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The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician's point of view

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Abstract
Clinical decision making is influenced by a range of factors and constitutes an inherently complex task. Here we present results from the decisions regarding ADHD management (DRAMa) study in which we undertook a thematic analysis of clinicians' experiences and attitudes to assessment, diagnosis and treatment of ADHD. Fifty prescribing child psychiatrists and paediatricians from Belgium and the UK took part in semi-structured interviews about their decisions regarding the assessment, diagnosis and treatment of ADHD. Interviews were transcribed and processed using thematic analysis and the principles of grounded theory. Clinicians described the assessment and diagnostic process as inherently complicated and requiring time and experience to piece together the accounts of children made by multiple sources and through the use of varying information gathering techniques. Treatment decisions were viewed as a shared process between families, children, and the clinician. Published guidelines were viewed as vague, and few clinicians spoke about the use of symptom thresholds or specific impairment criteria. Furthermore, systematic or operationalised criteria to assess treatment outcomes were rarely used. Decision making in ADHD is regarded as a complicated, time consuming process which requires extensive use of clinical impression, and involves a partnership with parents. Clinicians want to separate biological from environmental causal factors to understand the level of impairment and the subsequent need for a diagnosis of ADHD. Clinical guidelines would benefit from revisions to take into account the real-world complexities of clinical decision making for ADHD.
Keywords
GUIDELINES, ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, DEFICIT HYPERACTIVITY DISORDER, CHILDREN, HEALTH, ADHD, Clinical decision making, Prescribing medication, Clinical guidelines, Diagnosis

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Chicago
Kovshoff, Hanna, Sarah Williams, May Vrijens, Marina Danckaerts, Margaret Thompson, Lucy Yardley, Paul Hodgkins, and Edmund Barke. 2012. “The Decisions Regarding ADHD Management (DRAMa) Study: Uncertainties and Complexities in Assessment, Diagnosis and Treatment, from the Clinician’s Point of View.” European Child & Adolescent Psychiatry 21 (2): 87–99.
APA
Kovshoff, H., Williams, S., Vrijens, M., Danckaerts, M., Thompson, M., Yardley, L., Hodgkins, P., et al. (2012). The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician’s point of view. EUROPEAN CHILD & ADOLESCENT PSYCHIATRY, 21(2), 87–99.
Vancouver
1.
Kovshoff H, Williams S, Vrijens M, Danckaerts M, Thompson M, Yardley L, et al. The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician’s point of view. EUROPEAN CHILD & ADOLESCENT PSYCHIATRY. 2012;21(2):87–99.
MLA
Kovshoff, Hanna, Sarah Williams, May Vrijens, et al. “The Decisions Regarding ADHD Management (DRAMa) Study: Uncertainties and Complexities in Assessment, Diagnosis and Treatment, from the Clinician’s Point of View.” EUROPEAN CHILD & ADOLESCENT PSYCHIATRY 21.2 (2012): 87–99. Print.
@article{2083713,
  abstract     = {Clinical decision making is influenced by a range of factors and constitutes an inherently complex task. Here we present results from the decisions regarding ADHD management (DRAMa) study in which we undertook a thematic analysis of clinicians' experiences and attitudes to assessment, diagnosis and treatment of ADHD. Fifty prescribing child psychiatrists and paediatricians from Belgium and the UK took part in semi-structured interviews about their decisions regarding the assessment, diagnosis and treatment of ADHD. Interviews were transcribed and processed using thematic analysis and the principles of grounded theory. Clinicians described the assessment and diagnostic process as inherently complicated and requiring time and experience to piece together the accounts of children made by multiple sources and through the use of varying information gathering techniques. Treatment decisions were viewed as a shared process between families, children, and the clinician. Published guidelines were viewed as vague, and few clinicians spoke about the use of symptom thresholds or specific impairment criteria. Furthermore, systematic or operationalised criteria to assess treatment outcomes were rarely used. Decision making in ADHD is regarded as a complicated, time consuming process which requires extensive use of clinical impression, and involves a partnership with parents. Clinicians want to separate biological from environmental causal factors to understand the level of impairment and the subsequent need for a diagnosis of ADHD. Clinical guidelines would benefit from revisions to take into account the real-world complexities of clinical decision making for ADHD.},
  author       = {Kovshoff, Hanna and Williams, Sarah and Vrijens, May and Danckaerts, Marina and Thompson, Margaret and Yardley, Lucy and Hodgkins, Paul and Barke, Edmund},
  issn         = {1018-8827},
  journal      = {EUROPEAN CHILD \& ADOLESCENT PSYCHIATRY},
  keyword      = {GUIDELINES,ATTENTION-DEFICIT/HYPERACTIVITY DISORDER,DEFICIT HYPERACTIVITY DISORDER,CHILDREN,HEALTH,ADHD,Clinical decision making,Prescribing medication,Clinical guidelines,Diagnosis},
  language     = {eng},
  number       = {2},
  pages        = {87--99},
  title        = {The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician's point of view},
  url          = {http://dx.doi.org/10.1007/s00787-011-0235-8},
  volume       = {21},
  year         = {2012},
}

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