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Clinical factors associated with decision to recommend methylphenidate treatment for children with ADHD in France

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Abstract

European guidelines advise on best practices for the diagnosis and non-pharmacological and pharmacological treatment of attention-deficit hyperactivity disorder (ADHD). This study aimed to (1) assess whether clinician’s decisions to initiate methylphenidate treatment in children diagnosed with ADHD are in accordance with European guidelines and (2) identify clinical factors associated with the decision to recommend methylphenidate prescription. 5 to 13-year-old patients with an ADHD diagnosis were consecutively evaluated in an outpatient child and adolescent psychiatry clinic in France. Patients underwent a multidisciplinary evaluation including a diagnostic interview, symptom severity assessments with parent questionnaires, and IQ testing. We compared children with (n = 105) and without (n = 55) recommended methylphenidate treatment using Student’s t test or Wilcoxon Mann–Whitney test and Chi-square or Fisher’s test. Multivariate logistic regression was implemented to determine the respective influence of each variable on treatment recommendation. Recommendation to initiate methylphenidate treatment was associated with (1) ADHD combined presentation, (2) co-occurring Oppositional Defiant Disorder/Conduct Disorder (ODD/CD), Developmental Coordination Disorder (DCD) and Learning Disorder (LD), (3) clinical severity and impairment indicated on parent questionnaires, and (4) reduced perceptual reasoning. Using a multivariate regression model, ADHD combined presentation [combined versus predominantly hyperactive/impulsive and unspecified OR 4.52 (1.23–16.55), p = 0.023], age [OR 1.46 (1.14–1.88), p = 0.003], ODD/CD [OR 5.53 (2.19–14.01), p < 0.001], DCD [OR 4.22 (1.70–10.48), p = 0.002], PRI [OR 0.97 (0.94–0.99), p = 0.01] were significantly associated with recommendation of methylphenidate treatment. Our results indicate that clinicians’ treatment decision-making complies with European guidelines and is furthermore associated with the type and severity of ADHD symptoms but also with co-occurring disorders.

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Notes

  1. ICD-10 criteria for HKD hyperkinetic disorder require five inattentive, three hyperactive and one impulsive symptoms in several major life situations.

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Authors and Affiliations

  1. Médecine Psychologique de l’Enfant et de l’Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France

    Elodie Courtabessis, Florence Pupier, Laurie Surig, Elizabeth Stein & Diane Purper-Ouakil

  2. Unité de Recherche Clinique et Epidémiologie, Département Information Médicale, CHU Montpellier, 34295, Montpellier Cedex 5, France

    Marie-Christine Picot, Erika Nogué & Valérie Macioce

  3. INSERM, Centre d’Investigation Clinique 1411, Montpellier, France

    Marie-Christine Picot

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  1. Elodie Courtabessis
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Correspondence to Elodie Courtabessis.

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The author(s) EC, FP, LS, MCP, EN, VM, ES declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Pr Purper-Ouakil reports personal fees from Shire, Otsuka, Jensen and Boiron and research funding from Mensia outside the submitted work.

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The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: no funding.

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Courtabessis, E., Pupier, F., Surig, L. et al. Clinical factors associated with decision to recommend methylphenidate treatment for children with ADHD in France. Eur Child Adolesc Psychiatry 27, 367–376 (2018). https://doi.org/10.1007/s00787-017-1061-4

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