The role of General Practitioners in ADHD diagnosis and management
3. Identifying ADHD
Identifying individuals at risk of ADHD is very complex. Although referrals to secondary care do not always result in diagnosis, over 70% of referrals do. It is important to remember that most individuals with ADHD do not come for help to primary care until they are at a point of crisis. In order to avoid having to refer individuals at crisis point, here are some tips to help identify individuals at risk of ADHD.
- Listen to how the individuals describe their symptoms, the impact they have on their daily life, and their past case history.
- Ask if other family members have experienced similar issues. Remember that ADHD is a genetic disorder.
- Talk to the child and parent separately, bearing in mind that individuals might have minimal insight into their difficulties.
- Bear in mind that individuals might not display symptoms during short consultations
- Irrespective of the reasons for the consultation, ADHD may often be the explanation for the underlying problem
- Ask how the individual is doing at school/work
- It is important to try and triangulate agreements between the individual, school or work, and family. Identifying issues that all informants can agree upon. We have presented a short screening questionnaire earlier but examples of established questionnaires used in diagnosis for schools, parents and individuals will be available for download at the end of this resource.
Corrie now explains how her own diagnosis changed her practise and helps her identify ADHD
Transcript
In terms of picking up on ADHD it is really difficult and it not like you can screen for it like you can with depression so it’s about an awareness of your patient, to chuck out the stereotype of a naughty school boy because you’ll miss it if you think it’s just that. So things like people who have anxiety that’s not responding to things erm chaotic lifestyles, recurrent DNAers, people who are always late, come in looking really frazzled every time, people who’ve maybe changed jobs or lost jobs over and over again, or maybe lots of surgeries, lots of house moves, things like that, they are kind of signs of that more chaotic lifestyle that often comes with ADHD but ultimately I would say if someone comes saying they think they’ve got ADHD take them seriously because people do a lot of research on it before they come, often for most people you’ll hear them say it’s like a penny’s dropped their wiring, their make up makes sense to them, once they’ve seen it all together so they won’t have come with that request to be assessed lightly and so just do the screening when they come to you with that.
Obviously knowing your patients well makes a big difference in appreciating their personality types and who they are and what they are like on a day to day basis and the way GPs going that increasingly difficult with your large practices but if you can build a relationship with someone or you get a hunch maybe try and get them back to understand a bit more about their life or have a skim back through their notes just to see are you their 5th GP or have they tried 3 different SSRI’s and not got anywhere with their anxiety, it is really difficult with time pressures but that old fashioned GPing probably would go a long way in helping pick up on things.