Knowledge, practices and attitudes towards adult attention-deficit hyperactivity disorder (ADHD) were studied using a semi-structured questionnaire. There were 38 respondents (58% response rate, including 16 consultants) to the anonymous survey of 74 clinicians attending a training day in Stoke-on-Trent.
Four clinicians (10%) had actual experience dealing with adult ADHD and two of these had occasional transfer meetings with children and adolescent mental health services (CAMHS). Overall, 50% of respondents felt confident enough to diagnose adult ADHD in spite of having no actual experience and 63% felt confident enough to prescribe medication for adult ADHD.
Two clinicians were sceptical about the validity of the diagnosis and another consultant referred to the need for further evidence of treatment efficacy. Although 24% of clinicians felt life-coaching alone would suffice, 50% favoured a treatment combination of psychostimulants and life-coaching. The majority identified a need for further training. Almost everyone indicated a service gap at the time of transition from CAMHS to adult psychiatry.
Our survey highlights a mismatch between clinicians’ perceived confidence and their actual experience in diagnosis and treatment of adult ADHD (Reference Nutt, Fone, Asherson, Bramble, Hill and MatthewsNutt et al, 2007). Expert opinion suggests adult ADHD is underdiagnosed and mistaken for other conditions (Reference AshersonAsherson, 2004). Prevalence rates of adult ADHD is estimated at around 4%, which is four times higher than that of schizophrenia and, despite that, in our survey most clinicians (90%) did not have any actual adult ADHD patient contact. This raises the question of whether respondents’ high confidence in diagnosing and prescribing is misguided and whether they indeed have the knowledge and skills to manage adult ADHD.
Acknowledgements
We thank Dr Lesley Haines, Mrs Tracy Podmore and Ms Kay Statham for their contribution.
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