Upload
d
View
213
Download
1
Embed Size (px)
Citation preview
Paediatricians’ decision making about prescribingstimulant medications for children withattention-deficit/hyperactivity disorder
S-J. Chow,* E. Sciberras,*† L. H. Gillam,‡§ J. Green†¶** and D. Efron*†**
*Centre for Community Child Health, The Royal Children’s Hospital, Melbourne, Vic., Australia†Murdoch Childrens Research Institute, Melbourne, Vic., Australia‡Children’s Bioethics Centre, The Royal Children’s Hospital, Melbourne, Vic., Australia§School of Population Health, The University of Melbourne, Melbourne, Vic., Australia¶Parenting Research Centre, Melbourne, Vic., Australia, and**Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
Accepted for publication 3 December 2012
Keywordsattention-deficit/hyperactivity disorder,doctor decision making,qualitative, stimulantmedication
Correspondence:Emma Sciberras,Community Child Health,Murdoch ChildrensResearch Institute, TheRoyal Children’s Hospital,Flemington Road,Parkville, Vic. 3052,AustraliaE-mail: [email protected]
AbstractBackground Attention-deficit/hyperactivity disorder (ADHD) is now the most common reason for a
child to present to a paediatrician in Australia. Stimulant medications are commonly prescribed for
children with ADHD, to reduce symptoms and improve function. In this study we investigated the
factors that influence paediatricians’ decisions about prescribing stimulant medications.
Method In-depth, semi-structured interviews were conducted with paediatricians (n = 13) who
were purposively recruited so as to sample a broad demographic of paediatricians working in
diverse clinical settings. Paediatricians were recruited from public outpatient and private
paediatrician clinics in Victoria, Australia. The interviews were audio-recorded and transcribed
verbatim for thematic analysis. Paediatricians also completed a questionnaire describing their
demographic and practice characteristics.
Results Our findings showed that the decision to prescribe is a dynamic process involving two key
domains: (1) weighing up clinical factors; and (2) interacting with parents and the patient along
the journey to prescribing. Five themes relating to this process emerged from data analysis:
comprehensive assessments that include history, examination and information from others;
influencing factors such as functional impairment and social inclusion; previous success; facilitating
parental understanding including addressing myths and parental confusion; and decision-making
model.
Conclusions Paediatricians’ decisions to prescribe stimulant medications are influenced by
multiple factors that operate concurrently and interdependently. Paediatricians do not make
decisions about prescribing in isolation; rather, they actively involve parents, teachers and patients,
to arrive at a collective, well-informed decision.
Introduction
Attention-deficit/hyperactivity disorder (ADHD) affects
approximately 5% of children worldwide (Polanczyk et al.
2007) and is associated with an increased risk of educational
and social problems for affected children. Paediatricians are the
main doctors diagnosing ADHD (Concannon & Tang 2005)
and prescribing stimulant medications for children with ADHD
bs_bs_banner Child: care, health and developmentOriginal Article doi:10.1111/cch.12036
© 2013 John Wiley & Sons Ltd 301
in Australia (Western Australian Department of Health 2005).
In a recent Australian practice audit, 18% of patients attending
general or community paediatricians had ADHD, making
ADHD the most common diagnosis seen by paediatricians
(Hiscock et al. 2011).
Stimulant medication has been demonstrated to be the most
effective treatment for core ADHD symptoms (The MTA Coop-
erative Group 1999). In Australia, regulations in most states
and territories limit the prescribing of stimulant medications to
paediatricians and child and adolescent psychiatrists. Although
data collection systems for stimulant medication are variable,
best estimates are that approximately 1% of boys and 0.5%
of girls in the Australian population aged 10–14 years (peak
age of prescription) are prescribed stimulant medication
(Hollingworth et al. 2011), with some regional variation
(Berbatis et al. 2002; Reid et al. 2002; Calver et al. 2007).
Furthermore, in recent years more adults are being diag-
nosed with ADHD and treated with stimulant medications
(Salmelainen 2004).
Recent research has reported a rise in the prevalence of
ADHD, as well as stimulant medication prescription (Reid et al.
