Should GPs be playing a significant role in assessing patients for ADHD? - Dr Laura Powling
ADHD is under-recognised, under-diagnosed and under-treated, says the ADHD Taskforce, refuting some of the current political and societal narrative. Given the growing number of people questioning, recognising and being diagnosed, in relation to ADHD, NHS England created an ADHD Taskforce last year.
It was commissioned to evaluate and recommend transformation of ADHD service provision across health, education, employment and justice to help people with ADHD live to their potential. The lifelong perspective shared by the resulting report is a welcome development in terms of policymakers and policy influencers thinking, and communicating, about neurodivergency.
It’s also critical that the report acknowledges that people with ADHD can thrive with the right support. At Evolve Psychology we agree with the authors that ADHD should be approached the way a physical health challenge might. Earlier, better co-ordinated identification of, and accommodations for ADHD would be life-changing for the estimated 2.5 million people in England with this neurodivergency.
We support the Taskforce’s call for a more integrated and comprehensive net of support for people with ADHD and that much of this should not be dependent on a diagnosis, instead being guided by need.
It is, though, worth flagging that many of the people we assess take huge comfort and insight from receiving a diagnosis. It is an important step in enabling understanding of themselves, offering themselves compassion and building self-esteem.
The report’s depth should be applauded, for example its recognition of both the genetic causes of ADHD, which can mean whole families are under pressure and potentially less likely to seek help, as well as the relationship between neurodivergency and mental health challenges.
However, we question the recommendation that GPs should play a significant role in assessing patients for ADHD. The Royal Collage of General Practitioners has referenced the funding, training and time to develop specialisms that will be required for this shift to fulfil the promise signalled by the report.
We query whether it is reasonable to suggest GPs provide a service that takes clinicians, such as psychologists, many years of training to deliver.
Part of the challenge of a neurodiversity assessment is understanding complex relationships between behaviours and other factors that might lead to a differential diagnosis, linked to genetic disorders or developmental needs, for example.
Another key concern is the need for clinicians to recognise and be able to diagnose combined neurodivergency, given the extent of co-occurrence: 30-60 per cent of people with autism also have ADHD, 20-50 per cent of people with ADHD also have autism.
Most of the assessments we do at Evolve are combined, for both autism and ADHD. We believe best practice is to consider neurodivergency holistically. So, to avoid significant numbers of people continuing to fall through gaps in assessment and support provision, GPs would need to be trained in neurodivergency rather than just ADHD.
Additional questions include how they would provide assessments that take hours, when GP practices are overstretched in their provision of seven minute appointments, and how to integrate GPs with other healthcare workers to provide a multidisciplinary assessment, which is accepted as best practice.
We fear that, in exploring this route for increasing diagnostic capacity, the Taskforce report may fail to solve early problems.
However, diagnosis is just one step on the journey. As important is increasing capacity for support throughout people’s lifespan, so we applaud the Taskforce for considering this.
Dr Laura Powling is founder and CEO of Evolve Psychology.