What do general practitioners know about ADHD? Attitudes and knowledge among first-contact gatekeepers: systematic narrative review

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

The Future of Foreign Trade Support: Setting Global Standards for Export Credit and Political Risk Insurance

Creating growth through trade is an important part of the policy approach of many economies. For decades, many member countries of the Organisation for Economic Co-operation and Development (OECD) have cooperated in a fair competition for the benefit of their national exporters. The countries’ official export credit agencies (ECAs) have established and jointly improved rules and regulations for export credit and political risk insurance. However, new players such as China, Russia or other fast developing countries have now joined the list of top exporting nations. As these countries have established their own ECAs, there is a need to introduce rules and regulations on global standards for financial terms as well as truly international norms ensuring ‘ethical’ trading behaviour. But how will government support for foreign trade look like in the future? Will global standards for export credit and political risk insurance become reality by 2020? And how will strict rules and regulations for officially supported export credits and FDI regarding ethics, human rights and the environment impact growth through trade in general, or exporters in particular? These are questions addressed by the thirty eight contributions to Global Policy’s third eBook entitled ‘The Future of Foreign Trade Support – Setting Global Standards for Export Credit and Political Risk Insurance’, guest edited by Andreas Klasen and Fiona Bannert

General practitioners’ (GP) attitudes and knowledge about attention deficit hyperactivity disorder (ADHD) in Ireland

Background ADHD is the most frequent reason for attendance at Child and Adolescent Mental Health Services (CAMHS). General practitioners (GPs) play a key role in recognising symptoms, referring for assessment and supporting ongoing treatment. However, there is an ambiguous understanding of ADHD among GPs, and different attitudes regarding the validity of ADHD as a construct. The present study aims to explore and identify GPs attitudes and beliefs about ADHD in the Irish context, and to find out the association of those attitudes with other factors. Methods Representative sample of qualified GPs registered to the Irish Medical Directory. The survey included questions about GPs’ practice, attitudes towards ADHD, knowledge of symptoms and workup for ADHD, previous training and personal experience of ADHD. Results A hundred and forty GPs participated (response rate 28%). Factor analysis indicated 58.8% expressed a positive attitude towards ADHD. Those who have positive attitudes were more likely to be between 36 and 55 years old, seeing fewer children with suspected ADHD per year and working as part of a primary care team. Years of practice, personal experience of ADHD, training and knowledge in ADHD and access to CAMHS or psychology were not significantly related to either positive or negative ADHD attitudes. Conclusions Despite the high rates of ADHD among children, a slim majority of Irish GPs have positive attitudes towards ADHD. This could lead to undiagnosed or misdiagnosed cases. Strategies need to be considered to address this