A survey of adult referrals to specialist attention-deficit/hyperactivity disorder clinics in Canada

Abstract

BackgroundCanadian guidelines encourage family physicians to diagnose/manage adults with uncomplicated attention-deficit/hyperactivity disorder (ADHD); specialist referral is recommended only for complex cases. This retrospective case review investigated adults referred to Canadian ADHD clinics.MethodsAdult ADHD specialists reviewed referral letters/charts of patients (aged ≥18 years and no family history/known/expressed childhood ADHD) from family physicians/psychiatrists over 2 years.ResultsData on 515 referrals (mean age 33 years, 60% males) were collected (December 2014 to September 2015); 472/515 (92%) were made by family physicians. No psychiatric comorbid symptoms were noted in 344/515 (67%) referrals. ADHD was confirmed by a specialist in 483/515 (94%) cases, whether comorbid symptoms were noted at referral (155/171 [91%]) or not (328/344 [95%]). ADHD was reported to impact “work” (251/317 [79%]), “school” (121/166 [73%]), “social/friends” (260/483 [54%]), and “spouse/family” (231/483 [48%]). Overall, 335/483 (69%) patients had more than or equal to one comorbid symptom (diagnosed by referring physician or specialist). Stimulant monotherapy was recommended for 383/483 (79%) patients, non-stimulant monotherapy for 41/483 (8%) patients, and stimulant plus non-stimulant monotherapy for 39/483 (8%) patients. Almost half of patients were returned for referring physician’s follow-up, either before treatment initiation (102/483 [21%]) or after treatment stabilization (99/483 [20%]). Follow-up was by a specialist for 282/483 (58%) patients.ConclusionADHD diagnosis was specialist confirmed in most cases. Although most referrals (67%) noted no psychiatric comorbid symptoms, 69% of patients had ≥1 such symptom (diagnosed by a referring physician or specialist), so comorbid symptoms although not always noted at referral, may have contributed to the decision to refer. ADHD has a wide-ranging impact on patients’ daily lives. It is possible that greater confidence of family physicians to diagnose and treat adult ADHD could help to meet patients’ needs.

Patient visits and prescriptions for attention-deficit/hyperactivity disorder from 2017–2021: Impacts of COVID-19 pandemic in primary care

“…A US study found that ADHD management is not increasingly undertaken by recently trained pediatric primary care providers [42] and that pediatricians who were 10 years or more in practice were more likely to report regular ADHD care [44]. Family physician surveys in Ontario and British Columbia have indicated that most primary care physicians referred patients to a specialist for the diagnosis and management of ADHD [16,[45][46][47]. Also, about 80% of family physicians in an Ontario survey responded that they wanted additional training in the management of patients with ADHD [46] and this finding is consistent with more recent Canadian studies [16,47,48].…”

“…Family physician surveys in Ontario and British Columbia have indicated that most primary care physicians referred patients to a specialist for the diagnosis and management of ADHD [16,[45][46][47]. Also, about 80% of family physicians in an Ontario survey responded that they wanted additional training in the management of patients with ADHD [46] and this finding is consistent with more recent Canadian studies [16,47,48]. The increased intensity of patient visits for ADHD during the COVID-19 pandemic has highlighted the need for primary care physicians to have the necessary mental health supports in place to assist in the diagnosis and management of these patients.…”

Genetics and epigenetics of attention deficit hyperactivity disorder

“…По оценкам разных авторов, 67-87% детей с СДВГ имеют хотя бы одно коморбидное психическое расстройство, а 33-67% -два и более [1]. Самыми распространенными коморбидными психическим заболеваниями при СДВГ являются депрессия, биполярное, тревожные расстройства, SUD и расстройства личности.…”

“…в мире у детей составляет от 5 до 12% [4], встречается в 2-7 раз чаще у мальчиков [2]. Распространенность болезни у взрослых составляет от 5 [1] до 8% [4].…”

Healthcare provider perspectives on diagnosing and treating adults with attention-deficit/hyperactivity disorder

“…In a survey of USbased HCPs in the college/university setting, only 32% of nurses reported that they were comfortable/very comfortable in recognizing ADHD symptoms in young adults, and approximately two-thirds of physicians and nurses somewhat or strongly agreed that it was difficult to diagnose ADHD in young adults [16]. HCPs in the United States may also lack confidence in prescribing treatments for adult ADHD because of a lack of experience in managing adult patients with ADHD, the presence of psychiatric comorbidities, and a reluctance to prescribe psychostimulants [17]. Similar findings are reported in studies conducted outside of the United States, with 32% of PCPs in Saudi Arabia having poor knowledge of ADHD [18] and more than 40% of psychiatrists from Turkey agreeing that adult ADHD is difficult to differentiate from other disorders [19].…”