Clinical practice gaps, uncertainties and need for guidance
There is evidence that ADHD is underdiagnosed internationally and in Australia (Asherson et al., 2012; Deloitte Access Economics, 2019; Ginsberg, Quintero, Anand, Casillas, & Upadhyaya, 2014; Sciberras, Streatfeild, et al., 2020). Failing to provide people with a diagnosis of ADHD, and therefore failing to offer effective treatment, carries a high cost (Asherson et al., 2012; Deloitte Access Economics, 2019; Ginsberg et al., 2014; Sciberras, Streatfeild, et al., 2020). Early identification of people with ADHD is needed to allow for early intervention to occur as early in life as possible, to reduce impacts on functioning and maximise positive outcomes.
Whether to screen for ADHD at a population level needs to be considered. This includes exploring the sensitivity and specificity of screening tools, and the benefits and costs of screening in identifying true cases and false positive cases to the healthcare system, individuals and their families.
It is also well established that certain groups are at much higher risk of developing ADHD (see question 2.3). Costs of screening high-risk groups are therefore likely to be less than screening the general population, but screening may be similarly limited by the sensitivity and specificity of tools, and costs and burden to the healthcare system of screening. Guidance is thus required as to whether screening for ADHD should occur at a population level or within high-risk populations.