(Hoping that this post is seen as informative of discrepancy of practice and does not degenerate too very badly…)
http://www.orlandosentinel.com/news/custom/science/orl-insadhdmeds090703sep07,0,6275551.story?coll=orl-news-headlines-science
When it comes to diagnosing and treating ADHD, ‘evidence-based’ methods best
By E. Clarke Ross | Special to the Sentinel
Posted September 7, 2003
A major issue when discussing ADHD is whether the disorder has been correctly diagnosed.
Identifying, understanding and treating ADHD requires the involvement and expertise of qualified professionals who can carefully and comprehensively analyze the persistent symptoms associated with the disorder. Unfortunately, data on prescribing practices indicate that many medical doctors do not consistently use evidence-based science when diagnosing ADHD.
Two recent major national studies documented the significant variation in the prescription of stimulant medication: The May 6, 2001, issue of the Cleveland Plain Dealer included a map of the United States showing Ritalin (generic name “methylphenidate”) prescription rates for each of the 3,141 counties in the country. In some locations such as Dukes County (Massachusetts) and Dickinson and Emmet Counties (Michigan), well over 7 percent of all children in the county were receiving stimulant medication.
Yet, in some counties throughout the United States, not a single person receives stimulant medication.
These findings were reconfirmed in the February 2003 issue of Pediatrics, the professional journal of the American Academy of Pediatrics (AAP), when researchers documented the significant “geographical variation in the prevalence of stimulant medication use.”
Some believe that such variation (particularly in cities where stimulant medication is prescribed at exceedingly high rates) results from “prescribing presumptively rather than completing a thorough assessment.”
Presumptive prescription occurs when physicians spend very little time with the family and child yet prescribe medication following only a brief evaluation of the child and description of the presenting symptoms. By contrast, “evidence-based prescribing” includes a comprehensive and thorough evaluation of multiple data and experiences over an extended period of time and in a variety of settings.
Locating a professional who practices evidence-based medicine can be both daunting and difficult. Before making an appointment with a doctor for the assessment of possible ADHD, ask the professional if he or she is familiar with and practices the AAP guidelines. In addition, ask the physician if he or she is familiar with the principles for the assessment and treatment of ADHD and protocols for the prescribing of medication to treat ADHD as published in by the American Academy of Child and Adolescent Psychiatry (www.aacap.org).
Current evidence-based guidelines apply to children ages 6 to 12. The AAP is now developing guidelines for adolescents and teens. At this writing, there are no evidence-based guidelines for the treatment of ADHD in adults.
Medications are regulated by the Food and Drug Administration. Each medication is approved for a certain condition and age with a recommended range of dose level. Physicians are legally allowed to prescribe medications, in their medical judgment, for other age groups and using higher dose levels. This practice is known as prescribing “off label.”
Off-label use is the prescribing of a medication in a different dose, for a longer duration of time for a different age group, or for a different medical indication than recommended in the prescribing information. Although the FDA approves a drug for a specific indication, the physician has discretion to prescribe it as indicated above, or in combination with other medications in the treatment of patients.
While such flexibility is helpful, it only further underscores the need for physicians to use evidence-based medicine guidelines when making diagnostic and prescribing decisions.