چکیده (انگلیسی):

Background:Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder with international
prevalence estimates of 5 % in childhood, yet significant evidence exists that far fewer children receive ADHD
services. In many countries, ADHD is assessed and diagnosed in specialist mental health or neuro-developmental
paediatric clinics, to which referral by General (Family) Practitioners (GPs) is required. In such‘gatekeeper’ settings,
where GPs act as a filter to diagnosis and treatment, GPs may either not recognise potential ADHD cases, or may
be reluctant to refer. This study systematically reviews the literature regarding GPs’ views of ADHD in such settings.
Methods:A search of nine major databases was conducted, with wide search parameters; 3776 records were
initially retrieved. Studies were included if they were from settings where GPs are typically gatekeepers to ADHD
services; if they addressed GPs’ ADHD attitudes and knowledge; if methods were clearly described; and if results for
GPs were reported separately from those of other health professionals.
Results:Few studies specifically addressed GP attitudes to ADHD. Only 11 papers (10 studies), spanning 2000–2010,
met inclusion criteria, predominantly from the UK, Europe and Australia. As studies varied methodologically,
findings are reported as a thematic narrative, under the following themes: Recognition rate; ADHD controversy
(medicalisation, stigma, labelling); Causes of ADHD; GPs and ADHD diagnosis; GPs and ADHD treatment; GP ADHD
training and sources of information; and Age, sex differences in knowledge and attitudes.
Conclusions:Across times and settings, GPs practising in first-contact gatekeeper settings had mixed and often
unhelpful attitudes regarding the validity of ADHD as a construct, the role of medication and how parenting
contributed to presentation. A paucity of training was identified, alongside a reluctance of GPs to become involved
in shared care practice. If access to services is to be improved for possible ADHD cases, there needs to be a
focused and collaborative approach to training.