Barriers and facilitators to understanding of ADHD in primary care: a mixed-method systematic review

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Abstract

Attention deficit hyperactivity disorder (ADHD) is a developmental disorder affecting up to 5% of children and adults and is underdiagnosed in many European countries. The process of access to care for this disorder is complex and variable across countries. In general, those affected, or their caregiver, will seek help through their primary care practitioners who are then often responsible for referral to other professionals for diagnosis and provision of treatment. Previous studies have highlighted that many barriers to recognition exist in primary care settings (such as misconceptions, lack of education or lack of resources), preventing access to care for this population and potentially affecting diagnosis rate. This systematic review aims to establish the barriers and facilitators with regard to attitudes, beliefs and experiences of ADHD within primary care. Electronic searches of multiple databases identified 3898 articles of which 48 met our inclusion criteria—primary care professionals from any country, understanding, knowledge, awareness, attitude and recognition of ADHD. Four main themes were identified: (1) need for education, (2) misconceptions and stigma, (3) constraints with recognition, management and treatment, and (4) multidisciplinary approach. The findings suggest many interacting factors are at play in the recognition of ADHD by primary care practitioners with a strong recurring theme of a significant need for better education on ADHD. Implications for research and practice are discussed, suggesting that educational interventions for primary care practitioners could improve the recognition of ADHD in this setting.

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Author and article information

Contributors

D. Daley:

ORCID: http://orcid.org/0000-0002-3597-0408

david.daley@nottingham.ac.uk

Journal

Journal ID (nlm-ta): Eur Child Adolesc Psychiatry

Journal ID (iso-abbrev): Eur Child Adolesc Psychiatry

Title: European Child & Adolescent Psychiatry

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1018-8827

ISSN (Electronic): 1435-165X

Publication date (Electronic): 14 December 2018

Publication date PMC-release: 14 December 2018

Publication date (Print): 2019

Volume: 28

Issue: 8

Pages: 1037-1064

Affiliations

[1 ]ISNI 0000 0004 1936 8868, GRID grid.4563.4, Division of Psychiatry & Applied Psychology, , University of Nottingham, ; Nottingham, UK

[2 ]ISNI 0000 0004 1936 8868, GRID grid.4563.4, Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, , University of Nottingham, ; Nottingham, UK

Author information

B. French http://orcid.org/0000-0002-9395-5919

K. Sayal http://orcid.org/0000-0002-2050-4316

D. Daley http://orcid.org/0000-0002-3597-0408

Article

Publisher ID: 1256

DOI: 10.1007/s00787-018-1256-3

PMC ID: 6675769

PubMed ID: 30552584

SO-VID: 8e4ce178-63b0-4876-8d04-5a21daade200

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.