Sparking Attention: Qualitative Evaluation of General Practitioners' Perceptions of Rising Adult Attention Deficit Hyperactivity Disorder Presentations in a Scottish Setting.

Background Adult presentations for attention-deficit/hyperactivity disorder (ADHD) are perceived to be rising, placing pressure on services. General practitioners (GPs) are often the first point of contact and frequently collaborate with specialty care in ongoing management. We explored GP perspectives on drivers of demand and barriers to safe, coordinated care within the National Health Service (NHS). Methods We aimed to investigate GP perspectives on diagnosis and management of adult ADHD. We conducted a qualitative study with analysis initially drawing on grounded theory principles (inductive coding, constant comparison, and iterative refinement of topic guides), whilst later using the framework method to provide a systematic structure for analysis. Semi-structured video interviews were completed with 10 GPs and two psychiatrists from NHS Tayside (Scotland) from February to April 2022. Participants were purposively sampled by GP age, experience, practice size, and deprivation level. Transcripts were independently coded by two or more researchers, and a consensus analytical matrix was developed to identify themes across demographics and professional groups. Results Participants reported increased adult presentations for suspected ADHD, often prompted by self-identification, peer influence, or media exposure. Deprivation was viewed as the demographic factor with the greatest impact on need, whereas age and sex had modest effects. GPs described limited training and reliance on rating scales to support referral, alongside long waits and fragmented communication with psychiatry. Shared-care arrangements were inconsistently operationalised: most GPs expected psychiatrists to provide follow-up monitoring, while psychiatrists expected GPs to conduct physical health monitoring. Transition from child and adolescent mental health services (CAMHS) to adult services was a recurrent vulnerability, with young adults frequently "lost to follow-up." Patients commonly sought private assessment to bypass delays, raising concerns about variable quality and equity. GPs perceived medication benefits as largely subjective but generally positive, while expressing unease about under-monitoring and potential misuse. Conclusions GPs perceived rising adult ADHD demand driven by social awareness and self-identification, occurring within strained services and unclear monitoring responsibilities. Clarifying roles within shared care, strengthening CAMHS-to-adult transitions, and expanding multidisciplinary capacity may reduce waits, improve safety, and support equitable access to evidence-informed care.