2002). Published guidelines from American Academy of Paedi-
atrics (Committee on Quality Improvement, Subcommittee on
Attention-Deficit/Hyperactivity Disorder 2000; Subcommittee
on Attention-Deficit/Hyperactivity Disorder & Committee
on Quality Improvement 2001), National Institute of Health
and Clinical Excellence (National Institute for Health and
Clinical Excellence 2009), as well as Australia’s draft National
Health and Medical Research Council (National Health and
Medical Research Council 2009) are available to guide paedia-
tricians in ADHD assessment and management. However, each
patient is unique. Presenting problems, symptom severity and
co-morbidities vary between patients, as do family background,
and parental beliefs and expectations. In behavioural medicine,
few patients fit neatly into a clinical management box, rendering
therapeutic decision making challenging.
Although the efficacy of stimulant medication has been
established in treating core ADHD symptoms (The MTA Coop-
erative Group 1999), some paediatricians may be hesitant
to prescribe stimulant medications because of potential side
effects or the risk of patients or others abusing their medica-
tions (Stockl et al. 2003; Wilens et al. 2003; Katragadda &
Schubiner 2007); while others may be reluctant to treat behav-
ioural problems with medication for philosophical reasons
(Safer 2000). This qualitative study aimed to investigate how
paediatricians make decisions about whether to prescribe
stimulant medication for children with ADHD including the
factors which shape decision making in different contexts.
Methods
Sample
Participants were general paediatricians in Victoria, Australia,
sourced from the Royal Australasian College of Physicians
membership list. Participants were purposively sampled from
diverse settings to ensure a spread across a range of provider
characteristics including: (1) type of service model (public out-
patient versus private clinics); (2) clinic location (metropolitan
versus rural); and (3) paediatrician’s level of experience. Ethics
approval for the study was obtained from the Royal Children’s
Hospital Human Research Ethics Committee.
Data collection
Interviews were individual and semi-structured with open-
ended questions based on the published literature. The in-depth
interview is a powerful methodology that enables a researcher
to understand informants’ views through responses shaped by
informants themselves (Popay & Williams 1996), without pre-
supposing the parameters of discussion (Morse 1991). With
their capacity for producing elaborate and detailed accounts
(Seale 2004), interviews are frequently used in the health field to
understand how people view a particular issue, behave a certain
way or change their practices (Silverman 2006; Daly et al. 2007).
Interview duration ranged from 15 to 102 min. Interviews
were audio-recorded, de-identified and transcribed for analysis.
Paediatricians also completed a questionnaire detailing their
demographic and practice characteristics. We ceased data col-
lection when data saturation was reached.
Data analysis
In accordance with the preferred practice in qualitative research,
data analysis occurred alongside data collection to allow for
integration of new concepts and questions into the interview
schedule (Gibbs et al. 2007), providing opportunities to explore
additional issues that arose during the course of the research
(Denzin & Lincoln 2000). Interview data were analysed using
thematic analysis, with four key steps: (i) immersion in the data;
(ii) coding; (iii) creating conceptual categories; and (iv) identi-
fication of themes by linking categories with theoretical models
of physician’s decision making from the literature review
(Green et al. 2007). Codes and categories were discussed within
the team to ensure interpretive rigour. Data collected from the
demographic questionnaire were de-identified, grouped and
analysed using descriptive statistical methods.
302 S-J. Chow et al.
© 2013 John Wiley & Sons Ltd, Child: care, health and development, 40, 3, 301–308
Results
Sample characteristics
We interviewed 13 paediatricians. Participant characteristics are
outlined in Table 1. The number of patients with ADHD seen by
paediatricians was wide-ranging, as was paediatricians’ levels of
experience. Participants’ confidence in managing patients with
ADHD was high, with 85% of paediatricians self-rating as ‘very
confident’.
Domains and themes
The thematic analysis identified two principal domains encap-
sulating five discrete themes. The two domains were ‘weighing
up clinical factors’ and ‘journey to prescribing’. Together, they
highlight that the decision to prescribe is a dynamic process
involving an interplay between firstly, weighing up clinical
factors and secondly, interacting with parents and the patient in
the journey to prescribing. Each domain revealed emerging
themes (T1–5) (Fig. 1) which are detailed and illustrated below
using excerpts from the data.
