General practitioners' familiarity, attitudes and practices with regard to Attention Deficit Hyperactivity Disorder (ADHD) in children and adults
Background: Attention-Deficit Hyperactivity Disorder (ADHD) is a common disorder, affecting 4% to 5% of South African children. Recent studies reveal 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 (GP), but the question that arises is 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 (GPs) 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 GPs in South Africa. Methods: The research questions were addressed by means of a survey approach, using quantitative measures. An e-mail message with a covering letter, explaining the purpose of the research project, provided a link to a web-based questionnaire. It was relayed to 6 704 GPs on the database of the company MEDpages, which managed the distribution. 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 GPs. 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 GPs to increase their knowledge base with regard to ADHD (87% with regard to children and 89% with regard to adults). As they were of the opinion that they should be able to diagnose and manage ADHD in both children (90%) and adults (85%) a significant need for a screening tool (83%) was also found. The GPs' knowledge and training with regard to depression and generalised anxiety disorders were significantly more extensive with regard to adults than to children. Training with regard to ADHD in adults was almost non-existent. With regard to children the most important barriers were uninformed parents (70%), limited funds (61%), uninformed teachers (58%), and with regard to adults these barriers were uninformed patients (64%), lack of knowledge on ADHD in adults on the part of the GPs (63%), and consultation time (58%). Although GPs 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 GPs with regard to ADHD should be addressed by adapting the curriculum of undergraduate medical students and providing opportunities for continued medical education that focuses on the diagnosis and management of ADHD, in both children and adults. GPs should acknowledge the educational psychologist as an equal partner within a multidisciplinary team.