Latest news with #diagnosis
ABC News
8 hours ago
- Health
- ABC News
Some Canberra GPs will soon be allowed to diagnose ADHD
It's hoped the ACT Health pilot program, beginning in six months, will reduce the number of Canberrans facing lengthy waits for an attention deficit hyperactivity disorder diagnosis.
ABC News
20 hours ago
- Health
- ABC News
Canberra pilot program to allow select GPs to diagnose ADHD and prescribe medication
For Deranie Jackson, finding a specialist in Canberra to assess her child for attention deficit hyperactivity disorder (ADHD) was like finding a needle in a haystack. Instead, on a friend's recommendation, Ms Jackson made an appointment for Phoebe with a psychologist in Orange, 300 kilometres from home. Within weeks, Phoebe had their diagnosis — a moment the Year 12 student, who uses they/them pronouns, described as empowering. "For me, the main thing it impacted was my school life," they said. "It made me realise that I wasn't really bad at these subjects, I just process slower and need a slower environment. The diagnosis came in late 2023 but by November last year, it became clear that Phoebe could benefit from medication to treat their ADHD. "Phoebe was really struggling with school, despite working so hard," Ms Jackson said. "There were days when Phoebe just couldn't think properly, and I just knew they couldn't do their HSC under these conditions." Psychologists are unable to prescribe medication for ADHD so the hunt for a specialist — namely, a psychiatrist — began. Phoebe's general practitioner (GP), who specialises in ADHD, gave them and Ms Jackson a list of eight specialists in the ACT to contact. "I have spent eight months making phone calls, trying to get in, sending emails — and they've either not got back or their books are closed or they only do under-18s," Ms Jackson said. "Even though we've got a diagnosis and we've already paid more than $1,000 for that, it was still such a struggle to find a psychiatrist. No one on the list could see Phoebe ahead of the HSC in October, so Ms Jackson called the psychologist in Orange who made the diagnosis and was recommended a psychiatrist in Albury, more than 300km away. They have an appointment later this month. Phoebe said it had felt like they were in a race against time to access medication before the HSC started. "It's just taken so long and such a toll — I see Mum making phone calls all the time and I'm so grateful that she's doing all that for me," they said. "I really want the medication in time so I don't do really badly on the HSC because I really dislike not doing my best, which is what can happen if I'm not processing properly." As for Ms Jackson, the single mother doesn't understand why such a common condition is so hard and expensive to diagnose and treat. "This is life and death stuff for our children and it's not that the professionals aren't amazing, they just don't have capacity. There aren't enough of them. "I don't know why it's so hard." Soon, it won't be. The ACT's chief psychiatrist Dr Anthony Cidoni made a commitment in May last year to improving access to ADHD diagnosis and prescribing within 12 months. A little beyond that deadline, he's revealed plans for a pilot program that will see GPs given more authority to diagnose the condition and additional powers to prescribe ADHD medication — a task currently only done by paediatricians, neurologists and psychiatrists, who often have lengthy wait lists and charge high fees. Queensland has had a similar system in place since 2017 for patients aged between four and 18, while New South Wales, Western Australia and South Australia have also committed to rolling out a GP-led ADHD program for young people next year. "So, we're really mindful that we need to do something to address the issues that are out there." In late 2023 a Senate inquiry into ADHD recommended the development of uniform prescribing rules be expedited to ensure consistency between all jurisdictions. But Dr Cidoni said it had become evident that achieving that recommendation could take years, and ACT Health decided it couldn't afford to wait. "We don't want to wait for that because we think the need is there now," Dr Cidoni said. The pilot program is slated to start as early as December but no later than January next year, following stakeholder consultation. Canberra GPs already have some prescribing arrangements, which allow them to prescribe ADHD medication for adolescents for two years and adults for three years, as recommended by a specialist. "What we have planned is two streams — one stream will be for GPs to be able to do the actual diagnosis and prescribing, and the other stream will be to do the prescribing but on a much broader level than we have now. "So, I think we're looking at quite a significant change." General practitioners will have to apply to take part in the pilot program and, if approved, will need to complete comprehensive training before taking on patients. There will be clinical supervision by a specialist and a requirement for a GP to refer complex patients to either a paediatrician, psychiatrist or neurologist. "We've already scoped the level of interest in our GPs in the ACT so we're thinking there would be around 70 to 100 that might be interested in participating in a program like