Domain 1: Weighing up clinical factors
Theme 1: Comprehensive assessments Paediatricians conducted
comprehensive assessments to diagnose ADHD and assess the
child’s functional impairment. Assessments included a detailed
medical, family and social history, as well as a physical exami-
nation, and direct information from teachers. Validated ques-
tionnaires and psychological assessments, particularly cognitive
assessments, were used by some paediatricians, but not all.
Theme 2: Influencing factors Key factors related to the child
were the severity of functional impairment and social exclusion.
While academic failure was a major determinant in prescribing
stimulant medication, paediatricians commonly considered
social impairment a stronger impetus to prescribe:
The important things are quality of life . . . which brings
on the issue of when it is justified to use medications.
What does that mean? That means when it is affecting
their mental health, when it is affecting their self-esteem,
when it is affecting their peer relationships and when it is
affecting their family life adversely. (Paediatrician 9)
Our findings highlighted that paediatricians prescribed more
cautiously in younger children and with children with complex
co-morbidities:
Age is obviously one of those issues, we have children
who are four and it is pretty clear that the diagnosis is
ADHD but you would prefer not to start the medication
early unless there were some really severe behavioural
consequences. (Paediatrician 4)
Behavioural and educational strategies were utilized in conjunc-
tion with medication as first-line management to treat children
with ADHD. However, some tended to reserve medication until
non-medication treatments had been exhausted, especially for
younger children:
All the strategies have been implemented anyway. And
when they’re coming to you, you know they’ve already
done all of that . . . And the child’s not getting anywhere.
(Paediatrician 13)
Paediatricians identified family dysfunction as a major contrib-
uting factor. In particular, they considered discussing medica-
tion as a treatment option sooner, if the family was not coping:
Table 1. Characteristics of study participants
Characteristic n (%)
Age (years)30–39 3 (23)40–49 2 (15)50–59 5 (39)60–69 3 (23)
GenderFemale 5 (38)Male 8 (62)
Number of years working with children with ADHD0–9 3 (23)10–19 2 (15)20–29 6 (46)30–39 2 (15)
Number of ADHD patients per week<5 3 (23)5–10 4 (31)11–20 4 (31)>20 2 (15)
Practice type100% public patients 4 (31)Mixed public and private patients 6 (46)100% private patients 3 (23)
Location of practiceMetropolitan 9 (69)Outer metropolitan 2 (15)Rural 2 (15)
Confidence in ADHD management (out of 5)<3 0 (0)3–3.9 1 (8)4–4.9 1 (8)5 11 (85)
ADHD, attention-deficit/hyperactivity disorder.
Paediatricians’ decision making in ADHD 303
© 2013 John Wiley & Sons Ltd, Child: care, health and development, 40, 3, 301–308
If the child is at a crisis situation that would certainly
push me towards discussing medication earlier. (Paedia-
trician 5)
When parents were reluctant or uncertain about medication,
particularly when inter-parental conflicts were encountered,
initiation of medication was delayed as paediatricians contin-
ued discussions over a number of visits. Paediatricians sought to
explore parents’ understanding and ensure that both parents
were fully informed and educated:
This is a really important decision for these families, so,
I don’t care how long it takes. The easy bit is prescribing
and supervising the medication. The complex bit is
getting to the point of doing that and it can be ten con-
sultations if they want it. (Paediatrician 7)
Theme 3: Significance of previous success Paediatricians
acknowledged the complexity of managing ADHD, yet were
simultaneously confident in prescribing largely due to their
own past experience of success in using stimulant medications.
Evidence of the efficacy and safety of stimulant medications also
contributed to their confidence:
My experience is very much governed by the success I’ve
had with treatments also, so success leads to success.
ADHD is really one of the few conditions in paediatrics
full stop where you can make such a big difference to
the child, the education, the self-esteem, the family . . .
(Paediatrician 8)
Although some paediatricians expressed reluctance and dis-
comfort about prescribing stimulant medications on the basis
that they were giving medications for behavioural problems,
they still recognized that it is an effective treatment modality:
Unfortunately, medication is possibly the best thing to
do in this situation and even though you nor I like the
thought of it. I really try and put in the context of the
things that people know from research and experience.
(Paediatrician 6)
Domain 2: The journey to prescribing
This domain describes the interactions between the paediatri-
cian, parents and patient during the consultation. In particular,
parental understanding and preferences play an integral part in
the paediatrician’s decision.
