Attitudes and practices in the management of attention deficit hyperactivity disorder among Brazilian pediatric neurologists who responded to a national survey

a cross-sectional study

Autores

Palavras-chave:

Attention deficit disorder with hyperactivity, Child behavior disorders, Neurodevelopmental disorders

Resumo

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) has a prevalence of 5.3% among children and adolescents. It is characterized by attention deficit, hyperactivity, and impulsivity. OBJECTIVE: We aimed to conduct a survey involving pediatric neurologists in the management of ADHD and compare the results with the current literature and guidelines. DESIGN AND SETTING: Descriptive analytical study of a virtual environment, was used Test of equality of proportions for comparison between two groups of pediatric neurologists (working as specialists for > 6 versus ≤ 6 years), with a significance level of P = 0.05. METHODS: This cross-sectional study used a virtual questionnaire covering the steps in the diagnosis and treatment of children with ADHD. The inclusion criteria were professionals who had completed their residency/specialization in pediatric neurology and clinical neurologists working in pediatric neurology. RESULTS: Among the 548 electronic invitations sent, 128 were considered valid. For all participants, the diagnosis was clinically based on the disease classification manuals. Combination treatment promotes improvement of symptoms (96.9%). Among psychostimulants, short-acting methylphenidate was the most commonly prescribed medication (85.2%). Headache was the most common side effect (77.3%). Altogether, 73.4% of the participants requested laboratory tests, 71.1% requested an electrocardiogram, and 42.2% requested an electroencephalogram. Pediatric neurologists working as specialists for ≤ 6 years had more frequent referrals to psycho-pedagogists for diagnosis (P = 0.03). CONCLUSIONS: The participants complied with clinical guidelines, emphasizing the relevance of diagnostic manuals and treatment guidelines for an eminently clinical situation and enabling uniformity in quality treatment.

Downloads

Não há dados estatísticos.

Biografia do Autor

Marina Estima Neiva Nunes, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto

MD. Child Neurologist, Department of Neurosciences and Behavioral Sciences, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.

Patricia Aparecida Zuanetti, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto

PhD. Speech and Hearing Therapist, Department Health Sciences, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.

Ana Paula Andrade Hamad, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto

MD, PhD. Child Neurologist, Department of Neurosciences and Behavioral Sciences, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.

Referências

Faraone SV, Asherson P, Banaschewski T, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers. 2015;1:15020. PMID: 27189265; https://doi.org/10.1038/nrdp.2015.20.

Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164(6):942-8. PMID: 17541055; https://doi.org/10.1176/ajp.2007.164.6.942.

Feldman HM, Reiff MI. Clinical practice. Attention deficit-hyperactivity disorder in children and adolescents. N Engl J Med. 2014;370(9):838-46. Erratum in: N Engl J Med. 2015;372(2):197. Dosage error in text. PMID: 24571756; https://doi.org/10.1056/NEJMcp1307215.

Centers for Disease Control and Prevention. Children’s Mental Health. Data & Statistics. Available from: https://www.cdc.gov/childrensmentalhealth/data.html. Accessed in 2022 (Sep 28).

Edwards PJ, Roberts I, Clarke MJ, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev. 2009;2009(3):MR000008. PMID: 19588449; https://doi.org/10.1002/14651858.MR000008.pub4.

Fleming CM, Bowden M. Web-based surveys as an alternative to traditional mail methods. J Environ Manage. 2009;90(1):284-92. PMID: 18082316; https://doi.org/10.1016/j.jenvman.2007.09.011.

van Gelder MM, Bretveld RW, Roeleveld N. Web-based questionnaires: the future in epidemiology? Am J Epidemiol. 2010;172(11):1292-8. PMID: 20880962; https://doi.org/10.1093/aje/kwq291.

Austerman J. ADHD and behavioral disorders: Assessment, management, and an update from DSM-5. Cleve Clin J Med. 2015;82(11 Suppl 1):S2-7. PMID: 26555810; https://doi.org/10.3949/ccjm.82.s1.01.

Moriyama TS, Cho AJM, Verin RE, et al. Attention deficit hyperactivity disorder. In: Rey JM, Zepf FD, editors. IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions; 2012. p. 1-23.

Rohde LA, Buitelaar JK, Gerlach M, Faraone SV. The World Federation of ADHD Guide. Porto Alegre: Artmed; 2019. Available from: http://www.russellbarkley.org/factsheets/TheWorldFederationOfAdhdGuide.pdf. Accessed in 2022 (Sep 28).

Fitzgerald M, McNicholas F. Attitudes and practices in the management of ADHD among healthcare professionals who responded to a European survey. Ir J Psychol Med. 2014;31(1):31-7. PMID: 30189470; https://doi.org/10.1017/ipm.2013.45.

American Psychiatric Association. DSM-5 Task Force. 5th ed. Washington, DC: American Psychiatric Publishing; 2013. https://doi.org/10.1176/appi.books.9780890425596.

World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: World Health Organization; 1993. Available from: https://apps.who.int/iris/handle/10665/37108.

