Many kids with ADHD not followed after diagnosis

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Children with attention deficit-hyperactivity disorder (ADHD) who are prescribed stimulant medication rarely receive optimal follow-up care, the results of a new study suggest.

A survey of 659 children ages 4 to 15 found that in the 6 months after an ADHD diagnosis, the average number of follow-up visits was one. Children who had been prescribed medication - 78 percent of the total—were no more likely to have received follow-up care than children who had not. Just 26 percent of the patients in the study saw a mental health specialist for follow-up.

"This is too few visits to permit adjustment of medication or support adherence to treatment,” Dr. William Gardner of the Children’s Research Institute of Ohio State University in Columbus and colleagues write in The Journal of Pediatrics.

“The AAP Guideline for the treatment of ADHD says that immediately after diagnosis, families should be in contact with their doctor frequently until the child is stable and proper dosage has been established,” Gardner told Reuters Health. “‘Frequently’ can mean up to once a week. After the child is stable, follow-up visits should occur every 3 to 6 months to monitor treatment.”

Gardner added that he believes the findings, which used information from a large sample of pediatric practices across the country, represent fairly typical care received by a child after an ADHD diagnosis.

Black children and children on Medicaid were more likely to see a mental health specialist. The researchers also found that primary care clinicians who had received fellowship training in mental health provided better follow-up care than those who had not.

But better training for primary care physicians is not likely to be enough to improve follow-up care for ADHD patients, Dr. Gardner and his colleagues note.

“We would urge primary clinicians to establish office systems that would promote follow-up visits by families; for example, a system that prompted a nurse or social worker to call a family a week or two after the diagnosis if they haven’t had a return visit,” Gardner suggested. “The call could assess the child’s symptoms, find out whether a prescription has been filled [and] whether the medication is being taken.”

Based on the study findings, Gardner’s group concludes that systematic efforts to improve the quality of care for children with ADHD are warranted.

SOURCE: Journal of Pediatrics, December 2004.

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