Mayo Clinic researchers are presenting new findings on the early treatment of child and adolescent attention deficit hyperactivity disorder this week at the American Academy of Childhood and Adolescent Psychiatry annual meeting in San Francisco. They include a method to get better input from parents and teachers of children who are being diagnosed with ADHD for the first time—allowing for more effective treatment upon the first consultation. Researchers also showed how a tool can help clinicians better diagnose and treat children who have both ADHD and oppositional defiance disorder.
In the first study, Mayo Clinic researchers required parents and teachers of children coming in for their first ADHD consultation, defined by some combination of problems such as difficulty sustaining attention, hyperactivity and impulsive behavior, consultations to complete extensive background forms and analysis. By offering incentives and stressing the importance of being prepared for the first consultation, clinicians were able to boost parent and teacher compliance from 25 to 90 percent at the Mayo Clinic Child and Adolescent ADHD Clinic. As a result, researchers have been able to better recommend treatment and therapy right off the bat.
"I'd compare treating a child with ADHD for the first time to consulting with someone who has type II diabetes—we need to measure a diabetic patient's blood sugar level before we can properly treat them," says study lead author Jyoti Bhagia, M.D., a Mayo Clinic psychiatrist. "The same goes for ADHD. The more we know about children in the early stages of treatment, the more quickly we can get them the help they need."
In the second study, Mayo Clinic researchers gave 75 patients with ADHD at the Mayo Clinic Child and Adolescent ADHD Clinic a written, subjective evaluation to test for oppositional defiance disorder, a persistent pattern of tantrums, arguing, and angry or disruptive behavior toward authority figures.
They found that the test was far better able to pick up whether the child had the disorder than an anecdotal physician diagnosis. Of the 75 patients in the study, 27 percent, or less than a third, were diagnosed with oppositional defiance disorder by their providers. After taking the subjective test, 48 percent tested positive for oppositional defiance disorder. That shows the presence of oppositional defiance disorder with ADHD is underdiagnosed and children may not be receiving the behavioral treatment they need.
Children who have both ADHD and oppositional defiance disorder benefit from a combination of medication and behavioral therapy, says Dr. Bhagia.