The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician’s point of view

Abstract

Background: Clinical decision making is influenced by a range of factors and constitutes an inherently complex task.

Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials

“…These include: (i) partial or nonresponse; 3 (ii) possible adverse effects; 4 (iii) uncertainty about long term costs and benefits; 5 (iv) poor adherence; 6 and (v) negative medication-related attitudes from patients, parents or clinicians. 7 Psychological treatments such as behavioral parent training are also widely used. However, a recent meta-analysis 8 found no effects on ADHD symptoms when only ratings by assessors blind to treatment allocation were considered.…”

What influences clinicians’ decisions about ADHD medication? Initial data from the Influences on Prescribing for ADHD Questionnaire (IPAQ)

“…The IPAQ was developed on the basis of the key themes derived from qualitative analysis of semi-structured interview data carried out in the Decisions Regarding ADHD Management (DRAMa) study [27]. The DRAMa study focused on the uncertainties and complexities in assessment, diagnosis and treatment of ADHD from the clinician's point of view (for more detailed information and results, please refer to Kovshoff et al [27].…”

“…The DRAMa study focused on the uncertainties and complexities in assessment, diagnosis and treatment of ADHD from the clinician's point of view (for more detailed information and results, please refer to Kovshoff et al [27]. On the basis of inductive thematic analysis of 50 interviews with consultant psychiatrists and paediatricians, ten themes were identified that related to medication-related decision making.…”

“…In making treatment decisions, the clinician has to weigh-up different (and sometimes competing) formal (e.g., medical guidelines) and informal (parents, teachers, patients) sources of information, influences and priorities when determining whether, when and how to initiate medication, whether to alter the medication regime during treatment, and finally, when to stop medication. We have recently completed a series of semi-structured interviews with child psychiatrists, and paediatricians (in Belgium and England) exploring the range of factors that might influence diagnostic and treatment-related decisions [27]. On the basis of these findings we identified a number of factors likely to influence treatment and medication practice in relation to ADHD.…”

Evidence-based psychotherapy in children and adolescents: advances, methodological and conceptual limitations, and perspectives

“…It is also possible that different mechanisms leading to a respective mental disorder are present in routine clinical care than in research settings, thus rendering deviations from treatment protocols mandatory [23]. These differences raise concerns that treatments tested in RCTs may not be applicable to patients treated in routine clinical care [32], because the adherence to a predefined sequence of sessions with predetermined therapy contents in RCTs may constrain the therapist's ability to adapt each therapy session to the individual treatment needs of a patient.…”