A national survey in the UK conducted as part of research by the University of Exeter has found huge variation in treatment for ADHD, highlighting the struggle many young adults face once they turn 18.
Researchers have warned that the current system is failing many young adults as they transition from children’s to adult services, suddenly finding themselves unable to access treatment because services are not connecting effectively.
More than 750 people from across the country, including commissioners, health professionals working in primary care and people with lived experience of ADHD, completed the National MAP Survey, which highlights the challenges GPs face when prescribing ADHD medication.
ADHD affects up to seven per cent of children and up to five per cent of adults, and its symptoms include patterns of hyperactivity, impulsivity and/or inattention that interfere with daily life functioning. Lack of treatment for ADHD and gaps in treatment, especially as young people become adults, can have serious consequences for patients and families, increasing the risk of mental health crises and difficulties in work, education and relationships. This lack of treatment also puts additional pressure on those working in health services.
The survey found variations in the “shared care” arrangements between GPs, mental health specialists and patients, which must be in place for GPs to be able to prescribe ADHD medication. This was a particular problem when young people move into adult mental health services, suggesting that the current system fails teenagers at a critical time in their lives. Current NICE guidelines recommend that GPs prescribe medication for adult patients with ADHD under a shared care arrangement with adult mental health services.
However, the survey found that it is not always easy to set up such arrangements, and there are indications that GPs may not feel sufficiently supported to prescribe in this way. Indeed, without adequate support, some GPs may not prescribe ADHD medication due to insurance and liability concerns. This can be a particular problem for patients with a private diagnosis of ADHD and leaves GPs unable to provide effective care and many patients without access to the medication they need.
Furthermore, more than 40 per cent of respondents reported waiting times of two years or more for an appointment at adult mental health services. This leaves GPs with the responsibility of providing care, but without the support they need to offer the best care to their patients at a crucial time in their lives. This can include removing access to medication, despite successful treatment during childhood. Problems with access to ADHD treatment are also worse for some underserved groups, such as young women and young people who drop out of care, increasing health inequalities.
The survey results come as NHS England has announced the creation of a taskforce and a major review of ADHD services. As NHS England says: “People with ADHD deserve caring and effective services from the NHS and wider society. We know there is more to do, but we do not underestimate the complexity and challenges of realising this ambition.”
Dr Anna Price, lead researcher at the University of Exeter, said: “Our findings highlight the need for a co-ordinated approach to tackle the issues that lead to a postcode lottery for patients trying to access ADHD treatment. GPs and other primary care professionals really need better support to be able to provide shared prescribing of ADHD medication in line with UK guidelines.
“We know that not treating ADHD can have a huge impact. Turning 18 is often a crucial and sensitive time in life, and our research shows that not treating it at this time can be particularly damaging for young people who are learning to self-manage their health needs, while also perhaps sitting important exams, leaving home for the first time and embarking on a career or university course.
“We welcome the creation of the NHS England taskforce; it is a much-needed step towards achieving better outcomes for people with ADHD.”
Experts at the University of Exeter have recently created a collaboration on ADHD and neurodevelopmental science, working alongside senior experts and healthcare providers. The collaboration aims to develop solutions, such as curated digital interventions and standardised shared care arrangement templates, to help people with ADHD thrive.