who have undiagnosed and unmanaged ADHD?

What if there was an opportunity to support up to 1 in 20 of your registered patient list to achieve their full potential; to do better at school, to hold down a job for longer, to minimise their risk of substance misuse, or to avoid a premature accidental death from befalling them?

All of these long-term outcomes are, unfortunately, more likely in those who have ADHD.

Undiagnosed and unmanaged ADHD can have significantly negative impact on people’s lives, and those of their families, partners, colleagues and friends.

As GPs we meet people of all different ages, and at various stages in their lives, for multiple clinical or other reasons. Being alert to when ADHD may co-exist could help us to transform their lives.

They may come because of anxiety, or treatment-resistant depression, or for paperwork to support welfare and benefit applications. They may be drinking too much alcohol or have substance misuse issues. They may have been excluded from school, be dealing with a teenage pregnancy or have a gambling problem. They might be a ‘looked-after’ (in the care system) child. They might come because of autism spectrum disorder (and other neurodevelopmental disorders), epilepsy, conduct disorder, or bipolar symptoms.

In every one of these situations the person in front of you has a heightened risk of also having ADHD (NICE NG87, 2018).

By being aware of the long-term complications of ADHD, and the patient groups in whom it is more common, we, as GPs, have multiple opportunities to intervene, to ask the right questions, consider referral, and perhaps allow their lives to take a different path, a safer path, a path to reaching their academic, personal or social potential. These paths can be blocked or made unnecessarily challenging by ADHD, which is a barrier to engaging at school, to turning up on time for interviews or work, to time management, and is associated with increased risk of anxiety and depression, thus causing social and relationship problems too.

Recognising that ADHD commonly co-exists with multiple other disorders is important, as often either the ADHD or the other conditions are inadvertently overlooked and untreated, potentially causing significant difficulties for that person.

As GPs we can help by observing for the signs of ADHD in those patient groups in whom it is more common, by referring them to secondary care (paediatrician or psychiatrist) for assessment and diagnostic review, and by giving them the opportunity to consider support and treatment.

The NICE committee, in its 2018 guidance, considered the risk of false positive diagnosis to be small and felt it was far outweighed by the benefits of identifying ADHD in people where the diagnosis had been missed, and then providing them with effective treatment.

Such a diagnosis (even later in life) allows children and adults to be supported by lifestyle measures, CBT and potentially medication. It allows parents and families of sufferers to understand the condition and live with it more confidently, and to seek external support should they wish to, for example from national charities such as the ADHD Foundation.

ADHD has been a controversial condition for a long time, but we have the opportunity to make a transformational difference to our patients’ lives by being alert to it, and the conditions with which it co-exists frequently.

Author's Image

Dominique Thompson

Dominique has been a student health GP since 2000, developing innovative new services to treat eating disorders and personality disorder in primary care. She was the GP member of the NICE Eating Disorders Committee 2017. She was a Pulse ‘GP hero’, in 2014, and a ‘Rising Star’ in 2016. Dominique writes about young adult wellbeing and mental health, in both the medical and non-medical press. Her latest adventure is as an independent consultant in student health and wellbeing www.buzzconsulting.co.uk. She is fuelled by caffeinated drinks.
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