Unmonitored Child and Adolescent Health Risks Associated with ADHD

February 27, 2020

Adolescents with Attention Deficit Hyperactivity Disorder (ADHD or ADD) face a high risk of health hazards ranging from unsafe sex and distracted driving to illegal drug use and driving. diversion of drugs. These risks are well documented by scientific research, but a new study finds that primary care physicians largely ignore these critical topics when discussing and treating adolescent ADHD patients.1

Posted in the Journal of Developmental and Behavioral Pediatrics, this new study reveals how primary care physicians are overlooking the urgent health risks of adolescents with ADHD. According to research, less than half of doctors screen their adolescent ADHD patients for risky sexual activity, and hardly any of them discuss the dangers of driving or hijacking drugs.

“We found that clinicians are more skilled at treating ADHD in childhood than in adolescence,” said lead study author Thomas Power, PhD, ABPP, director of the Center for Management of ADHD.2 However, given the significant risks specifically faced by adolescents with ADHD – including higher dropout rates from high school, teenage pregnancies, car crashes, and the development of co-morbid mental health problems – a lucid and proactive treatment should be a higher priority, as the consequences of not adequately treating adolescents with ADHD could be fatal.1

In this retrospective longitudinal cohort study, researchers looked at how often primary care providers provide ADHD care and implement ADHD treatments for patients. Researchers also studied patient encounters to understand the range of concerns – such as depression, suicide, substance abuse, driving preparation, safe sex, and illegal drug distribution – expressed during the visits. at the doctor. This study followed these variables over three age periods: pre-adolescence (9 to 11 years old), early adolescence (12 to 14 years old), and late adolescence (15 to 18 years old) .

The group of participants in this study consisted of 262 patients diagnosed with ADHD before the age of 10 who had documented physician visits during all three age periods. Patients in this study sample were significantly more likely to be Caucasian (66%) and male (78%). One-third of the participants had a comorbid learning disability, almost a quarter had a comorbid disruptive behavior disorder, 28% had a comorbid anxiety or mood disorder, and 9% had a comorbid autism spectrum disorder.1

The researchers took data from three New Jersey primary care practices located at six different sites with 23 primary care physicians participating in total. The electronic health record (Epicare ™) allowed researchers to analyze the quality and content of patient care visits.1

Overall, physicians have followed their ADHD patients well for the development of co-morbidities. Namely, the researchers found that depression monitoring dropped from 37% to at least 90% during early and late visits by teens.1 Likewise, doctors tended to monitor their patients for warning signs of suicide and drug addiction with greater regularity during adolescence.1

Likewise, the rate at which primary care physicians monitored the sexual activity of their ADHD patients increased from 9% in early adolescence to 47% in late adolescence.1 This is a positive increase, but researchers found that only half of patients engage in conversations with doctors about risky sexual behavior. Given the abundant literature on the risks to the sexual health of adolescents with ADHD – including an increased risk of teenage pregnancy and contracting STIs – there is a significant potential benefit of increased clinical care.

Adolescents with ADHD are at higher than average risk for negative driving incident results. Specific risks include motor vehicle accidents and citations for driving offenses: In fact, a new study has found that drivers with ADHD are around 60% more likely to be involved in a motor vehicle accident in the past. during their first month of driving license than their neurotypical peers.1

Despite growing evidence for this risk, researchers found only two cases where primary care physicians were discussing driver readiness with ADHD patients. The researchers suggest that driver readiness should be included in standardized screening models, similar to those for depression, suicide and substance abuse.1

In addition, drug abuse and diversion remains a public health problem and a serious, but largely unrecognized, legal offense. Despite recent studies showing increasing rates of illegal drug diversion, researchers have found only one case in all age groups of a primary care physician discussing this topic with a patient.1

While doctors discussed academic performance in over 90% of all visits, the incidence of school interventions like IEPs or 504 plans fell from 36% to less than 20% when patients dropped out of school. elementary to middle school to high school.1 Since ADHD is a chronic disease that persists in multiple settings, young people with ADHD are in dire need of educational accommodations throughout the transition to adolescence; there is no research supporting the suspension of college or high school housing.

Although the health risks associated with ADHD intensify over time, researchers have found that primary care visits for ADHD-related problems greatly decrease as the child reaches adolescence. The study found that 61% of patients had a documented visit for ADHD in pre-adolescence, and only 41% of patients had a documented visit for ADHD in late adolescence.1

“These findings identify opportunities to improve care for adolescents with a history of ADHD,” said Dr Power, “Additional resources and training are needed so that we can ensure that primary care clinicians provide the best care. to patients with ADHD as they develop into their teenage years.2

Sources:

1Moss CM, Metzger KB, Carey ME, Blum NJ, Curry AE, Power TJ. Chronic management of attention deficit / hyperactivity disorder: clinical management from childhood to adolescence. Journal of Developmental & Behavioral Pediatrics. 2020; 41 Suppl 2S: S99-S10.

2Adolescents with a History of ADHD Need Closer Monitoring for Health Risks [press release]. Philadelphia, Pennsylvania: Children’s Hospital of Philadelphia; February 11, 2020.https: //www.newswise.com/articles/teens-with-a-history-of-adhd-need-stronger-monitoring-of-health-risks? Sc = dwhr & xy = 5029296

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