Abstract
As I am sure you can imagine working in a University Health Service our patient demography is different from other practices. Next week is freshers' week when the new intake of keen students enrols at University. The emphasis of freshers' week is on settling into University life, meeting new friends and joining clubs. Along side the socializing, it is a time when many leave home for the first time and have to fend for themselves and part of this is registering with a GP. We register some 2000 patients in the space of a couple of weeks. This requires a military style operation, with a large number of temporary staff to assist us. As part of the process, we have a new patient questionnaire, which asks among other things about significant health problems with an emphasis on those problems that count towards Quality and Outcomes Framework payments. One of these areas is learning disabilities and includes adults with autism, but not people with a higher level autistic spectrum disorder who may be of average or above average intelligence.
Every year I am struck by how many students who are embarking on a university course consider themselves to have a learning disability. This is particularly apparent in students coming from the USA, a significant number of who report that they have attention deficit hyperactivity disorder (ADHD) and are being treated with methylphenidate. We do not, however, see the same proportion of UK students self-reporting ADHD, is this because it is less prevalent in the UK, under diagnosed in UK or over diagnosed in USA?
The prevalence rate of ADHD in adults in the USA in 2006 was estimated to be 4.4% (Kessler et al., 2006); I was unable to find UK prevalence figures. However, there is a rising awareness of ADHD in adults in the UK with specialist services such as those at the Maudsley Hospital (www.slam.nhs.uk/services/servicedetail.aspx?dir=12&;id=1045) now well established. These services, however, are still not widespread. Although as GPs we have become more comfortable with considering the diagnosis of children and adolescences with ADHD, we are still hesitant about the diagnosis and treatment of ADHD in adults. NICE clinical guideline 72 Attention Deficit Hyperactivity Disorder (www.nice.org.uk/CG072), issued in September 2008, has a specific section of ADHD in adults and advocates methylphenidate as the first-line treatment started under guidance of a specialist. As this guidance becomes more widely accepted and implemented, we will probably begin to see a rise in the number of students of UK origin presenting with ADHD.
So what does a diagnosis of ADHD mean to the students coming to University Health Service? Well for the majority of patients we see they are well controlled on medication and have been living with the disorder for a number of years. Those who have not been assessed by UK psychiatrist are required to be seen and assessed by our local psychiatrist before we continue treatment. Once the issues around medication and ongoing psychiatric support are addressed, for many of them the biggest problems relate to social interactions with their peers and fitting into University life. As a practice, we can help direct them to the appropriate University support services and when they come for repeat medication we can review how they are doing and be alert for any signs of deterioration in their condition. For those who have not as yet been diagnosed, it is about being aware of the condition and in those who are struggling considering the possible diagnosis. Perhaps once freshers' week is over, I will look at our prevalence rate for ADHD; I suspect we are well below 4.4%.