Theme 4: Facilitating parental understanding Communication
with parents forms the basis of the journey to prescribing
stimulant medication. The way in which paediatricians com-
municated with parents was aimed at shaping and facilitating
discussions, leading to parental understanding of the diagnosis
and management.
Figure 1. Domains (D) and themes (T).
304 S-J. Chow et al.
© 2013 John Wiley & Sons Ltd, Child: care, health and development, 40, 3, 301–308
There were variations in the explanation of ADHD that
paediatricians reported giving to parents, but descriptions
of the core symptoms of ADHD were common across all
paediatricians’ accounts. Additionally, paediatricians also tried
to explain the condition in relation to the individual child’s
presentation and context:
There could be a whole lot of factors coming into it and
I like to try and give them a picture of why their child
appears to be the way that he or she is. (Paediatrician 4)
To further facilitate the parents’ understanding of ADHD,
paediatricians identified myths surrounding ADHD in society
and helped steer parents away from the confusion:
I find that there are a lot of myths which are perpetrated
by the media . . . this is not a new diagnosis, but it’s a
condition which has been around and treated for a long
time. (Paediatrician 7)
Theme 5: Decision-making model: (a) Roles and responsibilities
in decisions Paediatricians actively enlisted the participation
of parents in the decision-making process. The role of parents
varied from being joint decision makers, final decision makers
to more commonly, being guided by the recommendations
offered by paediatricians. However, paediatricians tended to
view the ultimate decision to medicate was to be made by
parents:
I would give them all the options, and then say this would
be my recommendation, but you know, obviously the
ultimate decision is with them. (Paediatrician 13)
Many emphasized that parents must not feel that they are being
forced to give their children medications. Instead, they should
be given the time and accurate information to enable them to
arrive at an informed decision:
The one thing that I don’t want to do is make people feel
they’re being railroaded into it. I’ll say ‘look you need a
little time to think about it’. (Paediatrician 9)
Theme 5: Decision-making model: (b) Involvement of child We
found that paediatricians could be uncomfortable when pre-
scribing medications and saw it as their responsibility to ensure
that they were acting in the child’s best interest. Participation
of the child in decision making was encouraged by some
paediatricians:
I know that the evidence is strongly in favour of medica-
tion being beneficial or more beneficial than anything
else but I still don’t like the idea of giving a child some-
thing that modifies how that child brain works. Because
what we are doing is we are acting in what we think are
the child’s best interests. We are putting ourselves on
the line in terms of responsibility . . . If it comes to the
stage of us thinking about medication, (I) will introduce
the proposition to not just the parents but the child.
(Paediatrician 6)
Discussion
Therapeutic decision making involves a complex analytical
process. Paediatricians integrate multiple variables including
clinical symptoms, co-morbidities and child/family factors
when making treatment decisions (Cebul & Beck 1985). Our
study demonstrated that paediatrician decision making regard-
ing whether to initiate stimulant medication is a dynamic
process involving two primary domains. These domains are not
isolated entities. Rather, they are interwoven in the paediatri-
cians’ practice, concurrently and interdependently.
To elaborate, the paediatrician first weighs up clinical
factors that would be in support of or militate against a deci-
sion to prescribe, including symptom severity and functional
impairment. Decision making is also influenced by the pae-
diatrician’s previous experiences. After the paediatrician has
considered these factors, they often make a preliminary deci-
sion that a trial of medication would be in the patient’s best
interest.
The second domain of decision making occurs predomi-
nantly during the interaction with the parents, where parental
understanding and preferences play a role. Style of communi-
cation plays an important role in gauging and facilitating paren-
tal understanding of aetiology, diagnosis and treatment. The
child, especially if older, is often involved. The ethics of prac-
tising medicine calls for the exercise of clinical judgement in
response to patient and parent needs, and respect for patient
autonomy is now recognized as an important element in any
clinical care plan (Mandell 2008). Interactions with parents may
consolidate or delay paediatricians’ decision to prescribe. In this
study, paediatricians emphasized that they were at pains for
parents not to feel that they are being forced to give their child
medication.
One critical factor which influenced the decision to prescribe
stimulant medications was severity of functional impairment.
