ADHD

Updated 20 September 2016

Most docs don't follow ADHD treatment guidelines

Study shows some specialists turn to medications too soon while others avoid them completely.

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About 90% of paediatric specialists who diagnose and manage attention-deficit/hyperactivity disorder (ADHD) in preschool children do not follow treatment guidelines published recently by the American Academy of Pediatrics, according to a new study.

Some prescribe medications too soon, while others do not give the young patients drugs even as a second-line treatment, according to study author Dr Andrew Adesman, chief of developmental and behavioural pediatrics at Cohen Children's Medical Center in New Hyde Park, NY, and colleagues.

The American Academy of Pediatrics (AAP) guidelines recommend that behaviour therapy be the first treatment approach for preschoolers with ADHD, and that treatment with medication should be used only when behaviour-management counselling is unsuccessful.

The researchers also found that more than one in five specialists who diagnose and manage ADHD in preschoolers recommend medications as a first-line treatment alone or in conjunction with behaviour therapy.

"It is unclear why so many physicians who specialise in the management of ADHD - child neurologists, psychiatrists and developmental paediatricians - fail to comply with recently published treatment guidelines," Adesman said.

Behaviour therapy recommended

Some physicians also deviate from guidelines with their choice of medication. Although methylphenidate (Ritalin) is recommended as the first drug to try when medications are warranted, many doctors prescribed other types of drugs.

"With the AAP now extending its diagnosis and treatment guidelines down to preschoolers, it is likely that more young children will be diagnosed with ADHD even before entering kindergarten," Adesman said.

"Primary care physicians and paediatric specialists should recommend behaviour therapy as the first-line treatment."

Awareness is lacking across specialties, another study author said.

"Although the AAP's new ADHD guidelines were developed for primary care paediatricians, it is clear that many medical subspecialists who care for young children with ADHD fail to follow recently published guidelines," study principal investigator Dr Jaeah Chung said in the news release.

"At a time when there are public and professional concerns about overmedication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children," Chung added.

More information

The US National Institute of Neurological Disorders and Stroke has more about attention-deficit/hyperactivity disorder.

 

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Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation (www.gb4adhd.co.za) She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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