Erbs GC. As várias formas de avaliação do TDAH na cidade de Joinville. Psicologia.pt. 2010. Available from: https://www.psicologia.pt/artigos/ver_artigo.php?codigo=A0540. Accessed in 2022 (Sep 28).

Peixoto ALB, Rodrigues MMP. Diagnóstico e tratamento de TDAH em crianças escolares, segundo profissionais da saúde mental. Aletheia. 2008;28:91-103. Available from: http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1413-03942008000200008&lng=pt. Accessed in 2022 (Sep 28).

Antshel KM, Olszewski AK. Cognitive behavioral therapy for adolescents with ADHD. Child Adolesc Psychiatr Clin N Am. 2014;23(4):825-42. PMID: 25220089; https://doi.org/10.1016/j.chc.2014.05.001.

Evans SW, Owens JS, Wymbs BT, Ray AR. Evidence-Based Psychosocial Treatments for Children and Adolescents With Attention Deficit/Hyperactivity Disorder. J ClinChild Adolesc Psychol. 2018;47(2):157-98.PMID: 29257898; https://doi.org/10.1080/15374416.2017.1390757.

Ferrin M, Sonuga-Barke E, Daley D, et al. Non-pharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD). In: Rey JM, editor. IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions; 2016. p. 1-23. Available from: https://iacapap.org/_Resources/Persistent/59eb6381de4a279b84838d2fc367fe701b0c50ea/D.1.1-ADHD-NON-PHARMA-2016.pdf. Accessed in 2022 (Sep 28).

He JA, Antshel KM. Cognitive behavioral therapy for attention-deficit/hyperactivity disorder in college students: a review of the literature. Cognitive and Behavioral Practice. 2017;24(2):152-73. https://doi.org/10.1016/j.cbpra.2016.03.010.

Knouse LE, Safren SA. Current status of cognitive behavioral therapy for adult attention-deficit hyperactivity disorder. Psychiatr Clin North Am. 2010;33(3):497-509. PMID: 20599129; https://doi.org/10.1016/j. psc.2010.04.001.

Hinshaw SP, Arnold LE; For the MTA Cooperative Group. ADHD, Multimodal Treatment, and Longitudinal Outcome: Evidence, Paradox, and Challenge. Wiley Interdiscip Rev Cogn Sci. 2015;6(1):39-52. PMID: 25558298; https://doi.org/10.1002/wcs.1324.

Rohde LA, Halpern R. Transtorno de déficit de atenção/hiperatividade: atualização [Recent advances on attention deficit/hyperactivity disorder]. J Pediatr (Rio J). 2004;80(2 Suppl):S61-70. PMID: 15154074; https://doi.org/10.2223/1170.

Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921. PMID: 17581453; https://doi.org/10.1097/chi.0b013e318054e724.

Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528. Erratum in: Pediatrics. 2020;145(3). PMID: 31570648; https://doi.org/10.1542/peds.2019-2528.

Bidwell LC, McClernon FJ, Kollins SH. Cognitive enhancers for the treatment of ADHD. Pharmacol Biochem Behav. 2011;99(2):262-74. PMID: 21596055; https://doi.org/10.1016/j.pbb.2011.05.002.

Sharma A, Couture J. A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). Ann Pharmacother. 2014;48(2):209-25. PMID: 24259638; https://doi.org/10.1177/1060028013510699.

Tripp G, Wickens JR. Neurobiology of ADHD. Neuropharmacology. 2009;57(7-8):579-89. PMID: 19627998; https://doi.org/10.1016/j.neuropharm.2009.07.026.

Zito JM, Safer DJ, DosReis S, et al. Psychotropic practice patterns for youth: a 10-year perspective. Arch Pediatr Adolesc Med. 2003;157(1):17-25. PMID: 12517190; https://doi.org/10.1001/archpedi.157.1.17.

Coghill D, Banaschewski T, Zuddas A, et al. Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies. BMC Psychiatry. 2013;13:237. Erratum in: BMC Psychiatry. 2015;15:202. PMID: 24074240; https://doi.org/10.1186/1471-244X-13-237.

Connor DF, Steingard RJ. New formulations of stimulants for attention-deficit hyperactivity disorder: therapeutic potential. CNS Drugs. 2004;18(14):1011-30. PMID: 15584770; https://doi.org/10.2165/00023210-200418140-00005.

Sharma A, Couture J. A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). Ann Pharmacother. 2014;48(2):209-25. PMID: 24259638; https://doi.org/10.1177/1060028013510699.32. Cortese S, Holtmann M, Banaschewski T, et al. Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. J Child Psychol Psychiatry. 2013;54(3):227-246. PMID: 23294014; https://doi. org/10.1111/jcpp.12036.

Graham J, Coghill D. Adverse effects of pharmacotherapies for attention-deficit hyperactivity disorder: epidemiology, prevention and management. CNS Drugs. 2008;22(3):213-37. PMID: 18278977; https://doi.org/10.2165/00023210-200822030-00003.

Pastura G, Mattos P. Efeitos colaterais do metilfenidato. Arch Clin Psychiatry (São Paulo). 2004;31(2):100-4. https://doi.org/10.1590/s0101-60832004000200006.

