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RE: Adult ADHD Diagnosis in a Family Medicine Clinic

  • Ediriweera Desapriya, Research Associate, Department of Pediatrics, Faculty of Medicine, University of British Columbia
19 January 2025

The article presents a practical and innovative approach to reducing waiting times for diagnosing and treating adult ADHD within a suburban family medicine residency clinic. By integrating behavioral health assessments into primary care, this model effectively addresses a critical gap in mental health services while maintaining a patient-centered focus.
Strengths
Significant Reduction in Wait Times:
The pilot program reduced the diagnostic timeline for uncomplicated adult ADHD cases by 46%-96%, with a mean delay of just 3-4 weeks compared to 20-56 weeks in traditional behavioral health settings. This efficiency is a major step toward addressing the unmet needs of adults struggling with ADHD.
Accessible and Cost-Effective Design:
Leveraging self-administered, validated screening tools such as ASRS-v1.1, PHQ-9, and DIVA-5, along with existing clinic workflows, keeps costs minimal. The program avoids specialized infrastructure, making it scalable and implementable in diverse healthcare settings.
Empowered Primary Care Clinicians:
Lunchtime learning sessions with psychiatrists have enhanced clinician confidence in using DSM-5 diagnostic criteria, psychostimulant medications, and managing ADHD alongside comorbid conditions. This cross-disciplinary collaboration strengthens primary care's role in mental health.
Holistic Care Model:
The integration of comorbidity screening (e.g., depression, anxiety, substance use, and sleep apnea) ensures a comprehensive understanding of patients' mental health. Treating these co-occurring conditions alongside ADHD improves care outcomes and patient satisfaction.
Challenges and Considerations
Potential for Overdiagnosis or Misdiagnosis:
While structured tools like DIVA-5 improve diagnostic accuracy, ADHD symptoms overlap with other conditions (e.g., anxiety, PTSD, or depression). Without robust training and ongoing support, primary care clinicians may overdiagnoses or overlook complex presentations.

Adding mental health assessments to primary care visits might increase clinician workload and burnout unless supported by adequate staffing or workflow adjustments. Initiating pharmacotherapy, especially psychostimulants, in primary care raises concerns about misuse, diversion, and the need for longitudinal follow-up to monitor efficacy and safety. Clear protocols and access to behavioral health consultation are essential. Approximately 12% of cases required referral to behavioral health for evaluation. This highlights the ongoing need for seamless referral pathways and collaboration between primary care and mental health specialists.
Real-World Implications
This innovative model demonstrates how family medicine clinics can play a pivotal role in addressing the mental health crisis by integrating ADHD care into routine practice. It aligns with broader healthcare goals of decentralizing mental health services, improving accessibility, and reducing stigma. However, real-world scalability requires:
• Enhanced clinician training in ADHD diagnosis and management.
• Mechanisms for periodic evaluation of diagnostic accuracy and treatment outcomes.
• Policy frameworks to mitigate risks associated with psychostimulant prescribing.
The pilot project offers a replicable and cost-effective solution to expedite ADHD care for adults. By equipping family medicine clinicians with tools and training, it bridges the gap between behavioral health and primary care, fostering timely interventions for ADHD and related conditions. Moving forward, continued evaluation of clinical outcomes, patient satisfaction, and healthcare equity will be critical for refining this model.
The authors deserve recognition for their innovative efforts in addressing an often-overlooked aspect of adult mental health care. Their work has the potential to significantly impact healthcare delivery in both urban and rural contexts.

Competing Interests: None declared.
See article »

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