General Practitioners' Familiarity, Attitudes and Practices with Regard to Attention Deficit Hyperactivity Disorder in Children and Adults

Abstract

Background: Attention-Deficit Hyperactivity Disorder (ADHD) is a common disorder affecting 4% to 5% of South African children. Recent studies revealed that 30% to 70% of children continue to experience problems related to ADHD in adulthood. Adults are becoming increasingly aware of adult ADHD as a result of public awareness campaigns in the media. Their first line of action is to visit their family physician, but the question arises whether these practitioners are ready to take on patients with ADHD. The aims of this study were to determine the familiarity, attitudes and practices of general practitioners (GP's) in South Africa with regard to ADHD in both children and adults and whether there are differences in children and adults with regard to depression and generalised anxiety disorders as comorbid disorders. The study also briefly explored the training models of GP's in South Africa. Methods: The research questions were addressed by means of a survey approach, using quantitative measures. An e-mail message with a cover letter, explaining the purpose of the research project, provided a link to a Web-based questionnaire. It was broadcast to 6704 GP's on the database of the company MEDpages, who managed the broadcast. A questionnaire attached to an e-mail message was sent to all Departments of Family Health at universities in the country to obtain information with regard to the training models of GP's. This was followed up with structured telephone interviews if no response was received. The questionnaire was completed by 229 respondents. The data were statistically analysed using Statistica Version 7.0. Results: The most significant outcome of the study revealed a considerable need among GP's to increase their knowledge base with regard to ADHD, more so with regard to adults. As they were of the opinion that they should be able to diagnose and manage ADHD in both children and adults, a significant need for a screening tool was also reported. The GP's knowledge and training with regard to depression and generalised anxiety disorders were significantly more extensive with regard to adults as opposed to children. Training with regard to ADHD in adults was almost non-existent. With regard to children the most important barriers were uninformed parents, reimbursement, uninformed teachers, liaison with schools, coordination of interventions and interdisciplinary contact. The important barriers preventing effective management with regard to adults were uninformed patients, lack of knowledge on ADHD in adults on the part of the GP's, consultation time and uninformed family members. Although GP's did seem to have an awareness of the important role of the psychologist in the diagnosis and effective management of patients with ADHD, their referral practices generally involved a limited interdisciplinary approach. Conclusion: It is recommended that the limited knowledge base of GP's with regard to ADHD should be addressed by adapting the curriculum of undergraduate medical students and providing opportunities for continued medical education that focus on the diagnosis and management of ADHD in both children and adults. GP's should acknowledge the educational psychologist as an equal partner within a multi-disciplinary team.