The rate of clinical diagnosis of ADHD has been reported to be approximately 1% in the UK and in Ireland. However, up to two-thirds of children who met criteria for ADHD in a UK study did not receive a formal diagnosis of ADHD, nor did they receive mental health care. In Ireland, the UK and some other EU countries, general practitioners (GPs) are essential in recognising ADHD symptoms and supporting ongoing treatment; however, numerous studies of GPs have indicated a lack of understanding of ADHD, negative attitudes regarding the validity of ADHD diagnoses, a reluctance to become involved in shared-care practice and a lack of ADHD-related training. This study aimed to determine the current knowledge of and attitudes (positive or negative) towards ADHD among GPs in Ireland, and to investigate the factors which influence those attitudes.
Participants were qualified GPs registered to the Irish Medical Directory of GPs. Of the >2500 GPs registered, 500 were sampled proportionately across Ireland’s 26 counties. GPs were required to complete a study-specific questionnaire relating to variables/attitudes considered important in establishing what may facilitate or hinder identification, referral or treatment of ADHD in children, including: demographics; questions regarding their practice*; previous training in ADHD; attitude to ADHD; knowledge of symptoms of ADHD; how they typically assessed ADHD; and personal experience of ADHD. Factor analysis was performed and GPs were assigned to one of two categories, representing either a ‘positive’† or ‘negative’‡ attitude towards ADHD. This then allowed multivariate analysis to identify the effects of GP characteristics on these attitudes towards ADHD.
Of the 500 GPs contacted, 140 (28.0%) participated in the study, and of these, less than half reported any ADHD-related training, but 1 in 5 reported personal experience of ADHD. In total, 70 GPs (58.8%) had a more positive attitude towards ADHD, whereas 49 (41.2%) had a more negative attitude. ADHD knowledge, adherence to the guidelines or training had no significant effect on attitude towards ADHD (p=0.549, p=0.749 and p=0.503, respectively). It should be noted, however, that regardless of attitude, the average scores on knowledge and clinical evaluation scales were low, therefore there was no statistically significant difference between those with a positive or negative attitude towards ADHD. GPs expressing a positive attitude towards ADHD were more likely to be between 36 and 45 years of age (p=0.009), although the reason for this association cannot be inferred from the presented data. Similarly, seeing fewer children with suspected ADHD per year and working as part of a primary care team were also found to be significantly associated with a positive attitude towards ADHD (p=0.019 and p=0.023, respectively).
This study has two notable limitations, the first being the small sample size; however, the participant response rate was similar to other studies on ADHD and mental health in Ireland and Northern Ireland, and the representative nature of the cohort (by geographical distribution, age and gender) does allow generalisation to the wider GP group. Secondly, the use of factor analysis to analyse attitudes to ADHD and the subsequent two-dimensional categorisation into either ‘positive’ or ‘negative’ attitudes resulted in loss of data in borderline cases. However, this allowed for subsequent multivariate analysis, making the data more interpretable.
The authors concluded that despite the high prevalence of ADHD amongst children, a slim majority of GPs in Ireland have a positive attitude towards ADHD, which may lead to undiagnosed or misdiagnosed cases. Optimisation of ADHD care has primarily focused on providing GPs with the appropriate training to enable recognition of ADHD-like symptoms and subsequent referral to services where necessary. Although this seems appropriate given the apparent lack of training reported in this study, these results also suggest that training alone does not impact the negative attitudes of Irish GPs, which can act as a barrier to appropriate referral in children and adolescents with ADHD.
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*GPs were asked whether they: are part of a primary care team; are in the general medical scheme; have access to primary care psychology; had an interest in sharing care with CAMHS; and/or if they have access to CAMHS. They were also asked to report the annual number of children with suspected ADHD seen and the annual number of children with confirmed ADHD
†Positive attitudes included those which suggested that ADHD is a valid diagnosis, that the symptoms are not attributable to bad behaviour, and that the diagnosis is perceived as helpful for children and parents
‡Negative attitudes included those which suggested that ADHD is a fashionable disorder, difficult to distinguish from normal behaviour, and that parents seek diagnosis as an excuse for bad parenting and receipt of educational benefits such as Disability Access to Education and the Domiciliary Care Allowance offered to families in Ireland
Adamis D, Tatlow-Golden M, Gavin B, et al. General practitioners’ (GP) attitudes and knowledge about attention deficit hyperactivity disorder (ADHD) in Ireland. Ir J Med Sci 2018; Epub ahead of print.