Help for pediatricians in treating behavioral health problems only partially successful

May 29, 2007

WINSTON-SALEM, N.C. - Continuing medical education, newsletters and resource guides were only partially successful in changing the way that pediatricians handled behavioral health problems, according to a follow-up study at Wake Forest University School of Medicine.

But external factors, especially "black box warnings" from the U.S. Food and Drug Administration "exerted a powerful effect on prescribing practices," said Jane Williams, Ph.D., and colleagues, writing in the June issue of Clinical Pediatrics. So did the changes in the public mental health system brought about by North Carolina's mental health reform.

In 2004, the same group reported in Pediatrics that pediatricians were diagnosing and treating growing numbers of children with behavioral health problems - about 15 percent of the children they see - but did not always feel sufficiently trained to fill this new role.

This year, Williams and her colleagues went back to 42 primary care pediatricians they had originally interviewed in 2002-03 to find out which of a series of what they called "structured interventions" worked.

The structured interventions "focused on recognition, treatment and referral of children with behavioral health problems," Williams said. They included a quarterly newsletter, Pediatric Mental Health Connections, a Mental Health Resource Guide consisting of information about community mental health providers, quarterly collaborative behavioral health "rounds," and three continuing education workshops covering screening children for developmental and behavioral problems and diagnosing and treating depression.

Williams noted that the structured interventions "focused on increased education in areas requested by the pediatricians, especially recognition of anxiety and depression, increased awareness of community mental health providers, increased communication between pediatricians and mental health providers, and use of a community protocol for attention deficit hyperactivity disorder (ADHD)."

She said the interventions were associated with: ADHD remained the behavioral problem most often diagnosed by the pediatricians, who continued to have a high degree of confidence in treating ADHD with stimulants.

The level of pediatricians who said they used a class of drugs called SSRIs (selective serotonin reuptake inhibitors) "frequently or occasionally" plummeted from 52 percent to 26 percent after the FDA warning that use of the drugs might increase suicidal behavior.

In the interviews, 88 percent of the pediatricians said they read the Pediatric Mental Health Connections, 79 percent used the resource guide, 31 percent participated in the interdisciplinary sessions, 21 percent attended a workshop, and 60 percent said they pursued increased mental health training.

Most important, "Eighty-three percent indicated they consulted with a mental health colleague concerning pediatric patients with mental health problems," Williams said.

Williams and her colleagues noted that identification and treatment of mental health disorders in primary care is evolving. She said systemic changes including use of financial incentives to motivate primary care pediatricians to identify, treat and refer behavioral patients, increased access to mental health providers for consultations, practice guidelines and use of technology for continuing education may change practice patterns.
-end-
The Wake Forest research team included Kurt Klinepeter, M.D., Guy Palmes, M.D., Anita Pulley, M.S.N., R.N., and Jane Meschan Foy, M.D.

Media Relations Contacts: Shannon Koontz, shkoontz@wfubmc.edu, or Karen Richardson, krchrdsn@wfubmc.edu, at (336) 716-4587.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. U.S. News & World Report ranks Wake Forest University School of Medicine 18th in primary care and 44th in research among the nation's medical schools. It ranks 35th in research funding by the National Institutes of Health. Almost 150 members of the medical school faculty are listed in Best Doctors in America.

Wake Forest Baptist Medical Center

Related ADHD Articles from Brightsurf:

Autism and ADHD share genes
Researchers from the national psychiatric project iPSYCH have found that autism and ADHD share changes in the same genes.

ADHD across racial/ethnic groups
This study of patients from diverse racial/ethnic backgrounds who received care at the Kaiser Permanente Northern California health system looked at how common attention-deficit/hyperactivity disorder (ADHD) diagnoses were over a 10-year period across seven racial/ethnic groups.

Cycles of reward: New insight into ADHD treatment
Researchers at the Okinawa Institute of Science and Technology Graduate University (OIST) in collaboration with scientists at the University of Otago and the University of Auckland in New Zealand, investigated the actions of the drug in rats.

Young mums more likely to have kids with ADHD
Young mothers have a greater chance of having a child with attention deficit hyperactivity disorder (ADHD) according to new research from the University of South Australia.

ADHD medication: How much is too much for a hyperactive child?
When children with ADHD don't respond well to Methylphenidate (MPH, also known as Ritalin) doctors often increase the dose.

Antipsychotic use in youths with ADHD is low, but still cause for concern
A new study eased fears about the proportion of youths with ADHD taking antipsychotic drugs, but still found that many prescriptions may be inappropriate.

How stimulant treatment prevents serious outcomes of ADHD
Analysis quantifies the extent which stimulant treatment reduces serious outcomes in children and young adults with ADHD.

Did Leonardo da Vinci have ADHD?
Leonardo da Vinci produced some of the world's most iconic art, but historical accounts show that he struggled to complete his works.

More sleep may help teens with ADHD focus and organize
Teenagers with attention deficit hyperactivity disorder (ADHD) may benefit from more sleep to help them focus, plan and control their emotions.

Researchers have found the first risk genes for ADHD
A major international collaboration headed by researchers from the Danish iPSYCH project, the Broad Institute of Harvard and MIT, Massachusetts General Hospital, SUNY Upstate Medical University, and the Psychiatric Genomics Consortium has for the first time identified genetic variants which increase the risk of ADHD.

Read More: ADHD News and ADHD Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.