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Study Reports Doctors Often Do Not Follow ADHD Treatment Guidelines

Update Date: May 06, 2013 03:12 PM EDT

Attention deficit hyperactivity disorder (ADHD) is a condition that involves the combination of the inability to concentrate and over hyperactive behaviors. ADHD is mostly diagnosed in children under seven-years-old, and is often diagnosed after inattention and hyperactivity lead to disruptive behaviors and academic development complications. Although ADHD can be treated effectively, a new study discovered that over 90 percent of pediatric specialists responsible for diagnosing and treating the condition do not actually follow guidelines set by the American Academy of Pediatrics (AAP).

The guidelines set by the AAP, which were last revised in 2011, are believed to be the standard ways to treat children with ADHD. These recommendations were also the first real set of guidelines given to pediatricians on how they should treat children. The research team, composed of researchers from the Cohen Children's Medical Center of New York, analyzed the statistics compiled from 3,000 randomly selected physicians who received a Preschool ADHD Treatment Questionnaire (PATQ). The physicians had all diagnosed or treated neurobehavioral conditions throughout the United States. The doctors were asked about their treatment methods, strategies, and prescription drugs.

Despite these guidelines, the study, headed by Dr. Andrew Adesman, the chief of developmental and behavioral pediatrics at the medical center, found that the majority of pediatricians did not follow these treatment plans. One of the key revisions to the guidelines was an expansion of the age requirement for diagnosing children, which means that more kids could qualify for the diagnosis, and subsequently, the treatments. Due to this wider range, Adesman and his colleagues concluded that most pediatricians are still uncomfortable with diagnosing ADHD in extremely young children.

According to the AAP, children should ideally receive behavioral therapy first once they are diagnosed. The study found, however, that pediatricians more frequently recommended pharmacotherapy, which was sometimes combined with behavioral therapy. The majority of the doctors that turn to drugs also did not seem to choose the drugs recommended by the AAP. The AAP considers pharmacotherapy one of the last options that doctors should turn to and when needed, the agency recommends methylphenidate. However, over one third of the pediatric specialists reported to have chosen a medication that was not methylphenidate. The discrepancies between the AAP guidelines and doctor's decisions appear to be due to a wide range of factors.

The researchers theorized at first that drug therapy might be more accessible for families who do not have the financial means of long-term behavioral therapy options. But, the study concluded based on self-reports, that pediatricians who chose drug therapy did not report the case of inaccessibility to behavioral therapy. Although the researchers did not find out why doctors did not follow the AAP guidelines, they believed that for some pediatricians, drug therapy was not as onerous for parents. Simply because drug therapy might be easier and appear to be effective in the short term, it does not mean that this option is necessarily better for all families.

"There is an important distinction, and that is that even if medication has been shown to be more effective in the short-term than behavior therapy in school age children, medication does not work quite as well or consistently in preschool kids," Adesman said.

The findings were presented at the Pediatric Academic Societies meeting. 

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