this," Dr Cidoni said. "A smaller proportion in the diagnosing and treatment arm, and then a larger proportion in the prescribing arm. "And if we get the parameters right, in terms of the appropriate education, psychiatrist oversight and access to ongoing support, I believe we can do it safely. When paediatrician Dr Kim Bland was told GPs would soon take on more of the ADHD workload, she breathed a sigh of relief. And Dr Bland suspects specialists across Canberra will do the same when they hear the news. "Even with my books closed and that being well-known, we are still getting daily inquiries from families not just looking for care like they would for other medical conditions, but being in crisis. "Not just asking for medical care, but asking for help and rescuing because they're really in a desperate and dire situation, and that's the difference with these children." Dr Bland said every aspect of life is impacted for a child living with undiagnosed ADHD, especially their education and self-esteem, plus the pressure on parents can lead to family breakdown. She said turning those families away is one of the most difficult parts of her job. "For parents, it's one thing to not know what they can do for their children but it's another to know it's right there, help is available, a diagnosis is available and all the support that comes with it, but they can't access it," Dr Band said. And for her, to know there will soon be a team of competent GPs to refer those families to feels like a weight being lifted. Dr Kerrie Aust, the ACT president for the Australian Medical Association, said it made perfect sense for general practitioners to play a more significant role in the ADHD space. She is hopeful she will get approval to be among the group of GPs able to diagnose ADHD and prescribe medication for the condition. "We are seeing an increase in young people and adults coming in to have discussions about whether they might have ADHD and it's really important they access care in a timely manner," Dr Aust said. "While psychiatrists and paediatricians have really been trying to step up into that space, I think this is a good example where GPs can work to the full of their breadth of scope and get involved in the diagnosis and management, especially where those cases are relatively straightforward and we've got proven treatments to work." Dr Aust said she was confident the take-up by general practitioners would be strong enough to have an impact on patient care. "Every little bit counts — if one doctor can see two or three new patients a week then that's a huge change to the backlog," Dr Aust said. "It also creates space for the paediatricians and psychiatrists to focus their attention on some of the more complex diagnostic cases, or where we're having trouble managing the medications." But she warned potential patients not to expect a diagnosis within a standard quarter-hour consultation. "It's not going to be a case of booking the 15-minute appointment and coming in and walking out with a diagnosis — it will still take time and patience, and we may need to try a few things before we get it right. "But I do think being able to access regular care with your GP is a really positive step." There will be an age limit for patients being seen as part of the pilot, with Dr Cidoni still to decide whether 18 or 26 is the most appropriate option. Dr Bland said she would urge him to extend the age to 26. "Usually by the time they're an adult, they're on a very stable dose, they've got a very good support around them, they know when they need to speak to their therapist, they know when they need to adjust their dose. "And if anything, it's slightly more simple diagnosing past that age so that would be a group I think would benefit greatly from seeing their GP." Dr Aust agreed, adding she had seen a growing gap in care for patients aged between 16 and 24. "Often young people who have been diagnosed when they were in primary school, they may have been lost to follow-up for a long period of time and we don't have access to their previous diagnostic records," she said. "And in those cases, it's both challenging and expensive to have those assessments. "We really find that they run into trouble as they get into the workplace or they're attending university and that's a group that I would really love to see supported." Both doctors agreed that it should be a question of complexity, not age, but acknowledged the pilot program had to start with some parameters in place. When Ms Jackson considers how Phoebe's experience could have been different had their diagnosis come from a general practitioner, she is brought to tears. "If we'd been able to go to a GP and they could have done tests the moment the anxiety and depression started, it would have been a totally different journey," Ms Jackson said. "School would have been a completely different experience for Phoebe, I would have parented differently — so much would have been different. "And it would have been so much more affordable. The cost is a really big impact — it is costing thousands of dollars out-of-pocket for these specialist appointments. "It's obviously too late for us, but maybe there's a little undiagnosed girl in Year 7 who can be picked up by her GP and find life a much easier journey as a result."
