Factors that influence the prescribing and use of methylphenidate for attention-deficit/hyperactivity disorder in primary school children in Polokwane

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.