A psychiatrist and a team of GPs with lived ADHD experience are out to make a big difference.
Specially trained and supported GPs could play a major role in helping reduce wait times, access and costs involved with the diagnosis and treatment of ADHD, says a Brisbane child and adolescent psychiatrist.
Dr Shannon Morton was diagnosed with ADHD herself last year, joining the ranks of more than a million Australians with the neurological condition.
She has just launched a new model of care – called The Hype! ADHD Centre – designed to fast-track diagnosis and treatment in line with Australia’s new evidence-based clinical practice guidelines for ADHD.
The NHMRC-endorsed guidelines, designed by the Australian ADHD Professionals Association (AADPA), were released last month and cover everything from identification of high-risk groups to professional training for those working with children and adults with the condition.
Dr Morton has a team of GPs in her new clinic, many with their own “lived experience” of ADHD, and she told The Medical Republic she hopes other states will follow her lead.
“The reality is that we have a massive critical shortage of psychiatrists around the country,” she said.
“I think there definitely is a lot that GPs can do, but it will involve additional training and support, and then being able to access assessment tools that are cost-effective.
“That’s really the model of care that we’re piloting with our Hype ADHD centre. Basically, I’m putting together a crash course in training for the GPs that will be working with us and that will be helping them to have the same level of skills that one would expect with say a psychiatric registrar or a paediatric registrar in these areas.”
Assessment templates of things to exclude or consider, and online assessment tools that are cost-effective and automatically reported on, will reduce the time needed to conduct the assessment and produce the diagnostic report, Dr Morton said.
“I think its really upskilling the GP workforce and then developing relationships that are supervised and supported, as in relationships with psychiatrists,” she said.
“So if the GP was able to cost-effectively do a portion of the work-up and then have the patient ready for a one-off 291 (MBS item number), then the psychiatrist is able to ratify the diagnosis and hand back that patient to the GP for a couple of years of care, with support and advice around titrating dosages and that sort of thing when needed.”
She hopes the model of care will mean non-GP specialists need to spend less time with patients, meaning more patients can be seen. She also hopes it will free her up to be able to provide training and support to more GPs.
“I would like to be able to spend time doing group supervision for GPs to support them, so we can get them trained up and more people can be seen,” she said.
The statistics around ADHD in Australia offer a compelling argument for more services. According to AADPA, 6-8% of children and 3-5% of adults have ADHD. And Deloitte Access Economics estimate that the social and economic burden of ADHD in Australia was $20 billion per year.
For Dr Morton the motivation is also close to home. She was in her early 40s when she was diagnosed with ADHD, not long after her children, now aged 11 and 13 years were also diagnosed.
“I guess I’ve always been aware that I felt quite different to a lot of my colleagues, and I had at times wondered, is it mild bipolar, is it bipolar II, is it is it personality, is it that I’m very cluster B or is it that I’m just a loud, outspoken artist-creative type who is a naturally divergent thinker,” she explained.
“I have mulled it over for a long period of time, there’s a lot of overlap between ADHD and lots of other conditions that look very similar. But it wasn’t until my kids were diagnosed last year that I was diagnosed.”
She is pragmatic about her delayed diagnosis, preferring to use her childhood experiences to motivate her push for change.
“I wish I knew much earlier that I had ADHD and been given the opportunity to embrace my neurobiology for the gifts it brings, such as the overflowing creative ideas, courage and adventurousness to go against the grain, and ability to hyperfocus on things I am passionate about,” she said.
“ADHD is often underdiagnosed or masked in females, those with the inattentive, as opposed to the hyperactive, sub-type, and those that have significant compensatory anxiety, or high intelligence. It is much more prevalent in populations such as those that have a close family member with ADHD, due to the significant genetic tendency, children that live in out of home care, people with substance abuse, gambling, or forensic problems, and those with other conditions such as anxiety, autism and tic disorders.”
Meanwhile, Dr Morton is excited to see the increased community conversations around ADHD, particularly adult diagnosis. Australian media and reality stars Mia Freeman, Em Rusciano and Abbie Chatfield are the most recent high-profile people to publicly reveal their diagnoses.
“I think it’s actually wonderful that more people are coming out, because that’s how you reduce stigma,” she said.