Daily Record
a day ago
- Sport
- Daily Record
Kate Middleton left Wimbledon's Centre Court 'in tears' after 'courageous' act
Kate's appearance at the Men's Singles Final at Wimbledon in 2024 could have offered solace to others, a Royal biographer said. Princess Kate Middleton was moved to tears upon her arrival at Wimbledon's Centre Court for the 2024 Men's Singles Final. The Princess had been undergoing treatment for an undisclosed cancer diagnosis throughout the first half of the year prior to making this public appearance. During this period, Kate had maintained a deliberately low profile, though Royal biographer Robert Jobson reveals in his book Catherine, the Princess of Wales: The Biography that she recognised how her public presence could offer solace to others. Robert suggests this understanding may have influenced her decision to attend Wimbledon - not merely due to her passion for tennis, but because of the symbolic significance her attendance would carry. "The world would also have intermittent glimpses of the steely inner strength of the Princess of Wales as the year continued," he noted. "At the same time, she was equally aware of the reassurance and comfort that she could provide to those in a similar predicament," reports Wales Online. "On the afternoon of 14 July, the 15,000 spectators packed inside Wimbledon's Centre Court rose as one to welcome the Princess to the Men's Singles Final of the tennis championships. Many in the crowd were in tears. "It was not just the shy smile on the face of the tennis-loving Princess, thrilled to be at one of her favourite events, that set them off. It was also the fact that a beaming nine-year-old Princess Charlotte was at her side." Kate has since finished her chemotherapy treatment and has begun making additional public outings. However, specifics regarding her cancer diagnosis haven't been revealed. The Duchess of Cambridge attended this year's Women's and Men's Singles Final of the competition, joined by Prince William and kids Prince George and Princess Charlotte. Before this, there had been speculation about her attendance at this year's Wimbledon fixtures, with suggestions she may skip the Women's Final should a player from Belarus or Russia look set to triumph. Russia remains engaged in conflict with Ukraine, a British ally, whilst Belarus supports Russia - creating a delicate situation should a member of the Royal Family present silverware to a competitor from either nation. Beyond the tennis tournament, attention has turned to Kate's nutrition, with the Princess reportedly incorporating a £1.48 superfood into her daily routine that could help combat inflammation. The superfood being discussed is blueberries, a berry thought to provide numerous wellness advantages. Discussing their effects, Dr Federica Amati explained: " Blueberries are touted as a superfood that we should be consuming every day. The evidence is really good - blueberries are a great fruit to add to your daily diet. "But it's important to remember that we need a diversity of plants, so enjoy your blueberries, but make sure they're not the only fruit you're eating." Join the Daily Record WhatsApp community! Get the latest news sent straight to your messages by joining our WhatsApp community today. You'll receive daily updates on breaking news as well as the top headlines across Scotland. No one will be able to see who is signed up and no one can send messages except the Daily Record team. All you have to do is click here if you're on mobile, select 'Join Community' and you're in! If you're on a desktop, simply scan the QR code above with your phone and click 'Join Community'. We also treat our community members to special offers, promotions, and adverts from us and our partners. If you don't like our community, you can check out any time you like. To leave our community click on the name at the top of your screen and choose 'exit group'.
