ABSTRACT
Objectives:
Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. Methylphenidate is a drug commonly used in the management of ADHD. Children with ADHD symptoms may firstly be applied to family practitioners, pediatricians and/or other physicians. Therefore, it is aimed to understand the attitudes, beliefs and knowledge of non-psychiatrist physicians about ADHD and methylphenidate treatment in this study.
Materials and Methods:
In our study, general practitioners and specialists were asked to answer questions such as their perceptions about ADHD and the scientificness of ADHD treatment, what they recommend to patients who were applied to them with attention problems and hyperactivity, and their recommendations to patients using methylphenidate. Data for this study were collected via an internet-based survey designed by the researcher using Google forms®.
Results:
Most of the 361 participants (96.4%) stated that they referred children with attention problems and/or hyperactivity to child and adolescent psychiatry. Likewise, 95.8% of the participants recommended to continue their treatment to patients using methylphenidate. 74.1% of the participants agreed that the diagnosis and treatment of ADHD had been supported by many scientific studies for many years. While 28.1% of the respondents thought that methylphenidate was addictive, 29.2% did not. 32.1% of the participants stated that methylphenidate can be misused. 35.3% of participants believed that there was an overdiagnosis of ADHD among children and 30.9% believed that many children were prescribed MPH unnecessarily.
Conclusion:
It is important to inform non-psychiatrist physicians about ADHD in terms of referring patients to child and adolescent psychiatry, and ensuring the continuation of ADHD treatment. Our study is among the few studies about the awareness of other physicians about ADHD in our country. Studies with more physicians are needed in relation to this issue.
References
1
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;164:942-948.
2
Ercan ES, Polanczyk G, Akyol Ardıc U, Yuce D, Karacetın G, Tufan AE, Tural U, Aksu H, Aktepe E, Rodopman Arman A, Başgül S, Bılac O, Coşkun M, Celık GG, Karakoc Demırkaya S, Dursun BO, Durukan İ, Fidan T, Perdahlı Fiş N, Gençoğlan S, Gökçen C, Görker I, Görmez V, Gündoğdu ÖY, Gürkan CK, Hergüner S, Tural Hesapçıoğlu S, Kandemir H, Kılıç BG, Kılınçaslan A, Mutluer T, Nasiroğlu S, Özel Özcan Ö, Öztürk M, Öztop D, Yalın Sapmaz S, Süren S, Şahin N, Yolga Tahıroglu A, Toros F, Ünal F, Vural P, Perçinel Yazıcı İ, Yazıcı KU, Yıldırım V, Yulaf Y, Yüce M, Yüksel T, Akdemir D, Altun H, Ayık B, Bilgic A, Hekim Bozkurt Ö, Demirbaş Çakır E, Çeri V, Üçok Demir N, Dinç G, Irmak MY, Karaman D, Kınık MF, Mazlum B, Memik NÇ, Foto Özdemir D, Sınır H, Ince Taşdelen B, Taşkın B, Uğur Ç, Uran P, Uysal T, Üneri Ö, Yilmaz S, Seval Yılmaz S, Açıkel B, Aktaş H, Alaca R, Alıç BG, Almaidan M, Arı FP, Aslan C, Atabay E, Ay MG, Aydemir H, Ayrancı G, Babadagı Z, Bayar H, Çon Bayhan P, Bayram Ö, Dikmeer Bektaş N, Berberoğlu KK, Bostan R, Arıcı Canlı M, Cansız MA, Ceylan C, Coşkun N, Coşkun S, Çakan Y, Demir İ, Demir N, Yıldırım Demirdöğen E, Doğan B, Dönmez YE, Dönder F, Efe A, Eray Ş, Erbilgin S, Erden S, Ersoy EG, Eseroğlu T, Kına Fırat S, Eynallı Gök E, Güler G, Güles Z, Güneş S, Güneş A, Günay G, Gürbüz Özgür B, Güven G, Çelik Göksoy Ş, Horozcu H, Irmak A, Işık Ü, Kahraman Ö, Kalaycı BM, Karaaslan U, Karadağ M, Kılıc HT, Kılıçaslan F, Kınay D, Kocael Ö, Bulanık Koç E, Kadir Mutlu R, Lushi-Şan Z, Nalbant K, Okumus N, Özbek F, Akkuş Özdemir F, Özdemir H, Özkan S, Yıldırım Özyurt E, Polat B, Polat H, Sekmen E, Sertçelik M, Sevgen FH, Sevince O, Süleyman F, Shamkhalova Ü, Eren Şimşek N, Tanır Y, Tekden M, Temtek S, Topal M, Topal Z, Türk T, Uçar HN, Uçar F, Uygun D, Uzun N, Vatansever Z, Yazgılı NG, Miniksar Yıldız D, Yıldız N. The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T). Nord J Psychiatry. 2019;73:132-140.
