Incorporating the management of ADHD into your practice. Can it be done?

Management of children with learning and behavioural disorders has traditionally been the precinct of specialist paediatricians, psychiatrists, psychologists and teaching professionals. Networks and teams have not generally included general practitioners. In Geraldton a professional network of health and educational professionals were of the view that learning disorders including attention deficit hyperactivity disorder (ADHD) frequently went unrecognised or misdiagnosed. In 1996 the National Health and Medical Research Council recommended use of the DSM-IV American Psychiatric Association diagnostic criteria for ADHD. A multimodal model of shared care was considered optimal. In 1999 the US National Institute of Mental Health's Multimodal Treatment Study of Children with ADHD was released.

To outline the development of a program to educate and support local professionals (doctors, teachers, psychologists, nurses, counsellors) in the management of behavioural disorders in which specific goals were to: build capacity for accurate diagnosis and management of children with learning and behavioural disorders facilitate via the Midwest Division of General Practice, a network of professionals to assess and manage learning disorders, including ADHD create a model of shared care with potential for application elsewhere formalise shared care/coprescriber arrangements for stimulant medications between GPs and specialists, including fast-tracking of medication develop school networks for early identification, referral and support of ADHD cases.

Our creation of a strong professional network enabling a GP case manager role has been very successful. Multiple treatment successes have created much community goodwill toward the Midwest Division of General Practice and my private practice has changed forever with the inclusion of 200 ADHD families. Colleagues considering entering this area need to recognise the potential for disruption to both their practice and their personal lives. A well organised practice with firm boundaries for difficult cases is essential.