Telegraph
a day ago
- Health
- Telegraph
Can ADHD really be diagnosed with a simple 18-question test? We ask the experts
There are now 2.6 million people in the UK with ADHD – and diagnoses are on the rise. Looking at 18 years of anonymised NHS patient records, researchers at University College London noted a 20-fold increase in the diagnosis of ADHD in adult men, and 15-fold in women. Meanwhile, demand for a diagnosis has soared by more than 400 per cent since the pandemic, according to figures from the ADHD Foundation. As those looking for an ADHD diagnosis face a wait as long as eight years on the NHS, the two-minute Adult ADHD Self-Report Scale (ASRS), which asks individuals to answer 18 questions themselves, has become widely used. But when Oxford University made the decision to use it to grant extra exam time to almost all students who got a positive result, it called to question the efficacy of the quick test. The students underwent a 90-minute assessment by an unqualified expert after the initial screening but still, it opened a heated discussion about whether the ASRS test was fit for purpose. There are two main concerns surrounding this test: One being that the ease at which people are accessing it is contributing to the fact that doctors are being inundated with diagnosis requests from people who believe they have ADHD. And secondly, if people know that a positive result on the ASRS test could lead to extra time in exams, or to being eligible for benefits, then there could be incentives to answer a certain way. What exactly is the ASRS test? Written in 2005, the self-reporting test was devised by the World Health Organisation (WHO) and experts from Harvard Medical School. It is generally used as an initial screening for ADHD and is widely used by the NHS and private clinicians. The test is only meant to be used as an initial screening and to assess whether a further assessment by a specialist clinician is necessary. 'It was designed to screen for what we call ADHD traits. The main purpose is to flag those patients to primary care providers like GPs, who might want to refer them to secondary care where a more thorough assessment can be done. It's not meant to be used alone for a diagnosis,' says Dr Alessio Bellato, clinical psychologist and lecturer in neurodiversity and mental health at the University of Southampton. With no blood test or objective criteria, ADHD is tricky to diagnose – and sometimes open to abuse. 'ADHD is a constellation of behaviours, but there's no specific gene or signal in the brain that we know about, so we have to rely on observations,' says Dr Bellato. 'The presence of symptoms alone is not enough for a clinical diagnosis; they must have negative consequences that are clinically impactful in everyday life, like maybe the person can't hold down a job or perform at university.' Ideally, a diagnosis should include extensive clinical interviews and evidence of impairment across more than one area of life, according to NICE (National Institute for Health and Care Excellence). So what's the theory behind this two-minute test for ADHD and is there still a place for it? Concerns over diagnosing ADHD with a two-minute test Dr Bellato believes the ASRS test, provided it's used correctly, is a useful tool for initial screening and referrals. 'As of today, it's the best screening tool we have – it's supported by the WHO and designed and developed by researchers from reputable institutions. We have to be realistic about the time GPs have, and ADHD assessment is not their job,' he says. But it isn't perfect. Since ADHD is being widely talked about amongst friends and on social media, most people now understand what boxes to tick on the test, and in some older versions of the test, the answers with the highest scores are also obvious because they're shaded grey. Dr Marios Adamou is a consultant psychiatrist with the adult ADHD and Autism Service, South West Yorkshire Partnership Foundation Trust. He's concerned that too many people are referred by GPs for an assessment after completing the test and are adding to already lengthy waiting lists. 'It used to be useful in the UK, but I don't think it's useful now. People are coming in and demanding a diagnosis because they have already diagnosed themselves,' he says. In his trust, they've recently started to trial a new system. 'GPs contact us and we complete a one-hour face-to-face interview for a referral,' he says, saying that the trial has significantly reduced referrals. Although some clinicians and politicians have claimed that ADHD is being over diagnosed, experts rightly point to the fact that, although it is estimated that around 2.8 per cent of adults have ADHD in the UK, only around 0.32 per cent currently have an ADHD diagnosis, although numbers are rising. How the ASRS test works The test has 18 questions linked to the criteria for diagnosing ADHD, which is set out in the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5. The manual classifies ADHD into three types: predominantly inattentive, hyperactive-impulsive and combined. None of these types are inherently more severe; it simply depends on how ADHD shows up in each individual. People with predominantly inattentive ADHD may struggle with focus, forgetfulness, procrastination, concentration and following through on tasks. Those with the hyperactive-impulsive type are more likely to experience restlessness, impulsivity and difficulty sitting still. The combined type includes significant symptoms from both categories. The ASRS test asks questions that help to identify traits of each type of ADHD outlined in the DSM-5. So part A of the test contains six questions that cover both symptoms of inattentiveness and hyperactivity-impulsivity. Part B has a further 12 questions that provide additional clues for clinicians and asks a broader set of questions about how severe the symptoms are and the impact on people's lives. Experts think that the criteria – and the questions – are due an update though, in light of how much researchers are beginning to understand about ADHD. 