Many paediatricians provide inadequate care for children with attention-deficit/hyperactivity disorder (ADHD), relying too heavily on drugs and failing to thoroughly assess kids' symptoms, a new study reports.
Nearly one-third of paediatricians who diagnose children with ADHD do not consult the Diagnostic and Statistical Manual of Mental Disorders, a necessary step in determining if the kids meet the criteria for the brain disorder, researchers found.
A large number of paediatricians also do not gather parent and teacher ratings of a child's day-to-day behaviour, information that is crucial in diagnosing ADHD and tracking whether prescribed therapies are working, the study said.
And finally, doctors appear to lean heavily on drugs for treating ADHD. Nine out of 10 kids with ADHD are on some sort of medication. But only one out of 10 kids is receiving behavioural therapy or psychotherapy as well, according to the study.
Read: Risk factors of ADHD
"The quality of care seems to be very low and not in accord with American Academy of Paediatrics guidelines," said lead author Jeffery Epstein, director of the Centre for ADHD, Behavioural Medicine and Clinical Psychology at Cincinnati Children's Hospital.
Treating ADHD in children
Children with ADHD exhibit levels of inattention, hyperactivity and impulsivity that can hurt their social and family relationships and impede their learning, according to the National Institute of Mental Health. The U.S. Centres for Disease Control and Prevention estimates that 9 percent of American children 5 to 17 years old have the condition, which often continues into adulthood.
A "combined approach of medication plus counselling is often considered the optimal approach," said Dr. Andrew Adesman, chief of developmental and behavioural paediatrics at Cohen Children's Medical Centre of New York.
Read: The dark side of ADHD
Researchers reviewed ADHD care by reviewing nearly 1 600 patient charts at random from 188 paediatric health care providers at 50 practices in central and northern Ohio, according to the study.
While more than 93 percent of ADHD children take medication, only 13 percent receive some form of therapy as well, according to the study published online November 3 in Paediatrics.
"Although behavioural treatments are considered a first-line treatment for preschool and grade-school children with ADHD, very few families received this type of [non-medication] treatment in a community setting," said Adesman, who was not involved in the study.
Lack of communication with parent/teacher
Paediatricians also largely fail to gather parent or teacher impressions of how well a child's ADHD treatment is going. Only 10.8 percent of patient charts contained a parent's rating of ADHD symptoms within the first year of treatment, and only 7.5 percent had any rating of symptoms from teachers.
"The guidelines suggest paediatricians should collect rating scales to see if medications are having the right and optimal effect," Epstein said. "These reports from parents and teachers are critical."
Nearly half the time, paediatricians also did not gather these behavioural rating scales from parents and teachers before diagnosing a child with ADHD, "despite unambiguous guidelines from the American Academy of Paediatrics," Adesman noted.
Paediatricians likely aren't following through with the rating scales because it can be time-consuming to get them out to parents and teachers, and then have them returned and processed, Epstein said.
"It's an effort-filled process that isn't reimbursed very well, and therefore it just doesn't get done," he said.
No consultation with DSM-5 before diagnosis
Also of concern, in 30 percent of cases, paediatricians are not consulting the DSM-5 before diagnosing a child with ADHD, researchers found.
A manual produced by the American Psychiatric Association, the DSM-5 serves as a universal authority for accurately diagnosing psychiatric and behavioural disorders. The American Academy of Paediatrics advises paediatricians to consult the DSM-5 before diagnosing ADHD.
"We found it was being used in about 70 percent of cases, and it should be used 100 percent of the time," Epstein said.
Adesman said the study "highlights many areas for improvement when it comes to paediatricians' approach to assessing and treating ADHD."
Read: Treating ADHD
Time pressures likely cause paediatricians to cut corners when assessing ADHD, Epstein said.
"Typical office visits are 10 to 15 minutes in length," he said. "To try and assess ADHD in a 15-minute period is a very difficult thing to do."
Concerned parents should feel free to ask paediatricians how they go about diagnosing the condition, Epstein said.
Ask if the paediatrician collects behavioural ratings scales from parents and teachers, both for diagnosis and for follow-up, he said. Also ask how a paediatrician makes sure that ADHD therapies are working, he added.
Parents also can talk with other parents and get references for paediatricians who provide satisfactory care, Epstein said.
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