Pediatricians and researchers at The Children's Hospital of Philadelphia's(CHOP) have developed a first-of-its kind tool to help parents and health care providers better treat ADHD (attention deficit-hyperactivity disorder). The new, three-part survey helps steer families and doctors toward "shared decision-making", an approach proven to improve healthcare results in adults, but not widely used in pediatric settings. The results of the CHOP study are published in the journal Academic Pediatrics.
"Shared decision-making in health care means that doctors and families make decisions together. Doctors contribute their professional knowledge, and families weigh their values and personal experience," explained lead author Alexander Fiks, M.D., M.S.C.E, an urban primary care pediatrician at CHOP and a faculty member at CHOP's PolicyLab. "We chose to focus on ADHD for this study, because it is a relatively common diagnosis with two recommended treatment options – prescription medication and behavioral therapy – that require the family to make decisions about what will work best for them. Choosing a treatment that doesn't 'fit' can lead to unsuccessful results. We wanted to see if we could create a tool to help guide families and physicians through this process."
According to a study published earlier this year, the number of physician outpatient visits in which ADHD was diagnosed in children under age 18 was 10.4 million. Psychostimulants were used in 87 percent of treatments prescribed during those visits.
The CHOP study involved 237 parents of children aged 6-12 who were diagnosed with ADHD within the past 18 months. Using a combination of parent interviews, current research, and input from parent advocates and professional experts, researchers developed a standardized three-part questionnaire to help parents define and prioritize their goals for treatment; attitudes toward medication; and comfort with behavioral therapies. The completed survey serves as a guide to support families and health care providers to reach the most effective and workable treatment for a child's ADHD.
"It's important to know whether a parent's primary goal is to keep a child from getting in trouble at school, improve academic performance, or maintain more peace with family members or peers," said Fiks. "We also need to learn about the family's lifestyle and attitudes toward behavioral therapy and medication. All of these factor into making the best treatment decision for each individual child and family."
Pediatric care providers do not usually use shared decision making to gauge families' preferences and treatment goals for ADHD. The Institute of Medicine and the American Academy of Pediatrics recommend healthcare providers use shared decision-making to help families select the best treatment option for ADHD. A well-designed questionnaire may help both patient-families and providers to feel more satisfied with their child's ADHD treatment. The researchers say this is a promising model for more widespread use to aid with treatment decisions for children with ADHD and, in the future, could be tailored for use with other medical conditions.
Until the approach is more widely adopted, Fiks and his colleagues recommend parents ask themselves a few questions to help get the most out of their office visit:
- What do you and your child want to achieve as a result of ADHD treatment? (Better behavior or better grades at school? More self-control at home? Less teasing by other kids?)
- Consider your attitudes and your family's attitudes about medication and behavioral therapy, and why they may or may not be right for you. Write down any questions you have about these treatment options to help remind you during your appointment.
"For the pediatrician's part, it is our responsibility to fully inform parents about their options for treating ADHD and to seek guidance from families about which options will best meet their treatment goals and be manageable for their lifestyle. Research shows that patients adhere much better to the treatment options that they are comfortable with and that are the most practical for them. We need to make sure we're asking the right questions," said Fiks, who is also co-medical director of CHOP's Pediatric Research Consortium.
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