'The DSM was created decades ago and is constantly updated by clinicians who also involve the public. Right now, signs of emotional dysregulation are not part of the diagnostic criteria, but when we move to DSM-6, I expect we might see that change,' says Dr Bellato. Questions about inattentiveness With ADHD, inattentiveness looks like difficulties focusing on details, organisation, remembering appointments, procrastination, making mistakes, losing things and struggling with concentration. So the ASRS also asks several questions about those things as well as their impact on life, like staying focused at work when doing a boring task, having difficulty concentrating on what people are saying to you or being distracted by noise or activity. 'Attention is a cognitive function, so what we are looking for here is someone with impaired function. If you're honest when you fill it out these questions could signal an attention problem. Of course, there could be other causes like depression, anxiety, alcohol disorder and trauma,' says Dr Adamou. For an ADHD diagnosis, inattention would usually need to have been present since childhood and be pervasive across multiple areas, like work and home. When it comes to ADHD, inattention and procrastination are often linked to the demands of the task; if it's boring, it can be impossible to get started, but if it's stimulating, ADHD people can hyperfocus for a long time. 'There are theories that say that lack of motivation in people with ADHD is due to altered neurotransmitters, including dopamine. This means that doing things that are not really engaging or exciting are much more challenging than they should be, then if something is exciting, they over focus, which is a trait that overlaps with autism,' says Dr Bellato. Questions about hyperactivity and impulsivity 'Hyperactivity is mostly applicable to children,' says Dr Bellato. 'It's the child with ADHD who can't sit still, who is always active, in a way that is excessive for their age. Impulsivity, on the other hand, is related to difficulties in inhibiting a response – for example, let's say, you provoke me and I will react immediately in an inappropriate way. ADHD is very closely related to aggression, and people often struggle with inhibiting their responses which aren't socially acceptable.' So the test also includes several questions that speak to the hyperactive and impulsive nature of ADHD. For adults, these can be physical hyperactive symptoms like difficulties sitting still or staying seated in meetings, feeling constantly restless or fidgety, unable to unwind or relax, or being overly compelled to do things as if being 'driven by a motor'. The questions also aim to measure how the impulsive behaviours relate to inner difficulties, asking whether people often interrupt others and finish their sentences, talk too much and find it difficult to wait their turn. Scoring the test A score between zero to nine indicates a low likelihood of ADHD, between 10-13; a moderate likelihood, 14-17; a high likelihood and 18-24; a very high likelihood. The questions that score highly can also indicate the ADHD subtype, which could be hyperactivity-impulsivity, inattentive or combined. Only the first six questions in Part A of the test are scored, and in 2024, the scoring system was updated to provide more nuance. Each question has a multiple-choice answer of Never/Sometimes/Often and Very Often, with a score ranging from zero to four points for each. Questions seven to 18 are answered in the same way but they're not included in the total score. They're simply used by clinicians to get a more detailed picture of how much of an impact the traits are having on an individual's life. Researchers are continuing to work on better diagnosis methods for ADHD, but in the meantime, Dr Bellato believes the ASRS can be helpful, provided it's used correctly as a first step and not a standalone diagnostic tool. As Dr. Bellato puts it, 'It's not the tool that's the problem, it's how the tool is used.' Where can I find the ADHD Self-Report Scale test? The updated ASRS test is freely available online. You can find a user-friendly version on the website of the charity ADHD UK, the updated version on the Psychology Tools website, and the original version on the ADD website. Experts advise answering the questions honestly and without overthinking your answers. A positive score is a sign to seek further clinical assessment, not a diagnosis of ADHD. Experts recommend sharing your results with a GP, who can refer you for a formal ADHD assessment if appropriate. The test can be a useful tool and a helpful first step if you have a history of symptoms, a family history or other mental health symptoms. But he emphasises that people shouldn't forget 'this is a self-reporting tool, so any non-honest reply will affect the final results, and each individual might have different opinions about how to define something occurring 'rarely' or 'sometimes'. It is always important to talk to your GP or clinical practitioner and only an expert and trained clinician can diagnose ADHD and it might be that follow up assessments rule out ADHD,' says Dr Bellato.
