Neurodevelopmental Conditions and Neurodiversity

Neurodevelopmental conditions are an expanding area of the RCGP curriculum and increasingly tested in the AKT. The focus is on recognition in primary care, appropriate referral pathways, and ongoing management.

ADHD presents with inattention, hyperactivity, and impulsivity that are persistent, pervasive (present in multiple settings), and cause functional impairment. In adults, hyperactivity often manifests as inner restlessness rather than physical overactivity. NICE guideline NG87 recommends that GPs can recognise symptoms and refer for specialist assessment, but should not initiate ADHD medication. Referral is to a psychiatrist or specialist ADHD service. Diagnosis requires symptoms present since childhood (before age 12), though formal diagnosis may occur much later.

ADHD medication: methylphenidate (Ritalin, Concerta) is first-line for children and young people. Lisdexamfetamine is first-line for adults. Non-stimulant options include atomoxetine and guanfacine. Before starting stimulant medication, baseline assessments include height, weight, blood pressure, pulse, and cardiovascular history. Ongoing monitoring includes cardiovascular parameters, growth (in children), appetite, sleep, and mood. Side effects include appetite suppression, sleep disturbance, headache, and increased blood pressure.

Autism spectrum conditions present with persistent differences in social communication and interaction, alongside restricted and repetitive patterns of behaviour, interests, or activities. In primary care, recognition may come from developmental concerns in children (delayed social communication, limited imaginative play, repetitive behaviours) or from adults who present with social difficulties, sensory sensitivities, rigid thinking patterns, and mental health comorbidities.

The diagnostic pathway for autism involves referral to a specialist multidisciplinary team. GPs should not diagnose autism but should recognise when to refer. Key indicators include difficulty with social reciprocity, limited use or understanding of nonverbal communication, difficulty developing and maintaining relationships, and sensory sensitivities.

Reasonable adjustments for neurodivergent patients in general practice include clear and literal communication, predictable appointment structures, reduced waiting in busy waiting rooms, written summaries of consultations, and awareness that sensory environments (lighting, noise) may be distressing.

Comorbidities are common: anxiety, depression, sleep disorders, and eating disorders frequently co-occur with both ADHD and autism. Mental health presentations in neurodivergent patients may present atypically and require adapted assessment approaches.