This view is reflected in the higher rate of treatment for children
aged 7–15 years, as academic and social impairments become
more noticeable (Salmelainen 2002; Preen et al. 2007). The
child’s level of functional impairment was also reported to be
Paediatricians’ decision making in ADHD 305
© 2013 John Wiley & Sons Ltd, Child: care, health and development, 40, 3, 301–308
influential in a qualitative study examining treatment decision
making by parents of children with ADHD (Brinkman et al.
2009). Paediatricians were more cautious when prescribing
for children under the age of 6 and children with complex
co-morbidities, where non-pharmacological treatments tended
to be implemented first. This prescribing pattern is consis-
tent with recommendations in ADHD practice guidelines, and
appears to be shared by the wider paediatric community
(Guevara et al. 2001; Jick et al. 2004; Preen et al. 2007;
National Health and Medical Research Council 2009).
Our study indicated that paediatricians were confident but
careful prescribers. This was influenced by the combination
of their previous clinical experience and research documenting
the efficacy and safety of stimulant medications. These converge
when they exercised clinical judgment, reflecting a similar con-
vergence in other medical decision making where evidence,
inference and experience were not competing ideologies but
‘complementary methodologies for synthesizing empirical
data’ (Marshall 2006). These findings are consistent with other
studies which have examined the prescribing practices of
doctors (Prosser & Walley 2006; Lin et al. 2011). Despite recent
reports that the prescribing rates for stimulant medications
for ADHD have increased (Reid et al. 2002), our data suggest
that paediatricians put considerable thought into the decision
to prescribe. Paediatricians assessed the presenting problem,
constructed a multi-informant picture, gave recommendations
and offered treatment options.
This study had some limitations. The sample of paedia-
tricians participating was Victorian, and decision making
may be different for paediatricians working in different
regions. We interviewed a relatively small number of paedia-
tricians; however, interviews ceased because data saturation
was reached; this approach is consistent with other qualitative
studies examining doctors’ decision making (Prosser & Walley
2006).
Decision making in relation to the prescription of stimulant
medication is a ‘science meets art’ area of paediatric medicine. It
requires excellent communication skills to build collaborative
partnerships with parents and children. The findings from our
study can be used to highlight areas where further emphasis
may be required in paediatric training, and raise paediatricians’
awareness in the evaluation and reflection of their clinical deci-
sion making. Although paediatricians in this study reported
that they work closely with parents when making decisions,
previous research has reported that shared decision making
between parents and paediatricians is low and that higher levels
of shared decision making is predicted by higher family socio-
economic status (Brinkman et al. 2011). Future research should
examine how shared decision making can be fostered in paedi-
atric consultations.
Decision making in prescribing for ADHD is a dynamic
process, involving the interplay of multiple factors, including
the child’s functional impairment, in navigating the journey to
prescribing. Overall, paediatricians are confident prescribers
shaped by their clinical experiences and knowledge of best
practice evidence. Paediatricians do not make decisions about
prescribing in isolation; rather, they actively involve parents,
teachers and patients. They provide education and strive to
allow the parents and the patients, in particular adolescents, to
arrive at a well-informed decision.
Key messages
• Published guidelines are available to guide paediatricians
in ADHD assessment and treatment. However, many indi-
vidual factors including symptom severity, co-morbidities,
family background and parental management preferences
vary between patients.
• This study found that decision making in prescribing for
ADHD is a dynamic process, involving the interplay of
multiple factors, including the child’s functional impair-
ment, in navigating the journey to prescribing.
• The findings can be used to raise paediatricians’ awareness
in the evaluation and reflection of their clinical decision
making.
Conflict of interests
The authors have indicated that they have no financial relation-
ship relevant to this article to disclose. All authors had full access
to all of the data (including statistical reports and tables) in the
study.
Acknowledgements
Dr Sciberras’ position was funded by an Australian National
Health and Medical Research Council (NHMRC) Population
Health Capacity Building Grant 436914 and an NHMRC Early
Career Research Fellowship (1037159) for the duration of this
manuscript’s preparation. Dr Green was partially funded by an
NHMRC Post-Doctoral Fellowship (607419). This research was
supported by the Victorian Government’s Operational Infra-
structure Support Program to the MCRI. We thank all of the
participating paediatricians for their contribution to this study.