3
Zorlu A, Unlu G, Cakaloz B, Zencir M, Buber A, Isildar Y. The Prevalence and Comorbidity Rates of ADHD Among School-Age Children in Turkey. J Atten Disord. 2020;24:1237-1245.
4
Shier AC, Reichenbacher T, Ghuman HS, Ghuman JK. Pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: clinical strategies. J Cent Nerv Syst Dis. 2012;5:1-17.
5
Lange KW, Reichl S, Lange KM, Tucha L, Tucha O. The history of attention deficit hyperactivity disorder. Atten Defic Hyperact Disord. 2010;2:241-255.
6
Shellenberg TP, Stoops WW, Lile JA, Rush CR. An update on the clinical pharmacology of methylphenidate: therapeutic efficacy, abuse potential and future considerations. Expert Rev Clin Pharmacol. 2020;13:825-833.
7
Malenka RC, Nestler EJ, Hyman SE, Sydor A, Brown RY. Molecular neuropharmacology: a foundation for clinical neuroscience, Chapter 15: Reinforcement and Addictive Disorders. In: Sydor A BR, ed. NY: McGraw-Hill Medical. New York: McGraw-Hill Medical.; 2009:368.
8
Tatlow-Golden M, Prihodova L, Gavin B, Cullen W, McNicholas F. What do general practitioners know about ADHD? Attitudes and knowledge among first-contact gatekeepers: systematic narrative review. BMC Fam Pract. 2016;17:129.
9
Ghanizadeh A, Zarei N. Are GPs adequately equipped with the knowledge for educating and counseling of families with ADHD children? BMC Fam Pract. 2010;11:5.
10
Shaw K, Wagner I, Eastwood H, Mitchell G. A qualitative study of Australian GPs’ attitudes and practices in the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD). Fam Pract. 2003;20:129-134.
11
Kandemir H, Selek S, Kılıcaslan F, Bayazıt H, Ekinci S, Kandemir SB, Güler K. Dikkat Eksikliği Hiperaktivite Bozukluğunda Şanlıurfa’da Görev Yapmakta Olan Pediatristlerin Bilgi ve Tutumları. Journal of Harran University Medical Faculty. 2014;11:223-230.
12
Soysal AŞ, Can H, Tan S, Keskinoğlu P, Elmastaş-Dikeç B. Evaluation of the knowledge level of psychology students on Attention Deficiency and Hyperactivity Disorder. Journal of Human Sciences. 2011;8:1601-1611.
13
Sabuncuoğlu M, Sevsen C, Mohammad Rahbar H, Manouchehr H. Autism spectrum disorder and attention deficit hyperactivity disorder: Knowledge and attitude of family medicine residents in Turkey. Turkish Journal of Family Medicine & Primary Care. 2015;9:46-53.
14
Adamis D, Tatlow-Golden M, Gavin B, McNicholas F. General practitioners’ (GP) attitudes and knowledge about attention deficit hyperactivity disorder (ADHD) in Ireland. Ir J Med Sci. 2019;188:231-239.
15
Sayal K, Goodman R, Ford T. Barriers to the identification of children with attention deficit/hyperactivity disorder. J Child Psychol Psychiatry. 2006;47:744-750.
16
Salt N, Parkes E, Scammell A. GPs’ perceptions of the management of ADHD in primary care: a study of Wandsworth GPs. Primary Health Care Research & Development. 2005;6:162-171.
17
Schwarz A. The selling of attention deficit disorder. New York Times. 2013:1-15.
18
Visser SN, Bitsko RH, Danielson ML, Perou R, Blumberg SJ. Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children-United States, 2003 and 2007. Morbidity and mortality weekly report. 2010;59:1439-1443.
