Abstract:
Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is the current diagnostic
label for children presenting with significant problems with attention, and typically with
impulsiveness and excessive activity as well. It is the most common neurobehavioural disorder
of childhood, and therefore critical to clarify the diagnosis. ADHD is a seemingly heterogeneous
group of behaviour disorders affecting between 5% - 10% of primary school children. Overdiagnosis
of ADHD and overprescribing of stimulants are considered problems in some
communities, emphasising the need for careful evaluation and diagnosis. Methylphenidate is
currently the first choice of treatment. The main focus of this study was to investigate whether
the diagnosis of these children was done by field experts according to the criteria as set in the
DSM-IV TR. This influences the decision to prescribe methylphenidate and the monitoring of the
child during treatment.
Method: The parents of 50 clinically diagnosed ADHD children, from various primary
schools situated in Polokwane, were interviewed and completed a questionnaire.
Results: The findings indicated that 20% of the sample did not meet the DSM-IV TR
criteria. 28% of the sample was advised to take methylphenidate by people without appropriate
clinical knowledge of ADHD. The final diagnosis and prescribing of methylphenidate is
overwhelmingly done by General Practitioners (47%). ADHD symptomatology (hyperactivity -
impulsiveness and inattention) was not taken in account when prescribing methylphenidate.
There was no definite monitoring of patients before and while on methylphenidate. Positive
improvements in ADHD symptoms after methylphenidate therapy, shows that methylphenidate
is still prominent and successful in the pharmacotherapy of the ADHD child.
Conclusion: Based on the results of the study there does not appear to be enough
evidence that proper protocols or guidelines were followed. Some children were diagnosed as
having ADHD with insufficient evaluation and in some cases stimulant medication was
prescribed when treatment alternatives might exist. It seems that not all clinicians prescribing
methylphenidate have the necessary professional experience and/or qualifications regarding
ADHD. This is an indication that there is a need for South African guidelines similar to The
American Academy of Pediatrics’ Clinical Practice Guidelines and the European Clinical
Guidelines for Hyperkinetic Disorder. However, with correct diagnosis and individualised
prescribing and usage of methylphenidate, there will be positive improvements in ADHD
symptoms after methylphenidate therapy.
