- Pediatricians rarely discussed ADHD with children and their families according to guidelines
- Patients and families rarely asked questions about ADHD
- Researchers: Not discussing ADHD is a missed opportunity to “treat the whole child”
- Study suggests more education about ADHD is needed for providers and families
- View infographic of the findings
Pediatricians are doing a poor job of discussing attention deficit hyperactivity disorder during visits with kids who have ADHD, according a study led by researchers at the UNC Eshelman School of Pharmacy.
The research, published online December 24 in Community Mental Health Journal, examined a subset of the data from a larger study of pediatrician visits with asthmatic children at five North Carolina practices from 2005 to 2008. For this paper, researchers analyzed audio recordings of visits for sixty-seven children who also had ADHD. The analysis showed that pediatricians rarely discussed ADHD with the children and their families according to national guidelines, while the children and parents seldom asked questions about ADHD.
The primary purposes for the visits in the study were unknown, but the researchers say pediatricians and patients should discuss ADHD even when a visit is not specifically about that.
“There is a movement toward treating the whole child,” says Betsy Sleath, PhD, the study’s principal investigator and a George H. Cocolas Distinguished Professor in the School’s Division of Pharmaceutical Outcomes and Policy.
“Families might not go to their pediatricians many times a year; it could just be once a year. So even if they are seeing their pediatricians about asthma or some other physical condition, it’s important for providers and patients to talk about ADHD and its treatment and make sure that everything is OK rather than just assuming everything is OK.”
The American Academy of Pediatrics has guidelines for treating ADHD, such as creating a treatment plan that recognizes ADHD as a chronic condition and scheduling follow-up visits. Pediatricians in the study, however, rarely took the actions suggested in the guidelines. View infographic.
Following the guidelines can help address, among other things, improper use of ADHD medications, which is a significant concern, Sleath says. For instance, some patients in the study reported only taking their medications as a way to improve performance on exams and in sports.
“That’s a totally inappropriate use of ADHD medications,” Sleath says. “We are hoping this paper draws attention to the American Academy of Pediatrics guidelines, and hopefully those guidelines can be better followed.
“Part of the problem is that many of these medical practices are extremely busy. They are in rural parts of the state, so they don’t have a lot of time to address these issues adequately.”
The doctors in the study also rarely involved children and their families in creating ADHD treatment regimens even though the Institute of Medicine emphasizes shared decision-making during pediatric visits. Inversely, the children and their families asked very few questions about ADHD.
The researchers say the study suggests a need to better educate providers and families about ADHD and its treatment. Sleath says pharmacists can play a key role in educating families and monitoring proper medication use.
“Families might see their pediatrician only once a year, whereas they see their pharmacist when they go refill their prescriptions,” she says. “I think there are two questions pharmacists and pediatricians should ask at every patient visit: ‘How are your ADHD medications working?’ and ‘What types of problems have you run into when using your ADHD medications?’ ”
The study was funded by the National Heart, Lung, and Blood Institute and the National Center of Research Resources at the National Institutes of Health. Other authors on the paper are
- Sandra H. Sulzer, PhD, a postdoctoral fellow at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill;
- Delesha Carpenter, PhD, MSPH, an assistant professor in DPOP;
- Catherine Slota, a graduate student in DPOP;
- Robin Sayner, PharmD, a postdoctoral research associate in DPOP;
- Christopher Gillette, PhD, a DPOP alum and an assistant professor at the Marshall University School of Pharmacy;
- Stephanie Davis, MD, a physician at the Riley Hospital for Children in Indianapolis, Indiana; and
- Adrian Sandler, MD, a physician at Mission Children’s Hospital in Asheville, North Carolina.
Infographic of the Findings DOWNLOAD PDF
