Australians with ADHD may be missing out on diagnosis and treatment

Many Australians living with attention deficit hyperactivity disorder – or ADHD – may be missing out on proper diagnosis and treatment, according to a new global survey.
 
Published in The Lancet Psychiatry, the study of 154 million people examined trends in the use of medication for the disorder in children, adolescents and adults across 14 countries, including the US, UK, Japan and Australia.
 
The research showed that despite increases in medication use for ADHD between 2001–15, prescription rates are still far below diagnosis rates in most countries, suggesting some patients may not be receiving the treatment they need. 
 
Professor David Coghill, who is Chair of University of Melbourne Developmental Mental Health, interpreted the global and Australian data. He told newsGP that although the rate of prescription is increasing in Australia, the data suggests children and adults are being under-diagnosed.
 
‘Around 5% of children have ADHD and we know that doesn’t vary hugely between different countries,’ Professor Coghill said. ‘[But] in Australia, the rate of prescription of medication, even though it has increased considerably over the years, is still only [up to] 1.74% of children.

‘Between one in three and one and four children are being treated in Australia [for ADHD].’
 
Those figures are worse for adults.
 
‘Around 2.5% of adults have ADHD; currently 0.2% are being treated,’ Professor Coghill said. ‘So around one in 10 adults with ADHD are being recognised and treated.
 
‘The increase in Australia in prescribing medicines for adults with ADHD is 4–10% each year.
 
‘So we have increased from a very low rate of treatment in Australia to a moderately low rate of treatment.’

Professor David Coghill believes healthcare professionals should consider the possibility of ADHD when they see patients who are having difficulties paying attention and concentrating, and with impulsivity.
 
While use of ADHD medications in children and adolescents, aged 3–18 years, has gone up in all countries, the data showed the number of people using medication ranged from 0.3% in France to 6.7% in the US in 2010.
 
Use of these drugs was less common in adults, ranging from 0.003% in Japan to 1.5% among privately insured individuals in the US in 2010.
 
Professor Coghill said the study suggests that ADHD might be over-diagnosed in the US, but under-diagnosed in other countries, including Australia.
 
When left untreated ADHD can have serious and far-reaching consequences for adults.
 
‘Those who are diagnosed with ADHD in adulthood, where it hasn’t been diagnosed in childhood, have a four times higher rate of mortality than those without ADHD,’ Professor Coghill said.
 
‘Adults with ADHD that are untreated are much more likely to have problems with substance misuse, they are more likely to smoke and drink as well as take illegal drugs.
 
‘They are much more likely to be involved in accidents, either as a pedestrian or as a driver of a vehicle, because of their impulsive behaviour.
 
‘They are much more likely to be involved in criminal activity. They have more family breakups, so they are more likely to be divorced, to have difficulties in their family relationships.’
 
Professor Coghill said adults with ADHD also often have poor peer relationships and poor work records, and are at an increased risk for all other mental health problems.
 
‘If you have someone with a chronic mental health problem and they are not responding to treatment, think about, “Could this be ADHD as part of this picture that I am seeing?”’ he said.
 
‘The message for all of us, but particularly for those in general practice, is that we should think about ADHD when we see patients who are having difficulties in paying attention, concentrating and with  impulsivity, and we should be asking questions about ADHD in order to increase the  rate of treatment.’

ADHD The Lancet Psychiatry University of Melbourne