Feb. 22, 2000 (Lake Worth, Fla.) -- Only 50% of children diagnosed with attention deficit hyperactivity disorder (ADHD) receive care that corresponds to the guidelines of the American Academy of Child and Adolescent Psychiatry (AACAP) or the American Academy of Pediatrics (AAP), a study finds. The study, which appears in the February issue of the Journal of the American Academy of Child and Adolescent Psychiatry, says ADHD patients who are treated by a primary care physician are likely to get prescriptions for stimulants, but too often are not referred to specialists or given follow-up care.
"There are big differences between what research is showing to be optimal treatment practices for children with ADHD and what physicians in actual clinical practice are doing," Kimberly Hoagwood, PhD, main author of the study, tells WebMD. "The research base isn't being used as much as it could."
ADHD is often recognized in school-age children by their parents and teachers. When diagnosed by a physician, it is generally treated with a combination of prescription medications (usually stimulants), counseling, behavior modification, and education. The AACAP and AAP also suggest regular follow-up care.
The study, by Hoagwood and colleagues from the University of Pittsburgh School of Medicine and Medical Center, reviews the existing literature, guidelines, and clinical practice for treatment of ADHD, and analyzes a nationally representative survey of physicians. It found that whether children are given follow-up treatment and counseling may depend on what kind of physician they see.
"Family practitioners are more likely than pediatricians or psychiatrists to prescribe stimulants, and less likely to prescribe anything else," writes Hoagwood, associate director of child and adolescent research at the National Institute of Mental Health.
The researchers found that over 75% of children with ADHD were given prescriptions for stimulants in 1996, up from 55% in 1989. Screening services for children with attentional problems increased from 22% in 1989 to 62% in 1996. But visits to psychotherapists decreased from 40% in 1989 to 25% in 1996, and the rate of follow-up treatment dropped from just over 90% to 75%.
Factors that kept primary care physicians from referring children to specialists included a lack of pediatric specialists, difficulty in getting appointments, and nonacceptance of Medicaid patients, the study says.
Leon Zacharowicz, MD, a child neurologist practicing at the Nassau County Medical Center in Long Island, N.Y., finds the revelations disturbing.
"ADHD is not like a simple ear infection," Zacharowicz, who was not involved in the study, tells WebMD. "A lot of parents and primary doctors don't seem to fully understand that yet." He says that while many parents seek a quick-fix approach, it's up to doctors to educate them about the reality of the disorder.
"A disorder like [ADHD], which disrupts so much of the person on an ongoing basis throughout their life span, requires more than just popping a pill," he says. "I think that the study shows that specialists in general are more likely to provide better follow-up and more of a multimodal approach."
Zacharowicz says he uses an ABC approach to ADHD -- awareness, behavior management, counseling (for both the child and family), drugs, and education. The AACAP guidelines stress the importance of this approach.
The costs to society of failing to use this multipronged approach when treating children with ADHD can be devastating, Zacharowicz says. "Kids, adolescents, and young adults with [ADHD] are overrepresented in accidents, in the criminal justice system, on the unemployment line, and in divorce court," he says.