Clinical Guidelines When Treating Preschoolers With ADHD Not Followed By 90 Percent Of Pediatric Specialists

Main Category: ADHD
Article Date: 07 May 2013 - 1:00 PDT Current ratings for:
Clinical Guidelines When Treating Preschoolers With ADHD Not Followed By 90 Percent Of Pediatric Specialists

A recent study by pediatricians from the Cohen Children's Medical Center of New York examined to what extent pediatric physicians adhere to American Academy of Pediatrics (AAP) clinical guidelines regarding pharmacotherapy in treating young patients with Attention Deficit Hyperactivity Disorder (ADHD). The results showed that more than 90 percent of medical specialists who diagnose and manage ADHD in preschoolers do not follow treatment guidelines recently published by the AAP.

"It is unclear why so many physicians who specialize in the management of ADHD -- child neurologists, psychiatrists and developmental pediatricians -- fail to comply with recently published treatment guidelines," said Andrew Adesman, MD, senior investigator and chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park. "With the AAP now extending its diagnosis and treatment guidelines down to preschoolers, it is likely that more young children will be diagnosed with ADHD even before entering kindergarten. Primary care physicians and pediatric specialists should recommend behavior therapy as the first line treatment."

Current clinical guidelines for pediatricians and child psychiatrists associated with the American Academy of Child & Adolescent Psychiatry (AACAP) recommend that behavior therapy be the initial treatment approach for preschoolers with ADHD, and that treatment with medication should only be pursued when counseling in behavior management is not successful.

The study also found that more than one-in-five specialists who diagnose and manage ADHD in preschoolers recommend pharmacotherapy as a first-line treatment alone or in conjunction with behavior therapy. Although the AAP recommends that pediatricians prescribe methylphenidate when medication is indicated, more than one-third of specialists who prescribe medication for preschool ADHD said they 'often' or 'very often' choose a medication other than methylphenidate initially (19.4 percent amphetamines; 18.9 percent non-stimulants).

"Although the AAP's new ADHD guidelines were developed for primary care pediatricians, it is clear that many medical subspecialists who care for young children with ADHD fail to follow recently published guidelines," said Jaeah Chung, MD, the study's principal investigator who also practices at Cohen Children's. "At a time when there are public and professional concerns about over-medication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our adhd section for the latest news on this subject. To view the abstract, "Medication Management of Preschool ADHD by Pediatric Sub-Specialists: Non-Compliance with AAP Clinical Guideline, go to http://www.abstracts2view.com/pas/view.php?nu=PAS13L1_1365.5
This study was presented at the Pediatric Academic Societies in Washington, D.C.
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posted by Harold Rongey, Ph.D. on 8 May 2013 at 2:47 pm

Apparently the 90 percent believe otherwise. As a first line of defense, I believe greater progress will be found by reviewing the person's diet to ensure adequacy. Those with autism have been shown to be low or lacking several nutrients including amino acids, fatty acids, vitamins, minerals as well as cholesterol.

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EudraCT, the clinical trials transparency tool held in secret

Ben Goldacre, The Guardian, Saturday 5 March 2011

The European Medicines Agency now regulate the pharmaceutical industry throughout the whole of Europe. In December 2010 Thomas Lonngren stepped down as their executive director. On the 28th of that month he sent a letter telling the EMA management board that he was going to start working as a private consultant to the pharmaceutical industry, in three days time, on 1 January 2011.

Some places have clear regulations on this kind of thing. In the US you have to wait a year after leaving defense department before you can work for a defence contractor, for example. After ten days the chairman of the EMA wrote back to Lonngren saying that his plans were all fine. He didn’t impose any restrictions, nor did he ask for any further information on what kind of work Lonngren intended to do. Lonngren had said there would be no conflict of interest, and that was enough.

Why does this matter? It’s an old story, after all, and the flow goes both ways. One of the pharmaceutical industry’s favourite lawyers has just become head of the US Patent Office. FDA employees routinely flow in and out of pharmaceutical companies. The UK lobbying industry is built on the same phenomenon.

These things aren’t a guarantee of a bad outcome: they’re a risk factor, like driving after 3 pints, and so we police them. Perhaps civil servants will be too friendly to industry, hoping for a lucrative commercial post one day. At the very least they bring insider knowledge of opaque systems, and personal contacts, which are the cornerstone of effective lobbying. At its extreme this free flow leads to regulatory capture, where regulators shift their culture incrementally until suddenly they find, one morning, that they protect the interests of the people they’re supposed to regulate.

In a fully transparent regulator, perhaps we could tolerate more of these risks. But it’s not just the natural opacity of a technical field that forces us into blinder faith on drug industry regulators. When the US Food and Drug Administration discussed banning rosiglitazone, as I described 6 months ago, for all their bad calls, these discussions were at least in public. For the EMA, all such meetings and minutes are secret. You and I are not allowed to know what happens at them.

This interest in secrecy reaches its most absurd expression in something called EUDRACT. You will know from reading this column that the key ethical issue in medicine is that trials are conducted, and then the results are left unpublished by industry (and others) if they don’t like them. We have seen this with rosiglitazone, paroxetine, countless antidepressants, and many more drugs. The solution was to start clinical trials databases: you declare what you’re doing, before you start, and we can hold you to it, and ask about missing data when the results don’t appear.

The EMA’s clinical trials database is called EUDRACT, it has run since 2004, and despite repeated promises to open it up, going back many years (they’re promising this month, again), EUDRACT has been held entirely in secret. I can tell you that this database contains 28,150 clinical trials, but that is all we are allowed to know. We cannot read a single detail about any single one of these 28,150 trials, which are all of real treatments being tested on real people. This is a theatrically bizarre situation, far more important than the story of one man’s choice of employment. It is, in fact, the ultimate administrative perversity: EUDRACT is a transparency tool that for 7 years has been held entirely in secret.

It’s all very well to regulate the pharmaceutical industry behind closed doors. Actually, it’s not all very well: it’s the antithesis of science, which is built on transparency, but the EMA have made their decisions about this, so we are left with a blinder faith, and that blind faith comes at an inevitable cost. Everyone involved in such a secretive system must be seen to be whiter than purest, cleanest white, not because we are puritans, or assume bad faith: but simply because, after the secrecy, this is what they have left us to work with.

Send your bad science to ben@badscience.net

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