Survey Examines Whether Primary Care Doctors Gave Correct ADHD Diagnosis

A study of adults in Canada found that family physicians were usually able to correctly identify patients with attention-deficit/hyperactivity disorder (ADHD), with the diagnosis being confirmed by a specialist in most cases.

This alignment between primary care doctors and specialists was achieved despite infrequent use of standardized screening tools for ADHD diagnosis in daily practice, according to the study published in the International Journal of General Medicine. In Canada, specialists for ADHD are used only for complex cases. The authors said that in Canada, “the use of specialist care alone is not a viable health care model” and guidelines encourage family physicians to diagnose and manage adults with uncomplicated ADHD within primary care.

In this retrospective study, adult ADHD specialists reviewed referral letters or charts of patients older than 18 years with no history of childhood ADHD. They evaluated whether family physicians diagnosed and treated uncomplicated ADHD by investigating the referral of adult patients by family physicians to ADHD specialist clinics, and also examined the impact of adult ADHD on daily life.

Data on 515 referrals (mean age, 33 years; 60% males) were collected between December 2014 to September 2015. Family physicians made 92% of the referrals. No psychiatric comorbid symptoms were noted in 67% of the referrals. ADHD was confirmed by a specialist in 94% of cases, whether comorbid symptoms were noted or not.

ADHD was reported to impact work, school, friendships, and family relationships. Overall, 69% of patients had 1 or more comorbid symptom (diagnosed by referring physician or specialist).

Stimulant monotherapy was recommended for 79% of patients, nonstimulant monotherapy for 8% of patients, and stimulant plus nonstimulant monotherapy for 8% of patients.

The authors wrote that many family physicians are reluctant to diagnose and treat even uncomplicated adult ADHD. This may be because they rely on subjective reports of symptoms, there are differences in ADHD symptoms in adults compared with in children or adolescents, and there is a perceived need by family physicians to be conservative when prescribing stimulants. Inadequate training in ADHD and comorbidities may also contribute to this reluctance.

It is possible that greater confidence among family physicians to diagnose and treat adult ADHD could help meet patients’ needs, as wait times in Canada to see a specialist for ADHD are longer than 3 months in one-third of referrals, the study noted.

In this study, 17% of the ADHD population was unemployed, compared with an overall unemployment rate of 7% in Canada. The high rates of unemployment could also be attributed to psychiatric comorbid symptoms, because the unemployment rate for individuals with mood and anxiety disorders is higher than that of the general population.

Reference

Klassen LJ, Blackwood CM, Reaume CJ, Schaffer S, Burns JG. A survey of adult referrals to specialist attention-deficit/hyperactivity disorder clinics in Canada. Int J Gen Med. 2018;(11):1-10. doi: 10.2147/IJGM.S145269.