ADHD guidelines for adults
With more than a million South Africans between the ages of 20 and 50 affected by adult ADHD, these guidelines will greatly assist those suffering from the illness to receive the necessary treatment.
Compiled by psychiatrists Drs Renata Schoeman and Rykie Liebenberg of the South African Society of Psychiatrists (SASOP) Special Interest Group (SIG) for adult ADHD, the comprehensive guidelines for medical professionals includes assessment procedures, drug treatment options and the treatment plan for long-term health.
The guidelines have been peer reviewed and scrutinised by fellow psychiatrists and has been ratified and approved by the SASOP adult ADHD SIG, as well as the boards of the South African Society for Psychiatrists and the Psychiatry Management Group (PsychMG).
Poor identification of mental disorders in SA
Dr Schoeman says despite the known efficacy of treatment and the substantial costs of untreated attention-deficit/hyperactivity disorder (ADHD), access to healthcare and treatment is not a given for many patients in South Africa.
“In SA, there is poor identification and treatment of common mental disorders at primary healthcare level and limited access to specialist resources with a service delivery and treatment gap of up to 75%.
“Medication options are also often limited in emerging markets and in SA psychiatrists and patients do not have access to the medication resources available in established markets. Often than not ADHD is not diagnosed, or misdiagnosed and can have a severe impact on the functioning of the patient and lead to costly medical aid or private out-of-pocket expenses.”
The guidelines outline the requirements for comprehensive diagnostic assessment (at specialist level) and diagnostic certainty prior to initiating drug treatment.
“Comprehensive assessment is not possible during the average 15-minute general practitioner consultation, and it is therefore strongly advised that the diagnosis of adult ADHD and treatment initiation should be made by a psychiatrist well versed in the complexities of ADHD and the comorbidity thereof.
“Raising the diagnostic bar for adult ADHD will also prevent the scripting of medication for patients who use the medication for reasons other than the treatment of ADHD (e.g. cognitive enhancement) which artificially escalates the prevalence and costs of ADHD – which forces medical schemes to manage their business risk by currently not covering ADHD as a chronic disorder.”
Once a proper treatment plan has been established, and a patient is contained within a multi-disciplinary and multi-modal (psychosocial intervention and an optimal medication regime) basket of care, follow-up can take place on primary healthcare level – leading to further cost savings to schemes and reducing pressure on resources (manpower and financial) at specialist level. Ongoing treatment – which includes compliance to treatment – is crucial in preventing complications and long-term costs.
The danger of misdiagnosis
If left untreated or misdiagnosed, Dr Schoeman says the consequences of adult ADHD can be detrimental to the long-term health and quality of life of those affected.
“Many adults with ADHD go untreated for the majority of their lives. This can lead to significant increases in the risk for other psychiatric conditions such as anxiety and mood disorder as well as substance abuse. In the work environment their poor time management, goal setting, stress management and organisational skills can have a considerable impact on their colleagues and employers.”
ADHD is characterised by severe and impaired levels of inattention, hyperactivity and impulsivity. As a developmental disorder, symptoms are already evident in childhood. Although some children appear to ‘outgrow’ their ADHD, it is more a case of some becoming more skilled in managing the symptoms and, as adults, compensating for their ADHD-related impairment through lifestyle and career choices.
The guidelines stems from Dr Schoeman’s MBA completed at the University of Stellenbosch Business School (USB) in 2015 where she explored for the first time in South Africa the situation with regards to the prevalence and treatment of adult ADHD and suggested a new funding model for medical schemes.
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