The RACGP has welcomed recommendations by a Senate inquiry for GPs to have a greater role in the diagnosis and management of attention deficit hyperactivity disorder, which affects more than one million Australians.
Vice President Dr Bruce Willett said the college supported moves towards a nationally consistent approach that helped adults and children with ADHD access support via their GP and a coordinated team of health professionals.
The Senate’s Barriers to consistent, timely and best practice assessment of attention deficit hyperactivity disorder (ADHD) inquiry report supported many of the RACGP’s recommendations, including for GPs to play a greater role in diagnosis and in management under a shared care model.
The inquiry drew on 700 submissions, and the evidence of 79 witnesses attending three days of public hearings across Australia, including a meeting in Perth in July with professional and advocacy organisations, medical professionals, people with lived experience and the WA Department of Health.
While no single cause of ADHD is known at this point, the report noted that to the best of clinicians’ knowledge, ADHD was an interaction of genetic, social, and environmental factors—and was ‘highly heritable,’ with an estimated rate of transmission between 70% and 80%.
Significantly, most people are diagnosed with ADHD before 12 years of age by a paediatrician, psychiatrist, or psychologist, but through learned behaviours such as masking, many people are diagnosed much later in life or not at all.
The committee found that barriers to people with ADHD accessing assessment, diagnosis and support services included a lack of services, with limited availability and long wait times for healthcare professionals; and high costs of service, including insufficient coverage under Medicare, the Pharmaceutical Benefits Scheme and the National Insurance Disability Scheme.
Poor consumer experiences were caused by lack of reliable information about ADHD, overly bureaucratic processes, fragmented care, inconsistent prescribing regulations, and stigma and variable quality of healthcare associated with ADHD, as well as use of stimulants.
Yet access to healthcare, supports and other environmental and social factors were repeatedly highlighted as some of the most important factors in determining the impact of ADHD in adulthood.
Dr Willett said that enabling GPs to improve early diagnosis and better support people living with the condition would have huge benefits for Australia.
“Many GPs are ready to help individuals and families who need support with ADHD in a shared care model with psychiatrists, paediatricians, and allied health professionals,” he said.
“GPs can alleviate that burden, and as this report recognises, the recently published ADHD clinical guidelines have given GPs a comprehensive, evidence-based resource to guide the diagnosis and management of ADHD and the Government should implement this framework into practice.
“The RACGP would also welcome reducing regulatory barriers so GPs with an interest in the area and appropriate training can continue and commence prescriptions for stimulant medicines for people living with ADHD.
“There is also scope for increasing rebates for longer consultations which are currently lower per minute for longer consultations which disadvantages people who require more time with their GP, including patients with ADHD. Increased investment in longer consultations is a simple way to build additional support for these patients.”
The committee heard that for about 65% of people with ADHD, it coexists with another physical and/or mental condition, potentially increasing the complexity of a diagnosis and adding to the impact of the condition.
“Common coexistences or comorbidities in children include oppositional defiant disorder (40% to 60% of children with ADHD), learning disabilities (46%), autism (28%), conduct disorder (27%), anxiety (18%), depression (1%) and speech problems (12%),” the report noted.
“Coexisting conditions are common in young people with ADHD, and delays in accessing assessment and treatment for ADHD can often lead to more complex mental health disorders, compounding the challenges they experience participating in education, and impacting their capacity to participate in and benefit from treatment.”
Dr Andrew Leech from the RACGP’s WA ADHD Working Group told the inquiry that paediatric services had “basically got to the point where there is no access.”
“We’ve got no capacity. I’ve got most of the patients I’ve referred returning quite frustrated, emotional, and overwhelmed by the response that they’re getting from the referrals that I’ve sent-very good referrals,” he said.
“They’ve explained to me that the phones just ring out when they call up to try and make a booking, or they’re told to send an email and they’ll be put onto a waitlist.”
Louise Brown, the lived-experience Director of the Australian ADHD Professionals Association and a PhD Candidate at Curtin University, said that although the report was heartbreaking to read, it was reassuring that the Senate inquiry included the voices of people with ADHD and their families.
But Curtin mental health researcher, Dr Martin Whitely, who has a doctorate in ADHD policy, said the report was “fundamentally flawed” and contributed to the over-prescription of medication for Australian children.