306 S-J. Chow et al.
© 2013 John Wiley & Sons Ltd, Child: care, health and development, 40, 3, 301–308
References
Berbatis, C., Sunderland, V. & Bulsara, M. (2002) Licit
psychostimulant consumption in Australia 1984–2000:
international and jurisdictional comparison. Medical Journal
of Australia, 177, 539–543.
Brinkman, W. B., Sherman, S. N., Zmitrovich, A. R., Visscher, M. O.,
Crosby, L. E., Phelan, K. J. & Donovan, E. F. (2009) Parental
angst making and revisiting decisions about treatment of
attention-deficit/hyperactivity disorder. Pediatrics, 124, 580–589.
Brinkman, W. B., Hartl, J., Rawe, L. M., Sucharew, H., Britto, M. T. &
Epstein, J. N. (2011) Physicians’ shared decision-making behaviors
in attention-deficit/hyperactivity disorder care. Archives of
Pediatrics and Adolescent Medicine, 165, 1013–1019.
Calver, J., Preen, D., Bulsara, M. & Sanfilippo, F. (2007) Stimulant
prescribing for the treatment of ADHD in Western Australia:
socioeconomic and remoteness differences. Medical Journal of
Australia, 186, 124–127.
Cebul, R. & Beck, L. (1985) Teaching Clinical Decision Making.
Praeger, New York, NY, USA.
Committee on Quality Improvement, Subcommittee on
Attention-Deficit/Hyperactivity Disorder (2000) Clinical
practice guideline: diagnosis and evaluation of the child with
attention-deficit/hyperactivity disorder. Pediatrics, 105,
1158–1170.
Concannon, P. E. & Tang, Y. P. (2005) Management of attention
deficit hyperactivity disorder: a parental perspective. Journal of
Paediatrics and Child Health, 41, 625–630.
Daly, J., Willis, K., Small, R., Green, J., Welch, N., Kealy, M. &
Hughes, E. (2007) A hierarchy of evidence for assessing qualitative
health research. Journal of Clinical Epidemiology, 60, 43–49.
Denzin, N. & Lincoln, Y. (2000) Handbook of Qualitative Research,
2nd edn. Sage, Thousand Oaks, CA, USA.
Gibbs, L., Kealy, M., Willis, K., Green, J., Welch, N. & Daly, J. (2007)
What have sampling and data collection got to do with good
qualitative research? Australian and New Zealand Journal of Public
Health, 31, 540–544.
Green, J., Willis, K., Hughes, E., Small, R., Welch, N., Gibbs, L. &
Daly, J. (2007) Generating best evidence from qualitative research:
the role of data analysis. Australian and New Zealand Journal of
Public Health, 31, 545–550.
Guevara, J., Lozano, P., Wickizer, T., Mell, L. & Gephart, H. (2001)
Utilization and cost of health care services for children with
attention-deficit/hyperactivity disorder. Pediatrics, 108, 71–78.
Hiscock, H., Roberts, G., Efron, D., Sewell, J. R., Bryson, H. E., Price,
A. M., Oberklaid, F., South, M. & Wake, M. A. (2011) Children
Attending Paediatricians Study: a national prospective audit of
outpatient practice from the Australian Paediatric Research
Network. Medical Journal of Australia, 194, 392–397.
Hollingworth, S. A., Nissen, L. M., Stathis, S. S., Siskind, D. J.,
Varghese, J. M. N. & Scott, G. (2011) Australian national trends
in stimulant dispensing: 2002–2009. Australian and New Zealand
Journal of Psychiatry, 45, 332–336.
Jick, H., Kaye, J. A. & Black, C. (2004) Incidence and prevalence of
drug-treated attention deficit disorder among boys in the UK.
British Journal of General Practice, 54, 345–347.
Katragadda, S. & Schubiner, H. (2007) ADHD in children,
adolescents, and adults. Primary Care, 34, 317–341; abstract viii.
Lin, S., Jan, K. & Kao, J. (2011) Colleague interactions and new drug
prescribing behavior: the case of the initial prescription of
antidepressants in Taiwanese medical centers. Social Science &
Medicine, 73, 1208–1213.
