GPs' perceptions of the management of ADHD in primary care: a study of Wandsworth GPs

Abstract

Attention-deficit hyperactivity disorder (ADHD) is a growing diagnosis in child mental health in the UK and is increasingly being treated with methylphenidate (Ritalin, Equasym, Concerta). There are, however, clinical and public controversies over the diagnosis and ‘labelling’ of ADHD as a disorder, the use of drug treatments, and a relative paucity of guidance on the initial diagnosis and referral of the disorder. General practitioners (GPs) are involved in the assessment, diagnosis and treatment of children with ADHD and in liasing with the other parties involved, such as parents, teachers and specialists. Therefore their understanding of ADHD and its treatment is important. This study explores Wandsworth (South West London) GPs‘ understanding of ADHD as a disorder and their views of its management in order to provide more precise detail about the issues concerning the management of ADHD in primary care by GPs.Qualitative information was collected by semi-structured interviews (with 13 GPs) and quantitative information by means of questionnaires (93 completed by GPs) in Wandsworth.Whilst GPs had differing views of the aetiology of ADHD, there was a consensus view about the division of responsibility in the treatment of those diagnosed with ADHD. GPs felt uncomfortable initiating the prescribing of methylphenidate and stressed the importance of ongoing specialist involvement in the management of ADHD. There was also a feeling of inadequacy in terms of the training that GPs had received.It is suggested that guidance on the initial diagnosis of ADHD is drafted for GPs and that shared care protocols are agreed between primary care and secondary care so that the ongoing division of labour in the management of ADHD is made explicit, ensuring continuity of care.