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If you or your kid have ADHD, do have a treatment monitoring plan in place for the New Year?

When a child is diag­nosed with ADHD, par­ents con­front the dif­fi­cult deci­sion about which treatment(s) to pur­sue to best help their child suc­ceed. While decid­ing on an ini­tial treat­ment plan is impor­tant, equal­ly impor­tant is estab­lish­ing a plan to mon­i­tor how well that treat­ment is work­ing on a sus­tained basis, regard­less of what spe­cif­ic treatment(s) is being used. This is because children’s response to ADHD treat­ment often changes over time and a strong ini­tial treat­ment response – be that med­ica­tion treat­ment, behav­ior ther­a­py, dietary treat­ment, etc., — pro­vides no assur­ance that impor­tant treat­ment ben­e­fits will per­sist.  

Core ADHD symp­toms of inat­ten­tion and hyper­ac­tiv­i­ty-impul­siv­i­ty that are well-con­trolled at one time may sub­se­quent­ly reemerge and cre­ate dif­fi­cul­ties. A child’s suc­cess with school work, meet­ing behav­ioral expec­ta­tions at school, and get­ting along with peers can also ebb and flow.

For this rea­son, ADHD treat­ment guide­lines from the Amer­i­can Acad­e­my of Pedi­atrics and the Amer­i­can Acad­e­my of Child and Ado­les­cent Psy­chi­a­try high­light the neces­si­ty of sus­tained, sys­tem­at­ic treat­ment mon­i­tor­ing so that adjust­ments to treat­ment can be made as need­ed. Hav­ing a strong mon­i­tor­ing plan in place is thus an inte­gral com­po­nent of high qual­i­ty ADHD treat­ment.

Monitoring is often absent

Despite the impor­tance of sus­tained and sys­tem­at­ic treat­ment mon­i­tor­ing, it is rarely done. In fact, data from one recent study with com­mu­ni­ty-based pedi­a­tri­cians indi­cat­ed that for chil­dren pre­scribed ADHD med­ica­tion, fol­low-up con­tact (vis­it, phone call, or email) with­in 30 days of pre­scrib­ing hap­pened less than half the time.

More strik­ing is that col­lect­ing any sys­tem­at­ic behav­ior rat­ings from par­ents and/or teach­ers – even a sin­gle time — seems to hap­pen for only about 10% of chil­dren. And, the aver­age amount of time between ini­ti­at­ing treat­ment and col­lect­ing any such rat­ings was rough­ly one year. Because of this, it is like­ly that many chil­dren were main­tained on a treat­ment pro­gram that was far from opti­mal.

What can parents do? 

Par­ents who rec­og­nize the impor­tance of treat­ment mon­i­tor­ing can speak with their child’s health care provider to make sure that a treat­ment mon­i­tor­ing plan is in place for their child.

One rea­son­able approach would be to obtain month­ly feed­back from teach­ers on the inten­si­ty of core ADHD symp­toms, and how well the child is doing over­all in their aca­d­e­m­ic, social, and behav­ioral func­tion­ing. Teacher rat­ings would be sup­ple­ment­ed by rat­ings from par­ents based on their obser­va­tions of their child at home. When med­ica­tion is part of a child’s treat­ment, mon­i­tor­ing for emer­gent side effects would also be rec­om­mend­ed.  

When teacher and/or par­ent rat­ings reflect impor­tant dif­fi­cul­ties, deci­sions about pos­si­ble changes/adjustments to the cur­rent treat­ment plan can be made in con­sul­ta­tion with par­ents. With­out such infor­ma­tion, mak­ing a well-informed deci­sion about the ade­qua­cy of a child’s cur­rent treat­ment is not pos­si­ble.

Ide­al­ly, your child’s provider will already have a sys­tem­at­ic approach for ADHD treat­ment mon­i­tor­ing in his or her prac­tice that he/she can imple­ment with your child. If not, you can also access a pen­cil-and-paper treat­ment mon­i­tor­ing sys­tem that I devel­oped that can be down­load for free Here.

Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­o­gy and Neu­ro­science at Duke Uni­ver­si­ty. He pub­lish­es the Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

References:

  1. Amer­i­can Acad­e­my of Pedi­atrics. ADHD: Clin­i­cal prac­tice guide­line for the diag­no­sis, eval­u­a­tion, and treat­ment of Atten­tion Deficit/Hyperactivity Dis­or­der in chil­dren and Ado­les­cents. (2011). Pedi­atrics, 128, 1007–1022.
  2. Amer­i­can Acad­e­my of Child and Ado­les­cent Psy­chi­a­try. Prac­tice Para­me­ter for the Assess­ment and Treat­ment of Chil­dren and Ado­les­cents with Atten­tion-Deficit/ Hyper­ac­tiv­i­ty Dis­or­der. (2007). Jour­nal of the Amer­i­can Acad­e­my of Child and Ado­les­cent Psy­chi­a­try, 46, 894–921.
  3. Epstein, J.N., et al., (2014). Vari­abil­i­ty in ADHD care in com­mu­ni­ty-based pedi­atrics. Pedi­atrics, 134, 1136–1143.

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