Mandell, M. S. (2008) Can we really randomize the thought process?
Critical Care Medicine, 36, 633–634.
Marshall, J. C. (2006) Surgical decision-making: integrating evidence,
inference, and experience. Surgical Clinics of North America, 86,
201–215.
Morse, J. (1991) Qualitative Nursing Research: A Contemporary
Dialogue. Sage, London, UK.
National Health and Medical Research Council (2009) Draft
Australian Guidelines on ADHD. National Health and Medical
Research Council, Australian Government.
National Institute for Health and Clinical Excellence (2009) Attention
Deficit Hyperactivity Disorder: Diagnosis and Management of
ADHD in Children, Young People and Adults. British Psychological
Society, London, UK.
Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J. & Rohde,
L. A. (2007) The worldwide prevalence of ADHD: a systematic
review and metaregression analysis. American Journal of Psychiatry,
164, 942–948.
Popay, J. & Williams, G. (1996) Public health research and lay
knowledge. Social Science & Medicine, 42, 759–768.
Preen, D. B., Calver, J., Sanfilippo, F. M., Bulsara, M. & Holman, C. D.
(2007) Patterns of psychostimulant prescribing to children with
ADHD in Western Australia: variations in age, gender, medication
type and dose prescribed. Australian and New Zealand Journal of
Public Health, 31, 120–126.
Prosser, H. & Walley, T. (2006) New drug prescribing by hospital
doctors: the nature and meaning of knowledge. Social Science &
Medicine, 62, 1565–1578.
Reid, R., Hakendorf, P. & Prosser, B. J. (2002) Use of psychostimulant
medication for ADHD in South Australia. Journal of the American
Academy of Child & Adolescent Psychiatry, 41, 906–913.
Safer, D. J. (2000) Are stimulants overprescribed for youths with
ADHD? Annals of Clinical Psychiatry, 12, 55–62.
Salmelainen, P. (2002) Trends in the prescribing of stimulant
medication for the treatment of attention deficit hyperactivity
disorder in children and adolescents in New South Wales. NSW
Public Health Bulletin, 13, 1–65.
Salmelainen, P. (2004) Trends in the prescribing of stimulant
medication for the treatment of attention deficit hyperactivity
disorder in adults in NSW. NSW Public Health Bulletin, 15,
S-3.
Seale, C. (2004) Qualitative Research Practice. Sage, Thousand Oaks,
CA, USA.
Silverman, D. (2006) Interpreting Qualitative Data: Methods for
Analysing Talk, Text and Interaction, 3rd edn. Sage, London, UK.
Paediatricians’ decision making in ADHD 307
© 2013 John Wiley & Sons Ltd, Child: care, health and development, 40, 3, 301–308
Stockl, K. M., Hughes, T. E., Jarrar, M. A., Secnik, K. & Perwien,
A. R. (2003) Physician perceptions of the use of medications
for attention deficit hyperactivity disorder. Journal of Managed
Care Pharmacy, 9, 416–423.
Subcommittee on Attention-Deficit/Hyperactivity Disorder
Committee on Quality Improvement (2001) Clinical
practice guideline: treatment of the school-aged child with
attention-deficit/hyperactivity disorder. Pediatrics, 108,
1033–1044.
The MTA Cooperative Group (1999) A 14-month randomized
clinical trial of treatment strategies for attention-deficit/
hyperactivity disorder. Multimodal Treatment Study of
Children with ADHD. Archives of General Psychiatry, 56,
1073–1086.
Western Australian Department of Health (2005) Stimulant
Prescribing and Usage Patterns for the Treatment of ADHD
in Western Australia (1 August 2003–31 December 2004).
Pharmaceutical Services Branch, Department of Health,
Western Australia. Available at: http://www.public.health.
wa.gov.au/cproot/3609/2/03-04_Report.pdf.
Wilens, T. E., Faraone, S. V., Biederman, J. & Gunawardene, S.
(2003) Does stimulant therapy of attention-deficit/hyperactivity
disorder beget later substance abuse? A meta-analytic review
of the literature. Pediatrics, 111, 179–185.
308 S-J. Chow et al.
© 2013 John Wiley & Sons Ltd, Child: care, health and development, 40, 3, 301–308