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Most ADHD Specialists Not Following Treatment Guildelines for Preschoolers
For example, some doctors started preschoolers on medication too soon before trying any non-drug treatment, such as counseling parents on how to deal with their child’s behavior.
The results are concerning because doctors should recommend behavioral treatments first, the researchers said.
“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,” said study researcher Dr. Jaeah Chung, of Cohen Children’s Medical Center in New York.
For the study, researchers surveyed 560 doctors who specialize in diagnosing and managing children ages 4 to 6 with ADHD.
The findings revealed that only 8 percent of doctors followed all guidelines from the American Academy of Pediatrics.
The rest prescribed medications too soon, prescribed medications without first checking to see if behaviora; therapy was working, or did not use the drug methylphenidate as the first drug treatment.
One in five doctors said they often prescribe medications to preschoolers with ADHD as their first line of treatment. The AAP said in 2011 that doctors should attempt to treat ADHD in preschoolers with behavioral therapies before prescribing medications.
Furthermore, about 40 percent of doctors said that when they did prescribe drugs, they initially used a medication other than the ADHD drug methylphenidate (Ritalin).
According to the AAP, methylphenidate should be used first in preschoolers because it has been more rigorously studied in young children than other medications such as amphetamines.
Approximately 20 percent of doctors said they expected the number of children they treated with medications would increase in the future.
Study researcher Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s, noted that the AAP guidelines are written for general pediatricians, and it’s possible that specialists see children with more severe ADHD (who are more likely to need medications).
However, “Doctors collectively should recommend their patients pursue behavior therapies first,” Adesman said.
Adesman noted that there may be obstacles to behavioral therapy: The treatment is not always covered by insurance, and families may live in an area without a behavior therapy specialist. In this case, the AAP recommends that doctors weigh the risks of starting drugs at an early age against the risks of delaying treatment.
Source: North Shore-Long Island Jewish (LIJ) Health System
Doctor holding out pills in his hand photo by shutterstock.
Study Finds 1 in 5 Suicidal Teens Have Guns in their Homes
What’s more, 15 percent of those kids can access both guns and bullets.
Suicide is the second leading cause of death among young people between the ages of 10 to 24 years in the United States, according to data from the Centers for Disease Control and Prevention. Nearly half who die by suicide use a firearm, according to researchers.
As part of a study to create a suicide risk screening tool that can be used in the emergency departments of hospitals, researchers asked kids about access to guns in or around their home and about gun and bullet storage.
“For more than 1.5 million adolescents, the emergency department is their primary point of contact with the health care system, which makes the ED an important place for identifying youth at risk for suicide,” said Stephen J. Teach, M.D., M.P.H., F.A.A.P., associate chief in the Division of Emergency Medicine at Children’s National Medical Center in Washington, D.C., and co-author of the study.
Because many health professionals and parents don’t know how to ask kids about suicide, they need screening tools to assist in detection, added study senior author Lisa M. Horowitz, Ph.D., M.P.H., staff scientist and a pediatric psychologist at the National Institute of Mental Health.
“According to our data, when asked their opinion, nearly all of the kids in our study were in favor of suicide screening in the emergency department,” she said.
“Our study shows that if you ask kids directly about suicide, they will tell you what they are thinking.”
Study participants included 524 patients between the ages of 10 and 21 who were seen for medical, surgical or psychiatric complaints at one of three pediatric emergency departments. They were asked to fill out a 17-item questionnaire that the researchers used to develop the Ask Suicide-Screening Questions (ASQ), a four-question screening tool that can be used for all pediatric patients visiting the ED. The ASQ has been validated against a longer more in-depth suicide assessment tool, researchers noted.
Of the patients who completed the screening tools, 151 — 29 percent — were found to be at risk for suicide, according to the researchers. The study also found that 17 percent of them reported guns in or around the home.
Of those at risk for suicide and reporting guns in the home, 31 percent knew how to access the guns, 31 percent knew how to access the bullets, and 15 percent knew how to access both the guns and the bullets, according to the study’s findings.
“This study highlights the importance of parents understanding the risks of having guns in their homes,” said co-author and youth suicide expert Jeffrey A. Bridge, Ph.D., principal investigator at The Research Institute at Nationwide Children’s Hospital.
“Being at risk for suicide and having access to firearms is a volatile mix. These conversations need to take place in the ED with families of children at risk for suicide.”
Bridge also noted that up to 40 percent of kids who kill themselves have no known mental illness. “Therefore, it is important to screen all children and adolescents for suicide, regardless of the reason they are visiting the ED,” he added.
The study was presented at the annual meeting of the Pediatric Academic Societies.
Source: American Academy of Pediatrics
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