A Survey of Patient Records Sheds Light on How Doctors Treat ADHD

Every so often, a study appears that stops me in my tracks and gets me thinking.

A recent study about medical care and ADHD did just that. The study involved a survey of 1,600 patient records, from 188 health care providers in 50 pediatric practices. The survey looked at how doctors interact with and diagnose kids who have features of ADHD. It also looked at the interventions that doctors recommend and prescribe to treat inattention, hyperactivity and impulsivity—the hallmarks of ADHD.

The survey found many red flags in the patient records. Here are the ones that stuck with me:

• Pediatricians collected information in the form of rating scales from parents and teachers only about half the time (56 percent). (Rating scales are questions for assessing behavior. For example, “How often do you feel restless?” “Never/Rarely/Sometimes/Often/Very Often.”)
• Medication was prescribed 93 percent of the time; but behavioral treatment was only recommended 13 percent of the time.
• 30 percent of patient charts didn’t mention that a child met the established medical criteria for ADHD.
• In more than half the charts reviewed, there was no mention of any follow-up with parents of children within the first month after medication was prescribed.
• Regular feedback to health care providers was rare. Only 11 percent of the charts indicated that parents monitored and shared information about their child’s progress on medication. And only 8 percent of the charts contained feedback and ratings from teachers. On average, more than a year went by before any feedback from parents or teachers was found in these children’s records.

The American Academy of Pediatrics has clear guidelines for what an ADHD evaluation and treatment approach should look like. Among other things, the guidelines include gathering information at the beginning of and during treatment. They also say that doctors should at least consider behavioral treatment before medication. In this study, it appears these guidelines may not have been followed with some of the patients whose records were surveyed.

So what’s a parent to do?

First, be informed. A medical evaluation can help you find out whether your child might have ADHD. Having your child undergo an evaluation doesn’t mean you have to consent to trying a course of behavioral therapy or medication. It simply provides you and your child’s doctor with the information needed to make informed decisions.

Second, follow up. Rating scales can be an important part of an ADHD evaluation. Find out the policy of your child’s school on filling out rating scales. Avoid delays in getting completed forms back to your child’s doctor. It’s also helpful to ask the doctor’s office to collect rating scales feedback on a regular basis.

Third, consider behavioral treatment options. For many kids with ADHD, medication can make a huge difference. But it’s only a first step.

Medication doesn’t automatically result in new and more effective ways to interact with peers. And it can’t teach a child how to be more organized or how to monitor their activity level and emotions.

There are many types of behavioral therapies and support that can help kids develop strategies to help them manage their symptoms. This can also help kids feel good about themselves and experience success.

Some behavioral approaches are best delivered by professionals (with follow-up at home and in school by parents and teachers). Others can be developed in discussion with teachers and (yes!) your child.

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