The Decisions Regarding ADHD Management (DRAMa) study; Uncertainties and complexities in assessment, diagnosis and treatment from the clinician’s point of view Seminar

Methods: Fourty-nine prescribing child psychiatrists and paediatricians from Belgium and the UK were interviewed about their decisions regarding the assessment, diagnosis and treatment of ADHD. Interviews were designed to elicit accounts of actual decision making through the description of recent cases studies including the referral system, how and which information were gathered, how clinicians came to decisions about whether to diagnose ADHD and which treatments were used.
Results: Clinicians described the assessment and diagnostic process as inherently complicated, requiring time and experience to piece together the accounts of children made by multiple sources, and through the use of varying information gathering techniques. This included differing opinions on how and whether to separate biological from environmental causal factors to understand the level of impairment and the subsequent need for a diagnosis of ADHD. Treatment decisions were viewed as a shared process between families, children, and the clinician. Published guidelines were viewed as vague, and few clinicians spoke about the use of symptom thresholds or specific impairment criteria. Furthermore, systematic or operationalized criteria to assess treatment outcomes were rarely used.
Conclusions: These data highlight clinicians’ views that decision making in ADHD is a complicated, time consuming process which requires extensive use of clinical impression, and involves a partnership with parents. Clinical guidelines would benefit from revisions to take into account the real world complexities of clinical decision making for ADHD.

Tea will be served beforehand at 15:45 in room 3096 (iZone room).