Blandine French is a lived-experience senior research fellow at the University of Nottingham, specialising in attention-deficit/hyperactivity disorder.
Vibhore Prasad is an academic GP who’s clinical and research interests are in improving the health (including mental health) of children and young people.
The last 6 months have shown a rise in attention-deficit/hyperactivity disorder (ADHD) media attention with celebrities getting a diagnosis late in life.1,2 While some people think this is a rise in the number of people affected by ADHD, this likely demonstrates a rise in ADHD awareness and a ‘catch-up’ of years of many people not being diagnosed. Overall, the prevalence of ADHD is 3%–5%, but only 1% are diagnosed in England.3
ADHD is defined by the National Institute for Health and Care Excellent (NICE) guidelines by hyperactivity, impulsivity, and inattention occurring in more than one setting (for example, school and home).4 There is not one single diagnostic test, and diagnosis is undertaken by specialists in secondary/tertiary care services, with assistance from a multidisciplinary team.
“There is a lack of ADHD training for GPs, and GPs are often lacking accurate knowledge and confidence when dealing with ADHD in their practice.”
ADHD is normally present from an early age and strongly impacts families. However, parents, carers, and GPs do not always recognise the diagnosis and often its recognition is delayed. Detecting ADHD earlier and recognising it at a young age could prevent serious consequences, such as poor educational attainment, low socioeconomic status, parental relationship discord, crime, and injuries.5,6 With many barriers at all levels of the education, health, and care systems, one solution to the under-recognition of ADHD could be better education of GPs.7
In clinical practice, we often see young people with symptoms of ADHD. However, perhaps we do not recognise the symptoms to be ADHD. At other times, parents/carers present with the consequences of challenging behaviour, such as carer stress. This requires GPs to be vigilant for elements of the adult’s story that might prompt them to ask for the young person to come to the GP for their own consultation so that the issues can be explored in more detail.
There is a lack of ADHD training for GPs, and GPs are often lacking accurate knowledge and confidence when dealing with ADHD in their practice.7 We know that ADHD is undertreated and under-recognised,8 and we also know that lack of diagnosis leads to further health complications such as substance abuse and increased use of mental health services.5
In light of these, we received 3-year funding from the Economic and Social Research Council to co-develop and evaluate tailored online ADHD training to support GPs in their role in the ADHD pathway.9 The co-development process ensured that the training was of an accessible and acceptable format for GPs and contained the most relevant evidence-based information for their practice (http://www.adhdinfo.org.uk). While the project was based at the University of Nottingham, the training was evaluated nationwide through a randomised controlled trial (RCT) and showed a significant positive change in knowledge and confidence. Most importantly, it changed GPs’ attitudes and practice, as demonstrated by the quotes below from our qualitative interviews post-RCT:7
‘I offer them extra support, give them extra time in appointments … There are certain questions I might ask now that I wouldn’t before.’
‘My threshold to refer people for assessment would be much, much lower now.’
‘Actually it has changed my attitude, it’s not very often that some sort of learning will do that because attitudes are quite hard engrained.’
‘The fact that I can remember so much about it is probably testament to how good it was at reinforcing and retaining the information.’
This training has been accredited by the Royal College of General Practitioners and is a great way of learning about ADHD as the co-production development process made it so specifically tailored to GPs. It was very important that the information included was specific to GPs’ needs and practice in order for them to benefit from it. The online, short format was also the best mode of delivery and was preferred to other ways, such as face-to-face training, as it is more accessible in a short period.
“… a short, 45-minute, free, evaluated, and accredited online training will increase your knowledge and confidence in ADHD … “
The training impacts multiple people at various levels. At the personal level, as a clinician, there is the opportunity to engage in training and update one’s own knowledge, improving practice. At a family level, it helps families receive access to care and support earlier, minimising struggles in the long term. The continuing increase in good practice for ADHD will also impact the surgeries and efficient communication with secondary/tertiary care services.
At the level of the primary care network, there is the opportunity to consider communication with other community services, listen to the voice of young people, and to have closer links with voluntary, community, and social enterprise organisations (such as local self-help or support groups, regional charities, and national charities). At a regional level, there is an opportunity to challenge lengthy delays in the provision of care and question the budget that is spent on young people’s mental health.
‘I was able to pass on the learning to other doctors in our doctors meeting so. I’m hoping that will have impact not just on me but doctors at the surgery too.’
‘I’ve got a couple of adults with ADHD (who have been refereed) and I’m able to empathize with them a lot more whilst we are “holding them” until they get to the top of the list to see a psychiatrist.’
In conclusion, a short, 45-minute, free, evaluated, and accredited online training will increase your knowledge and confidence in ADHD, but also impact your practice and in turn have a ripple effect on many families, adults, and other stakeholders around you.
References
1. Badshah N. Lily Allen reveals she has been diagnosed with ADHD. The Guardian 2023; Apr 1: https://www.theguardian.com/music/2023/apr/01/lily-allen-reveals-she-has-been-diagnosed-with-adhd (accessed 21 Jun 2023).
2. Grierson J. ‘It’s made me who I am’: Johnny Vegas diagnosed with ADHD at 52. The Guardian 2023; 11 Jan: https://www.theguardian.com/society/2023/jan/11/i-always-knew-i-was-disorganised-johnny-vegas-diagnosed-with-adhd (accessed 21 Jun 2023).
3. Prasad V, West J, Kendrick D, Sayal K. Attention-deficit/hyperactivity disorder: variation by socioeconomic deprivation. Arch Dis Child 2019; 104(8): 802–805.
4. National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. NG87. 2019. https://www.nice.org.uk/guidance/ng87 (accessed 21 Jun 2023).
5. French B, Daley D, Groom M, Cassidy S. Risks Associated with undiagnosed ADHD and/or autism: a mixed-method systematic review. J Atten Disord 2023; DOI: 10.1177/10870547231176862.
6. Shaw M, Hodgkins P, Caci H, et al. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC Med 2012; 10: 99.
7. French B, Hall C, Perez Vallejos E, et al. Evaluation of a web-based ADHD awareness training in primary care: pilot randomised controlled trial with nested interviews. JMIR Med Educ 2020; 6(2): e19871.
8. Sayal K, Prasad V, Daley D, et al. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry 2018; 5(2): 175–186.
9. French B, Daley D, Perrez-Vallejos E, et al. Development and evaluation of an online education tool on attention deficit hyperactivity disorder for general practitioners: the important contribution of co-production. BMC Fam Pract 2020; 21(1): 224.
Featured photo by Markus Spiske on Unsplash.
