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2007, Number 1

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Arch Med Fam 2007; 9 (1)

Common Dilemmas in the Diagnosis and Treatment of ADHD. Experts' Opinions for the Improvement of Practice Management in the Outpatient Setting

Fogelman Y, Kahan E

Language: English
References: 45
Page: 41-48
PDF size: 93.05 Kb.


ABSTRACT

Background: Attention deficit-hyperactivity disorder (ADHD) is one of the most common behavioral disorders of childhood. The large variations in care and the growing prevalence of pharmacologic treatment are a source of public and professional debate worldwide. The aim of the study was to evaluate the opinion of experts about the effectiveness of office-based practices in the management of ADHD. Methods: An ad hoc, mostly open, questionnaire was distributed to the 10 members of an international forum of experts on ADHD. Results: Nine experts recommended multidisciplinary training of medical practitioners in the screening, diagnosis and treatment of ADHD and regular, standardized monitoring of drug use for effectiveness and safety by the care providers in collaboration with parents and school officials. Most of the experts thought that trained primary care physicians (pediatricians and family physicians) could handle straightforward cases and appropriately refer more complicated ones. The large differences in care among countries was attributed to the lack of strong, specific scientific data on the long-term effectiveness of stimulant medication for ADHD; the nonspecific effect of methylphenidate; the difference between the DSM-IV definition of ADHD and the ICD-10 definition of hyperkinetic disorder; the highly subjective and impressionistic nature of current diagnostic questionnaires; and cultural differences in medical models used to treat behavioral problems. The need for broader data on drug misuse was emphasized Conclusions: To improve the effectiveness of office-based practices for ADHD, an improved international diagnostic system is needed, together with standardized tools for patient evaluation, education of professionals, and public and international research projects.


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