Clinical factors associated with decision to recommend methylphenidate treatment for children with ADHD in France

Clinical factors associated with decision to recommend methylphenidate treatment for children... European guidelines advise on best practices for the diagnosis and non-pharmacological and pharmacological treatment of attention-deficit hyperactivity disorder (ADHD). This study aimed to (1) assess whether clinician’s decisions to initiate methylphenidate treatment in children diagnosed with ADHD are in accordance with European guidelines and (2) identify clinical factors associated with the decision to recommend methylphenidate prescription. 5 to 13-year-old patients with an ADHD diagnosis were consecutively evaluated in an outpatient child and adolescent psychiatry clinic in France. Patients underwent a multidisciplinary evaluation including a diagnostic interview, symptom severity assessments with parent questionnaires, and IQ testing. We compared children with (n = 105) and without (n = 55) recommended methylphenidate treatment using Student’s t test or Wilcoxon Mann–Whitney test and Chi-square or Fisher’s test. Multivariate logistic regression was implemented to determine the respective influence of each variable on treatment recommendation. Recommendation to initiate methylphenidate treatment was associated with (1) ADHD combined presentation, (2) co-occurring Oppositional Defiant Disorder/Conduct Disorder (ODD/CD), Developmental Coordination Disorder (DCD) and Learning Disorder (LD), (3) clinical severity and impairment indicated on parent questionnaires, and (4) reduced perceptual reasoning. Using a multivariate regression model, ADHD combined presentation [combined versus predominantly hyperactive/impulsive and unspecified OR 4.52 (1.23–16.55), p = 0.023], age [OR 1.46 (1.14–1.88), p = 0.003], ODD/CD [OR 5.53 (2.19–14.01), p < 0.001], DCD [OR 4.22 (1.70–10.48), p = 0.002], PRI [OR 0.97 (0.94–0.99), p = 0.01] were significantly associated with recommendation of methylphenidate treatment. Our results indicate that clinicians’ treatment decision-making complies with European guidelines and is furthermore associated with the type and severity of ADHD symptoms but also with co-occurring disorders. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Child & Adolescent Psychiatry Springer Journals

Clinical factors associated with decision to recommend methylphenidate treatment for children with ADHD in France

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Publisher
Springer Berlin Heidelberg
Copyright
Copyright © 2017 by Springer-Verlag GmbH Germany
Subject
Medicine & Public Health; Psychiatry
ISSN
1018-8827
eISSN
1435-165X
D.O.I.
10.1007/s00787-017-1061-4
Publisher site
See Article on Publisher Site

Abstract

European guidelines advise on best practices for the diagnosis and non-pharmacological and pharmacological treatment of attention-deficit hyperactivity disorder (ADHD). This study aimed to (1) assess whether clinician’s decisions to initiate methylphenidate treatment in children diagnosed with ADHD are in accordance with European guidelines and (2) identify clinical factors associated with the decision to recommend methylphenidate prescription. 5 to 13-year-old patients with an ADHD diagnosis were consecutively evaluated in an outpatient child and adolescent psychiatry clinic in France. Patients underwent a multidisciplinary evaluation including a diagnostic interview, symptom severity assessments with parent questionnaires, and IQ testing. We compared children with (n = 105) and without (n = 55) recommended methylphenidate treatment using Student’s t test or Wilcoxon Mann–Whitney test and Chi-square or Fisher’s test. Multivariate logistic regression was implemented to determine the respective influence of each variable on treatment recommendation. Recommendation to initiate methylphenidate treatment was associated with (1) ADHD combined presentation, (2) co-occurring Oppositional Defiant Disorder/Conduct Disorder (ODD/CD), Developmental Coordination Disorder (DCD) and Learning Disorder (LD), (3) clinical severity and impairment indicated on parent questionnaires, and (4) reduced perceptual reasoning. Using a multivariate regression model, ADHD combined presentation [combined versus predominantly hyperactive/impulsive and unspecified OR 4.52 (1.23–16.55), p = 0.023], age [OR 1.46 (1.14–1.88), p = 0.003], ODD/CD [OR 5.53 (2.19–14.01), p < 0.001], DCD [OR 4.22 (1.70–10.48), p = 0.002], PRI [OR 0.97 (0.94–0.99), p = 0.01] were significantly associated with recommendation of methylphenidate treatment. Our results indicate that clinicians’ treatment decision-making complies with European guidelines and is furthermore associated with the type and severity of ADHD symptoms but also with co-occurring disorders.

Journal

European Child & Adolescent PsychiatrySpringer Journals

Published: Oct 5, 2017

References

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