Psychiatrists, parents significantly differ in ADHD, psychiatric comorbidities perceptions

According to a small-scale, in-office, observational study, psychiatrists and parents have significantly different perceptions of the importance of pediatric ADHD and psychiatric comorbidities, particularly regarding the patients' most concerning behavior.

The study, which utilized accepted sociolinguistic methodologies to evaluate the tone, content and structure of in-office visits, was presented recently at the 20th annual U.S. Psychiatric and Mental Health Congress (USPMHC).

“We found that among the psychiatrists and parents studied, 78 percent provided different responses when asked about the patient's ‘most concerning behavior,'” said Robert Findling, M.D., lead author and professor of psychiatry at Case Western Reserve University and director of the division of child and adolescent psychiatry at University Hospitals Case Medical Center. “There was a notable incidence of psychiatrist/parent misalignment regarding the patients' most concerning behaviors, including aggression and defiance.”

The study, designed to capture naturally occurring conversations between psychiatrists, patients with ADHD and their parents, consisted of eleven psychiatrists, thirty-two child and adolescent ADHD patients and their parents. Half of the patients were younger than 13 years old, and the majority fulfilled the criteria of “complicated ADHD,” which was defined in the study as a patient “having or suspected to have one or more psychiatric comorbidities.” Physicians classified 81 percent of patients as having one or more psychiatric comorbidities/learning disabilities. The most common comorbidities greater than 20 percent included: depression (46 percent), oppositional defiant disorder (42 percent), anxiety (38 percent), learning disabilities (35 percent) and bipolar disorder (23 percent). In post-visit interviews, parents most often reported concern about aggression and defiance; however, these behaviors that parents reported as “most concerning” post-visit were unaddressed in one-third of the visits.

“These results indicate psychiatrists can adopt several techniques to improve in-office communication about complicated ADHD, including structuring visits, so that all voices are heard, discussing comorbidities using language that is more comprehensible to parents, and eliciting parents' expectations at the initiation of treatment,” said Dr. Findling. “By focusing on how time is spent and what types of questions are asked of parents and patients, this can lead to successful expectation-setting with both parents and patients. As a result, psychiatrists can have better in-office discussions about ADHD as well as improved treatment of patients suffering from complicated ADHD.”