These are activities that expand general practice knowledge, skills and attitudes, related to your scope of practice.
These are activities that require reflection on feedback about your work.
These are activities that use your work data to ensure quality results.
These are activities that expand general practice knowledge, skills and attitudes, related to your scope of practice.
These are activities that require reflection on feedback about your work.
These are activities that use your work data to ensure quality results.
ADHD is not a benign condition, says Dr Chris Soo, a lived experienced GP with a special interest in ADHD, neurodevelopmental disorders and mental health. There are significant mental health and cardiovascular comorbidities, lost opportunities due to educational and employment difficulties, injuries and accidental deaths, and research shows that ADHDers live up to 9 to 13 years less than the general population.
“The longer that you leave ADHDers without helping them, the worse things get for the person, their family and society,” Dr Soo says.
But ADHD is also extremely treatable.
“It really is one of the most treatable conditions that a doctor can diagnose. When medication goes well, it often goes really well; you can really change lives almost overnight, and prevent most of those negative outcomes,” Dr Soo says.
With lengthy wait times for ADHD specialists, there are several ways that GPs can make a big difference in the lives of kids with ADHD and their families.
One way to help is to do some basic workup and encourage parents to collect evidence of the person’s function before they’re seen by an ADHD specialist; such as school reports and any correspondence from concerned educators or health professional, says Dr Soo.
Free screening tools that you can easily find online include:
The CADDRA teacher assessment form in particular, is a tool that can be quite useful for screening for ADHD and other neurodevelopmental disorders.
Observations include:
Investigations:
If there’s time:
Whomever you choose to refer to, it’s crucial to find someone with a special interest in ADHD/neurodevelopmental disorders, he says. “ADHD is not every paediatrician or psychiatrist’s cup of tea, and the clinicians who state their interest in neurodevelopmental disorders are more likely to really know what they’re doing,” Dr Soo says.
If wait times are too long for a paediatrician or psychiatrist with a special interest in ADHD in your area, he suggests considering a telehealth service, as long as you’re open to prescribing with an appropriate level of support from the telehealth paediatrician or psychiatrist. GPs can co-prescribe and, in most states, assist in titrating ADHD stimulant medication in shared care arrangements. Telehealth services can often assess new ADHD patients within a month or two, Dr Soo says.
“Local wait lists are often incredibly long. Why? Mostly because ADHD is the one condition where the paediatricians and child psychiatrists are booked up doing all the low-risk, routine care” he says, adding that even just keeping a script going can be an important way to help.
And if you get stuck, another valuable resource can be your fellow GPs with a special interest in ADHD—who will likely have their own network of clinicians with whom they work, and know how to navigate the system efficiently.
A review of the evidence by NICE, cited in the Australasian ADHD Professionals Association evidence-based guidelines, found that pharmacological treatment was more effective than non-pharmacological treatment when it comes to reducing core ADHD symptoms – however combining both pharmacological and non-pharmacological treatment was better than either alone.
“A combination of medication and non-medication strategies is the gold standard for ADHD treatment,” Dr Soo says.
Psychostimulants are the first line drug of ADHD treatment—and they can make a significant difference.
“Psychostimulants are at least twice as effective for treating ADHD as the next best treatment options, and, when it goes well, almost overnight you can have a kid who is thriving when they were really struggling before treatment,” Dr Soo says.
“They increase the availability of dopamine and norepinephrine in the brain (the main neurotransmitters that are lacking in ADHD brains).”
Increasing evidence supports long term safety of ADHD stimulant medication, he adds, with some studies showing a reduction in all-cause mortality after treatment, with no significant increase in rates of serious cardiovascular outcomes like myocardial infarction, stroke or life threatening arrhythmias.
In Queensland, GPs can prescribe psychostimulants without regulatory approval for children with ADHD between the ages of 4 and 18, Dr Soo says, which makes it easier for GP to be involved in ongoing care in at least some capacity. Other states have different requirements.
Stimulants are often co-prescribed for low-risk ADHD patients via a shared care arrangement with a supportive paediatrician or child psychiatrist – who would normally provide clear instructions as to how a GP colleague could start and then titrate stimulant medication.
“If you’re not sure what you’re doing, follow those instructions directly – start low and increase as you and the patient feel comfortable,” Dr Soo says, noting it’s usually clear to all involved when ADHD medications are optimised.
“When things are at the right dose, it’s usually obvious to the person and everyone around that everything is way better. And if you get in any trouble or aren’t sure what you are doing – make sure you reach out to your supportive specialist colleague for help”.
Regular review is important. Each check should include a chat about how things are going, measuring and plotting weight, height, blood pressure and heart rate, he says.
Adherence can be an issue, so it’s important to identify and address contributing factors.
“Unfortunately, even though ADHD medication can make things better if it goes well, teenagers go off their medication all the time; often because they don’t like how they feel, or the medications aren’t working well enough so they can’t be bothered continuing to take this pill that isn’t doing anything. It’s vital that they can find a clinician they can talk to about their concerns, and help them adjust to try to fix their concerns in a timely manner.”
Up to 1 in 13 ADHD patients have a comorbid bipolar spectrum disorder, Dr Soo says, so listen out for any severe mood or sleep instability, especially in the teenage years when bipolar begins to show, and seek help from a more experienced colleague if you have any concerns. It’s important to be aware that both stimulants and antidepressants increase the risk of triggering hypomania/mania.
If any of these occur, stop the stimulant and get the patient to call the local acute mental health service help line. The GP Psychiatry Support Line offers free advice Monday to Friday from 7am to 7pm AEST on 1800 16 17 18.
Psychology, ADHD coaching, parenting courses, occupational therapy, behavioural therapy, and strategies to improve sleep can all be helpful, Dr Soo says.
Exercising and sufficient sleep are two of the things that help most, he adds. So, while waiting for further review – try to ensure that they’re getting enough of each.
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