Clinicians' Adherence to Guidelines When Initiating Methylphenidate Treatment

Abstract

Aims: Between 2008 and 2012, the number of children and adolescents in the Netherlands who received methylphenidate prescriptions increased by 35.6%. We determined guideline adherence regarding the assessment of attention-deficit/ hyperactivity disorder (ADHD) and rates of off-label use in those 2 years. We also compared adherence to guidelines between mental health and pediatrics settings. Methods: We conducted a medical file audit of 506 children or adolescents who had received a first methylphenidate prescription in 2008 (n = 208) or 2012 (n = 298) across mental health (n = 333) and pediatrics outpatient clinics (n = 173) in the Netherlands and assessed adherence to seven guideline recommendations. Results: We did not find significant differences between 2008 and 2012 regarding the mean adherence to the seven recommendations (43% vs. 45%) or the percentage of off-label use (35% vs. 30%). Best adherence rates (over the years 2008 and 2012 combined) concerned the assessment of comorbidities (89%) and the involvement of teachers in the diagnostic process (75%). Least frequently adhered to were assessing ADHD severity (1%), the use of a (semi-)structured parent interview (16%), and providing psycho-education to parents (42%) or teachers (1%). Mental health settings showed better adherence than pediatrics settings (over the years 2008 and 2012 combined) concerning the use of (semi-)structured parent interviews (22% vs. 3.1%), having a separate diagnostic session directed at the child (81% vs. 63%), assessment of comorbidities (95% vs. 76%), and providing psycho-education to parents (51% vs. 24%). Conclusions: There was neither a decrease in adherence to guidelines nor an increase in off-label use between 2008 and 2012. However, there is ample room for improvement regarding guideline adherence.

Results of N=1 randomized, double-blind, placebo-controlled, cross-over discontinuation trials embedded in clinical practice after longer term methylphenidate use: A pilot study

“…Second, it could be criticized that an ADHD diagnosis based on standardized assessments was not required to be included in the study. However, our sample represents clinical practice, as children are often treated with off-label methylphenidate without the use of standardized assessments for ADHD [25]. Third, we cannot exclude that our sample overrepresented families who suspected that methylphenidate did not work as intended.…”

Adherence to Clinical Guidelines for Dose Finding and Monitoring Methylphenidate Use: A Medical Record Audit in Child and Adolescent Mental Health Care and Pediatric Settings

“…Between March 2015 and July 2016, we investigated 506 medical records of children, adolescents, and young adults (age range 4-24 years of age at first prescription of ADHD medication) from two large organizations for child and adolescent mental health care and nine pediatric outpatient clinics spread across the Netherlands in a 2:1 ratio between mental health care and pediatric settings. Every center provided a list of patients who had started methylphenidate treatment in 2008 or 2012 and we investigated consecutive medical records until we had reached our predetermined target for each center (targets differed per center and between mental health care and pediatric settings, depending on the size of the center; Matthijssen et al, 2022). These years were chosen because of a twofold increase in the number of ADHD medication prescriptions in the Netherlands, from 1.8% of children and adolescents in 2008 to 3.9% in 2012.…”