Patients harbouring ‘unrealistic expectations’ for ADHD diagnoses, doctors warn

Consultant psychiatrist Professor Richard Harvey says social media content has contributed to patients pressuring doctors for a diagnosis and treatment.
Professor Richard Harvey.

Doctors are facing a deluge of patients requesting ADHD diagnoses and treatments after watching videos on TikTok and other social media platforms, a leading psychiatrist says.

While social media has been credited for raising awareness of ADHD, consultant psychiatrist Professor Richard Harvey said it had also led to “unrealistic expectations” about assessments and treatment.

It has been estimated that the number of Australians diagnosed with ADHD has more than doubled to 418,000 since 2018.

“You get pressured to prescribe something that they have heard about rather than perhaps what the best available treatment would be for them,” Professor Harvey, who is based in Geelong, told AusDoc.

“It skews the doctor–patient consultation a bit and makes it slightly more difficult to give the best possible advice because they may not want to hear something different from what they have read online.”

This was echoed by Perth GP Dr Andrew Leech, who said social media had driven some patients to seek an ADHD diagnosis despite not meeting the criteria.

The federal Department of Health and Aged Care’s submission to the Senate inquiry on ADHD services showed that nearly 3.2 million PBS scripts for ADHD medications were dispensed to 413,000 patients last year more than double the 1.4 million scripts issued to some 186,000 patients in 2018.

The health department also estimated that ADHD affected 6-10% of Australian children and adolescents and 2-6% of adults.

There was heated debate about whether this represented overdiagnosis or better recognition, but the point was moot for those at the coalface.

Professor Harvey, who currently receives around 8-9 referrals a day for ADHD assessments, said the situation was “out of control” compared with 10 years ago.

He said more and more patients were showing up to appointments armed with their own research and requests for treatment based on what they had seen on the video-sharing platform TikTok.

“They are always talking about controlled substances — it is not just any medication — they are talking about dexamphetamine, methylphenidate, Ritalin and Adderall.

“As soon as patients start talking about Adderall, you just know, ‘Okay, that is not available in Australia,’ so they have picked it up from somewhere else.”

A search on TikTok showed that videos tagged with ‘#adhd’ had a total of 31.5 billion views and counting, while Instagram has more than 3.9 million posts with the hashtag.

Dr Leech said social media content, including influencers and celebrities speaking about their own diagnoses, had helped improve awareness and normalised the condition but had affected patient presentations.

“[It has] potentially contributed to some patients putting pressure on psychologists, psychiatrists and GPs to get diagnosed when they do not fulfil the criteria,” Dr Leech, who has a special interest in children’s mental health, told AusDoc.

“I have had patients leaving my consultation almost feeling disappointed that they probably do not have ADHD — or have very mild symptoms — and are not being referred on for a psychiatric assessment.

“I think this sort of pressure would impact GPs to feel compelled to refer just in case they are missing something, and then the specialist has the same sort of pressure to diagnose and treat.”

The RACGP recently called for all GPs to be allowed to diagnose and prescribe ADHD medications, but some doctors — including leading GP Professor Simon Willcock, who is clinical director of primary care at Macquarie University Health Sciences Centre, Sydney — have pushed back.

Writing in the Medical Observer in July, Professor Willcock argued that he did not want to be known as the “the GP who prescribes ADHD medication”.

But Dr Leech, who has advocated for increased GP involvement in ADHD management to improve patient outcomes, said various studies had shown that ADHD remained under-recognised and underdiagnosed in Australia and stressed patients deserved to be appropriately assessed and treated.

“While it feels like we are seeing a lot more patients, the reason we are playing catch-up and feel busier in this area is probably down to the fact they have felt ashamed to get help and speak out until now.”

“Prior to this increase in presentations, I have felt that it has been difficult for patients to present with these conditions because of the stigma attached to them and that they might be seen as a label,” he added.

The Senate inquiry — which has looked at the barriers to consistent, timely and best practice assessment of ADHD and support services — is due to publish its final report on 6 November.

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