Scottish Sun
a day ago
- Health
- Scottish Sun
How the way you WALK could reveal a hidden autism diagnosis – the 3 signs to look for in your child
Gait differences may be a supporting characteristic of autism - read on for the core traits of the condition and why they often go unnoticed IN STEP How the way you WALK could reveal a hidden autism diagnosis – the 3 signs to look for in your child Click to share on X/Twitter (Opens in new window) Click to share on Facebook (Opens in new window) AUTISM is a neurodevelopmental condition that affects how people socialise, communicate and interact with the world. Autistic people may find socialising confusing or tiring, become overwhelmed in loud or crowded places and crave order and routine. Sign up for Scottish Sun newsletter Sign up 2 Toe-walking, walking on tip toes or the balls of the feet, can be a characteristic of autism if it continues past early childhood Credit: Getty 2 Walking with feet turned in can be another one - though autism isn't the only cause of this Credit: Getty But the condition - which is not an illness or disease that needs to be 'cured' - can also affect how some people move or walk, researchers say. In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM) - a guide book widely used for diagnosing mental health conditions - lists an "odd gait" as supporting feature of autism. Nicole Rinehart, a Professor of clinical psychology and director of the neurodevelopment program at Monash University outlined three "noticeable gait differences" autistic people might have in The Conversation. These may include: Toe-walking, walking on the balls of the feet In-toeing, walking with one or both feet turned inwards Out-toeing, walking with one or both feet turned out Walking on the toes or the balls of the feet is fairly common in children who are just beginning to walk, until the age of three. Most will outgrow it the habit. If toe-walking doesn't correct itself over time, or begins suddenly, the NHS recommends children be assessed by a health professional for growth-growth related pain, neurodevelopmental disorders or autism. "Children with autism spectrum disorder or sensory integration issues will frequently toe walk as it feels more comfortable for them," the East Sussex Healthcare NHS Trust explains. In and out-toeing are also fairly common and can simply be caused by the rotation of the thigh and shin bones, aside from autism. Simple 10-question test that can help determine if you have autism They don't usually need treatment and will go away on their own by the time a child is eight. The NHS advises parents to speak a GP about their children's gait if they're worried about it. Autism can cause other, more subtle changes to the way people walk, according to Prof Rinehart. She pointed to 30-year study of autistic people, which found that some with the condition may: Walk more slowly Take wider steps Spend longer in the 'stance' phase, when the foot leaves the ground Take more time to complete each step "Autistic people show much more personal variability in the length and speed of their strides, as well as their walking speed," Prof Rinehart wrote. "Gait differences also tend to occur alongside other motor differences, such as issues with balance, coordination, postural stability and handwriting." She explained that gait differences in autistic people might be caused by "differences in brain development". What is autism? Autism spectrum disorder (ASD) is an incurable, lifelong developmental condition that affects how people perceive the world and interact with others. It affects around one in 100 people in the UK and is three to four times more common in boys than in girls. Many people with ASD find it hard to understand other people's feelings and emotions, and they may have difficulty holding conversations. When they are young, their language development may take longer and they can struggle to use facial expressions, using gestures to communicate instead. They may also find it hard to connect with other people and to hold eye contact with unfamiliar individuals. Many children with ASD like to follow a routine, and changes to this can cause distress. High functioning autism is an informal term some people use to describe those on the autism spectrum disorder. Areas such as the basal ganglia - which is responsible for making walking effortless, smooth and automatic - and the cerebellum, which controls and coordinates movement, may develop differently in people with autism, the expert said. "While some researchers have suggested that autistic gait occurs due to delayed development, we now know gait differences persist across the lifespan. "Some differences actually become clearer with age." Some people with gait differences may also have more difficulties with language and cognition. In some cases, these signs can indicate that an autistic person is experiencing "sensory or cognitive overload" and might need some "extra support or a break" in that moment, the expert said. Do gait differences need to be treated? Differences in the way autistic people walk don't necessarily need to be treated, Prof Rinehart said. "Some autistic people might have subtle gait differences that are observable during testing," she wrote. "But if these differences don't impact a person's ability to participate in everyday life, they don't require support." But some may be at increased risk of falls, have difficulty participating in sports or other physical activities, or may get pain in their legs or back from the way they walk. In these cases, children may benefit from some additional support, whether that be from a clinic, at school, or in their local communities. "Our community-based intervention studies show autistic children's movement abilities can improve after engaging in community-based interventions, such as sports or dance," Prof Rinehart said. "Community-based support models empower autistic children to have agency in how they move, rather than seeing different ways of moving as a problem to be fixed."
