Clinical practice gaps, uncertainties and need for guidance
This guideline highlights a number of practice gaps. A key gap is the lack of ADHD trained staff, resulting in bottlenecks in the diagnosis and support of people with ADHD. Training of clinicians is highly variable and this section outlines what is currently known about ADHD training for clinicians and what needs to be developed to reduce bottlenecks for diagnosis and treatment of people with ADHD.
Summary of narrative review
Given that ADHD requires a multimodal and multi-disciplined approach, training curriculums across disciplines need to provide adequate exposure, training and experience so they can provide comprehensive care to people with ADHD (Coghill, 2016). Whilst ADHD is typically on the curriculum for the training of psychiatrists, paediatricians, and psychologists, adult clinicians and psychiatrists, in particular, are unlikely to have practical training in diagnosis and treatment. The majority of training for psychiatrists is conducted in public mental health settings and it is widely known that, with a few exceptions, the public health systems do not diagnose and treat adult ADHD.
There is an increasing move to train GPs to diagnose and treat ADHD due to the shortage of medical specialists. Whilst diagnosis and treatment of ADHD is currently the province of both adult and child and adolescent psychiatrists, paediatricians, and psychologists, there is an under-recognition of ADHD in those groups as well as GPs who are usually the first line of referral. This leads to significant underdiagnosis.
GP training is particularly important because ADHD has implications for poor physical health outcomes (for example, difficulties taking medication regularly, and co-occurring medical and health conditions). GPs also manage chronic disease, making them uniquely placed to support individuals with long-term lifelong disorders, such as ADHD, with specialist care as needed. Accessing healthcare from GPs will also be more affordable, especially for those on low incomes.
In Australia, the services for people with substance use disorders are primarily assessed and treated by publicly funded Drug and Alcohol services, through a variety of government and non-government agencies. The majority of these services are independent of mental health services and staffed by workers specialising in addiction medicine, without training in identifying and treating ADHD. Thus, there is a service divide for those with co-occurring conditions such as ADHD. Clinicians in these settings need training to increase awareness of ADHD as per recommendations in section 6.3.
There are no current Australian standards for the training of health professionals in the diagnosis and treatment of ADHD. There are considerable advances in the treatment and understanding of ADHD which will require ongoing learning, which may be done via web-based resources or the RANZCP Adult ADHD Network model.