19
Giuliano K, Geyer E. ADHD: Overdiagnosed and overtreated, or misdiagnosed and mistreated. Cleveland Clinic journal of medicine. 2017;84:873-880.
20
Storebø OJ, Krogh HB, Ramstad E, Moreira-Maia CR, Holmskov M, Skoog M, Nilausen TD, Magnusson FL, Zwi M, Gillies D. Methylphenidate for attention-deficit/hyperactivity disorder in children and adolescents: Cochrane systematic review with meta-analyses and trial sequential analyses of randomised clinical trials. BMJ. 2015;351.
21
Fazel M. Methylphenidate for ADHD. BMJ. 2015;351:5875.
22
Hoekstra PJ, Buitelaar JK. Is the evidence base of methylphenidate for children and adolescents with attention-deficit/hyperactivity disorder flawed? Eur Child Adolesc Psychiatry. 2016;25:339-340.
23
Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. J Clin Child Adolesc Psychol. 2018;47:199-212.
24
Dürsteler KM, Berger EM, Strasser J, Caflisch C, Mutschler J, Herdener M, Vogel M. Clinical potential of methylphenidate in the treatment of cocaine addiction: a review of the current evidence. Subst Abuse Rehabil. 2015;6:61-74.
25
Schubiner H, Saules KK, Arfken CL, Johanson CE, Schuster CR, Lockhart N, Edwards A, Donlin J, Pihlgren E. Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Exp Clin Psychopharmacol. 2002;10:286-294.
26
Kollins SH. ADHD, substance use disorders, and psychostimulant treatment: current literature and treatment guidelines. J Atten Disord. 2008;12:115-125.
27
Parran TV Jr, Jasinski DR. Intravenous methylphenidate abuse. Prototype for prescription drug abuse. Arch Intern Med. 1991;151:781-783.
28
Coetzee M, Kaminer Y, Morales A. Megadose intranasal methylphenidate (ritalin) abuse in adult attention deficit hyperactivity disorder. Subst Abus. 2002;23:165-169.
29
Levy S, Katusic SK, Colligan RC, Weaver AL, Killian JM, Voigt RG, Barbaresi WJ. Childhood ADHD and risk for substance dependence in adulthood: a longitudinal, population-based study. PLoS One. 2014;9:105640.
30
Ohlmeier MD, Peters K, Te Wildt BT, Zedler M, Ziegenbein M, Wiese B, Emrich HM, Schneider U. Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD). Alcohol Alcohol. 2008;43:300-304.
31
Fatséas M, Hurmic H, Serre F, Debrabant R, Daulouède JP, Denis C, Auriacombe M. Addiction severity pattern associated with adult and childhood Attention Deficit Hyperactivity Disorder (ADHD) in patients with addictions. Psychiatry Res. 2016;246:656-662.
32
Wilens TE, Faraone SV, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics. 2003;111:179-185.
33
Karabekiroğlu K, Cakin-Memik N, Ozcan-Ozel O, Toros F, Öztop D, Özbaran B, Cengel-Kultur E, Akbaş S, Taşdemir GN, Ayaz M, Aydın C, Bildik T, Erermiş S, Yaman AK. DEHB ve Otizm ile İlgili bilgi düzeyleri ve damgalama: sınıf öğretmenleri ve anababalarla çok merkezli bir çalışma. Klinik Psikiyatri. 2009;12:79-89.
34
Göl İ, BAYIK TEMEL A. İlköğretim sınıf öğretmenlerinin çocuklarda dikkat eksikliği ve hiperaktivite bozukluğunu tanıma yeterlikleri. 2013;6:207-213.
35
Soysal AŞ, Can H, Tan S, Keskinoğlu P, Elmastaş-Dikeç B. Psikoloji öğrencilerinin Dikkat Eksikliği Hiperaktivite Bozukluğuna ilişkin bilgi düzeylerinin değerlendirilmesi. International Journal of Human Sciences. 2011;8:1601-1612.
36
Şimşek Ş, Yıldırım V, Bostan R. Psikolojik danışmalık ve rehberlik öğretmenlerinin dikkat eksikliği ve hiperaktivite bozukluğu hakkındaki bilgi ve inançları. Van Tıp Dergisi. 2015;22:34-40.