Current Pediatric Care may be Inadequate for the Treatment of ADHD

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Jay Tarnow, MD

Attention Deficit Hyperactive Disorder, or ADHD, is a condition that plays a prominent role in a child’s development. According to the Center of Disease Control, roughly 11% of children age 4-17 in the United States are diagnosed with ADHD. However, regardless of its prevalence in our homes and our communities, ADHD is consistently undertreated by Pediatricians and other health specialists.

To diagnose and treat ADHD, doctors refer to the Diagnostic and Statistical Manual, Vol. 5 (DSM-V), a standard classification of mental disorders published by the American Psychiatric Association. According to the DSM-V, ADHD should be properly managed with a combined approach of medicine and behavioral therapy. Yet despite this recommendation, a recent study found that 93.4% of patients with ADHD were treated with medication, but only 13.0% were also receiving behavioral therapy. This study, published in the Journal of the American Academy of Pediatrics, sheds some light on the some of the resources Pediatricians are missing and reasons why your children might not be getting all the care they need.

One of the many important resources needed to diagnose ADHD is a rating scale provided by both the child’s parents and teachers. These ratings provide the doctors with general idea of the severity of the child’s ADHD in multiple settings. This study found that Pediatricians used parent ratings and teacher ratings only 56.7% and 55.5% of the time, respectively. Another equally important asset to managing ADHD is the DSM-V itself. This research found that Pediatricians participating in ADHD management recorded using the DSM-V criteria for ADHD only 70.4% of the time.

Why is this occurring? I firmly believe Pediatricians are highly trained professionals who truly want what’s best for your child. However, current stressors of insurance and the medical field in general have made it difficult for Pediatricians to provide the focus and quality of care their patients deserve. Part of this could be due to time constraints. Due to the ever changing status of medical insurances and reimbursements, doctors now have to see more and more patients to maintain their practice. Therefore, the more patients that need to be seen, a smaller amount of time is allotted for each patient. Even now in medical schools, students are trained to gather patient histories, make an accurate diagnosis, create a treatment plan, and record it all in only 15 minutes. For some conditions, such as a runny nose or sore throat, 15 minutes is adequate amount of time. However, ADHD is a complicated, intricate condition that can have a variety of different symptoms presenting at different stages of childhood. Long story short, 15 minutes is not an appropriate amount of time to spend diagnosing and treating ADHD.

The type of practice can also determine access to psychosocial therapy. In this study, academic practices were compared to non-academic practices, and found that academic practices had a lower percentage of patients undergo psychosocial treatment. This may be attributed to the habit of academic pediatricians referring patients to professionals within their affiliated medical center, which may have longer waiting period to for appointments compared to unaffiliated practices.

Unless the right resources are utilized for diagnoses and treatment, your child’s ADHD may not be adequately managed. If you have concerns that your child’s ADHD is not being treated appropriately, or would like to know more information regarding the resources needed to diagnose ADHD, please contact the Tarnow Center.

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