Spencer T, Biederman J, Wilens T. Nonstimulant treatment of adult attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2004;27(2):373-83. PMID: 15064003; https://doi.org/10.1016/j.psc.2003.12.001.

Waxmonsky JG. Nonstimulant therapies for attention-deficit hyperactivity disorder (ADHD) in children and adults. Essent Psychopharmacol. 2005;6(5):262-76. PMID: 16222911.

Dopheide JA, Pliszka SR. Attention-deficit-hyperactivity disorder: an update. Pharmacotherapy. 2009;29(6):656-79. PMID: 19476419; https://doi.org/10.1592/phco.29.6.656.

Carlini A, Nappo AS, Nogueira V, Naylor FGM. Metilfenidato: Influência da Notificação de Receita A (cor amarela) sobre a prática de prescrição por médicos brasileiros. Arch. Clin. Psychiatry (São Paulo). 2003;30(1):11-20. https://doi.org/10.1590/S0101-60832003000100002.

Greenhill L, Kollins S, Abikoff H, et al. Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. J Am Acad Child Adolesc Psychiatry. 2006;45(11):1284-93. Erratum in: J Am Acad Child Adolesc Psychiatry. 2007;46(1):141. PMID: 17023867; https://doi.org/10.1097/01.chi.0000235077.32661.61.

Canadian ADHD Resource Alliance (CADDRA): Canadian ADHD Practice Guidelines. Fourth Edition. Toronto ON: CADDRA; 2018.

NICE - National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder: diagnosis and management. Nice Guideline no 87. March, 2018. Available from: https://www.nice.org.uk/guidance/ng87/resources/attention-deficit-hyperactivity-disorder-diagnosis-and-management-pdf-1837699732933. Accessed in 2022 (Sep 28).

Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528. Erratum in: Pediatrics. 2020;145(3). PMID: 31570648; https://doi.org/10.1542/peds.2019-2528.

Aggarwal V, Aggarwal A, Khan D. Electrocardiogram before starting stimulant medications: to order or not? Cardiol Young. 2016;26(1):216-9. PMID: 26278960; https://doi.org/10.1017/S1047951115001274.

Elia J, Vetter VL. Cardiovascular effects of medications for the treatment of attention-deficit hyperactivity disorder: what is known and how should it influence prescribing in children? Paediatr Drugs. 2010;12(3):165-75. PMID: 20481646; https://doi.org/10.2165/11532570-000000000-00000.

Thapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet. 2016;387(10024):1240-50. PMID: 26386541; https://doi.org/10.1016/S0140-6736(15)00238-X.

Kaufmann R, Goldberg-Stern H, Shuper A. Attention-deficit disorders and epilepsy in childhood: incidence, causative relations and treatment possibilities. J Child Neurol. 2009;24(6):727-33. PMID: 19491115; https://doi.org/10.1177/0883073808330165.

Gonzalez-Heydrich J, Dodds A, Whitney J, et al. Psychiatric disorders and behavioral characteristics of pediatric patients with both epilepsy and attention-deficit hyperactivity disorder. Epilepsy Behav. 2007;10(3):384-8. PMID: 17368109; https://doi.org/10.1016/j.yebeh.2007.01.010.

Gucuyener K, Erdemoglu AK, Senol S, et al. Use of methylphenidate for attention-deficit hyperactivity disorder in patients with epilepsy or electroencephalographic abnormalities. J Child Neurol. 2003;18(2):109-12. PMID: 12693777; https://doi.org/10.1177/08830 738030180020601.

Gross-Tsur V, Manor O, van der Meere J, Joseph A, Shalev RS. Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective? J Pediatr. 1997;130(1):40-4. Corrected and republished in: J Pediatr. 1997;130(4):670-4. PMID: 9003849; https://doi.org/10.1016/s0022-3476(97)70308-1.

Hemmer SA, Pasternak JF, Zecker SG, Trommer BL. Stimulant therapy and seizure risk in children with ADHD. Pediatr Neurol. 2001;24(2):99-102. PMID: 11275457; https://doi.org/10.1016/s0887-8994(00)00240-x.

Rotta NT, Ohlweiler L, Riesgo RS. Transtornos da aprendizagem. abordagem neurobiológica e multidisciplinar. Porto Alegre: Editora Artmed; 2016. p. 262-356, 392-405.

Dulcan M. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry. 1997;36(10 Suppl):85S-121S. PMID: 9334567; https://doi.org/10.1097/00004583-199710001-00007.

Downloads

Publicado

2023-06-27

Como Citar

1.
Nunes MEN, Zuanetti PA, Hamad APA. Attitudes and practices in the management of attention deficit hyperactivity disorder among Brazilian pediatric neurologists who responded to a national survey: a cross-sectional study. Sao Paulo Med J [Internet]. 27º de junho de 2023 [citado 14º de março de 2025];141(4):1-8. Disponível em: https://periodicosapm.emnuvens.com.br/spmj/article/view/483

Edição

Seção

Artigo Original