ADHD: Overdiagnosed and overtreated, or misdiagnosed and mistreated?

Manos, Michael J.; Giuliano, Kimberly; Geyer, E

doi:10.3949/ccjm.84a.15051

Cited by 26 publications

(21 citation statements)

References 58 publications

(61 reference statements)

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“…We found that only patients who felt their economic status were higher than the average was less likely to be misdiagnosed. This is in line with the findings from previous studies which state that people with low income are more likely to lead to misdiagnosis [ 15 , 16 ]. However, limited findings were reported when patients living with RDs, as seen from our data, RDs do not ‘discriminate’ in terms of gender, age, ethnicity, residential area, or educational levels.…”

Section: Discussionsupporting

confidence: 93%

Why is misdiagnosis more likely among some people with rare diseases than others? Insights from a population-based cross-sectional study in China

Dong

Chung

Chan

et al. 2020

Orphanet J Rare Dis

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Background For patients with rare diseases (RD), misdiagnosis (or erroneous diagnosis) is one of the key issues that hinder RD patients’ accessibility to timely treatment. Yet, little is known about the main factors that are associated with RD patients’ misdiagnosis. The objective of this study is to analyze data from a national survey among 2040 RD patients from China to explore the association between misdiagnosis and various factors, including patients’ demographics, socio-economic status, medical history, and their accessibility to RD information. Results Three binary logistic regression analyses were performed to assess the relationships between misdiagnosis and level of rarity of the RDs (mild, moderate, and severe), demographics, health insurance levels, and accessibility to disease-related information by using the total sample, and the adult and non-adult sub-samples. We found that accessibility to RD information is the most critical factor influencing the patients’ chances of being misdiagnosed (odds ratio [OR] = 4.459, p < 0.001). In other words, the greater the difficulty in accessing the information on RD management, the higher the possibility of experiencing misdiagnosis. Such influences of information accessibility on misdiagnosis were repeatedly discovered when examining the adult (OR = 3.732, p < 0.001) and the non-adult (OR = 5.174, p < 0.001) sub-samples. The association between perceived economic status and misdiagnosis was only significant in the total sample. The only other factor significantly associated with misdiagnosis was disease multimorbidity: participants who reported no multimorbidity are less likely to experience misdiagnosis (OR = 0.42, p < 0.001). Conclusions Our study indicated that patients with RDs who have difficulty in accessing disease-related information are two to five times more likely to have experienced misdiagnosis. Even after adjusting for the patients’ age, gender, economic levels, and education levels, the impact of information accessibility was still significant. Our finding highlights the importance of access to information in reducing misdiagnosis among RD patients.

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Section: Discussionsupporting

confidence: 93%

Why is misdiagnosis more likely among some people with rare diseases than others? Insights from a population-based cross-sectional study in China

Dong

Chung

Chan

et al. 2020

Orphanet J Rare Dis

View full text Add to dashboard Cite

show abstract

“…We found that only patients who felt their economic status were higher than the average was less likely to be misdiagnosed. This is in line with the ndings from previous studies which state that people with low income are more likely to lead to misdiagnosis [15,16]. However, limited ndings were reported when patients living with RDs, as seen from our data, RDs do not 'discriminate' in terms of gender, age, ethnicity, residential area, or educational levels.…”

Section: Discussionsupporting

confidence: 92%

Why is misdiagnosis more likely among some people with rare diseases than others? Insights from a population-based cross-sectional study in China

Dong

Chung

Chan

et al. 2020

Preprint

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Background For patients with rare diseases (RD), misdiagnosis (or erroneous diagnosis) is one of the key issues that hinder RD patients’ accessibility to timely treatment. Yet, little is known about the main factors that are associated with RD patients’ misdiagnosis. The objective of this study is to analyze data from a national survey among 2,040 RD patients from China to explore the association between misdiagnosis and various factors, including patients’ demographics, socio-economic status, medical history, and their accessibility to RD information. Results Three binary logistic regression analyses were performed to assess the relationships between misdiagnosis and level of rarity of the RDs (mild, moderate, and severe), demographics, health insurance levels, and accessibility to disease-related information by using the total sample, and the adult and non-adult sub-samples. We found that accessibility to RD information is the most critical factor influencing the patients’ chances of being misdiagnosed (odds ratio [OR] =4.459, p<0.001). In other words, the greater the difficulty in accessing the information on RD management, the higher the possibility of experiencing misdiagnosis. Such influences of information accessibility on misdiagnosis were repeatedly discovered when examining the adult (OR=3.732, p<0.001) and the non-adult (OR=5.174, p<0.001) sub-samples. The association between perceived economic status and misdiagnosis was only significant in the total sample. The only other factor significantly associated with misdiagnosis was disease multimorbidity: participants who reported no multimorbidity are less likely to experience misdiagnosis (OR=0.42, p<0.001).Conclusions Our study indicated that patients with RDs who have difficulty in accessing disease-related information are two to five times more likely to have experienced misdiagnosis. Even after adjusting for the patients’ age, gender, economic levels, and education levels, the impact of information accessibility was still significant. Our finding highlights the importance of access to information in reducing misdiagnosis among RD patients.

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“…It is known that physician contact and engagement/partnership with families play a major role in both medication adherence and improved ADHD medication titration. 7,22 This supports the idea that more physician attention is needed in these populations.…”

Section: Discussionsupporting

confidence: 65%

“…The prescribe-and-wait method is the most common. 7 During this titration process, patient treatment adherence and physician contact play a key role in successful stimulant treatment. However, there is minimal research on the duration of titration.…”

Section: Introductionmentioning

confidence: 99%

Time to Stable Dose of Psychostimulants in Pediatric Patients With ADHD

Pasadyn¹,

Giuliano²,

LaBianca³

et al. 2020

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES The prevalence of attention-deficit/hyperactivity disorder (ADHD) is increasing and psychostimulants are the pharmacological standard of care. Patients benefit most when there is efficient titration to a stable dose of medication as defined by maintaining that same dose for 6 months. The aims of this study were to describe time to stable dose in a cohort of children with ADHD and examine the impact of demographic factors. METHODS A list of pediatric patients with a diagnosis of ADHD in the electronic health record was generated, and a retrospective chart review of stimulant use was conducted on 500 patients randomly selected from 2010 to 2015 who met inclusion criteria. Time to stable dosing and its association with demographic characteristics were assessed. RESULTS Patients were predominantly male (72%), white (81%), and privately insured (67%). Fifty-five percent of patients achieved a stable dose of medication on first attempt; therefore, the median time to stable dosing for the cohort was 0 days with the interquartile range being 0 to 133.8 days. There was significant increase in time to stable dose for patients younger than 10 years compared with those ≥10 years of age (p = 0.01). Time to stable dose was not significantly associated with race (p = 0.13), sex (p = 0.72), type of insurance (p = 0.56), or formulation being immediate or extended release (p = 0.56). CONCLUSIONS Many patients had long titration periods when trying to reach a stable dose. Given that medication switching can be challenging for patients and families, more frequent contact with providers during titration may be necessary.

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ADHD: Overdiagnosed and overtreated, or misdiagnosed and mistreated?

Cited by 26 publications

References 58 publications

Why is misdiagnosis more likely among some people with rare diseases than others? Insights from a population-based cross-sectional study in China

Why is misdiagnosis more likely among some people with rare diseases than others? Insights from a population-based cross-sectional study in China

Why is misdiagnosis more likely among some people with rare diseases than others? Insights from a population-based cross-sectional study in China

Time to Stable Dose of Psychostimulants in Pediatric Patients With ADHD

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