National ADHD plan needed to standardise use: report — (The West Australian)

SSRI Ed note: Australian psychiatrists, paediatricians are inconsistent in how they prescribe stimulants, antidepressants to kids.

Original article no longer available

The West Australian

16th March 2008, 12:45 WST

Only a handful of ADHD kids are being prescribed stimulant drugs by a trained psychiatrist, with the vast majority getting treated by paediatricians who dish out varying doses, a report has found.

Population health experts are calling for a national plan to standardise treatment of the controversial condition after a new study showed “significant inconsistencies” in prescribing by psychiatrists and paediatricians.

A new report published in the Medical Journal of Australia today shows major differences in prescribing patterns between, and even within, the two clinical specialities that treat children with Attention Deficient Hyperactivity Disorder.

The study from Western Australia, where prescribing rates are 3.5 per cent higher than the national average, showed that the vast majority of ADHD children, 92 per cent, are treated by paediatricians, who have less mental health training than psychiatrists.

They generally prescribe lower doses of stimulant drugs Ritalin and dexamphetamine, though levels varied significantly from doctor to doctor.

Child and adolescent psychiatrists were more likely to give higher stimulant doses, and partner them with other medications like anti-depressants and anti-psychotic drugs.

Lead researcher David Preen, director of the Centre for Health Services Research at the University of Western Australia, said the results show significant inconsistencies in treatment for children with the disorder.

Differences in medication prescription between the two specialties may be because psychiatrists are more often referred children with psychiatric or behavioural disorders requiring multifaceted medication regimens, Dr Preen said.

“It is also feasible that the observed differences are due to fundamental variations surrounding ADHD diagnosis and treatment as a result of differing levels of mental health training.”

A WA parliamentary review in 2004 suggested that paediatricians were largely responsible for soaring prescribing rates because they had inadequate training on ADHD diagnosis and alternative non-drug treatment.

Dr Preen said there was a strong case for a federal plan to standardise treatment.

“A case could be made for the standardisation of diagnosis and treatment of ADHD within and between specialities,” he said.

“A state or national ADHD plan with consistency across clinical disciplines appears to have merit.”

The medical field has come under fire for supposed over-diagnosis and over-prescribing of stimulants to create a so-called “Ritalin generation”.

However, a NSW government review released last month stated that prescribing in the state mirrored international best practice and most of clinicians were “thoughtful and cautious” in their approach.