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Gregório J, Ferreira R, Fernandes AS. The Perception of Primary School Teachers Regarding the Pharmacotherapy of Attention Deficit Hyperactivity Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126233. [PMID: 34207624 PMCID: PMC8296060 DOI: 10.3390/ijerph18126233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is raising concerns across health systems, affecting about 5% of the school-age population. Therapy usually involves psychostimulants, which are prone to adverse drug reactions (ADRs). Teachers have many contact hours with children and can easily detect behavioral changes upon the beginning of medication. However, few studies have focused on the role of teachers in the management of ADHD children and detection of ADRs. The present work aimed to characterize the perception of primary school teachers regarding the impact of ADHD therapeutics. A questionnaire was constructed focused on teachers’ training regarding ADHD and its therapy; experience with students with ADHD; changes upon beginning of medication; and observation of ADRs. A total of 107 completed questionnaires were obtained. The results indicate that more than 40% of the inquired teachers have received training in ADHD, but in most cases, the theme of therapeutics was absent from that training. The vast majority of teachers (91.6%) have had students with ADHD and observed mood alterations associated with medications. More than 60% of the teachers answered that they are aware of the ADRs and of these, 24% have already detected them in their students. The teachers reported the observed ADRs to parents in 93% of the cases and to doctors in 28% of the cases. In conclusion, the results show the need to reinforce teachers’ training in ADHD and its therapeutics.
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Kazda L, Bell K, Thomas R, McGeechan K, Sims R, Barratt A. Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA Netw Open 2021; 4:e215335. [PMID: 33843998 PMCID: PMC8042533 DOI: 10.1001/jamanetworkopen.2021.5335] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services. OBJECTIVE To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions. EVIDENCE REVIEW This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality. FINDINGS Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms. CONCLUSIONS AND RELEVANCE This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms; therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy.
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Affiliation(s)
- Luise Kazda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Bosman RJ, Zee M, Koomen HMY. Do Teachers Have Different Mental Representations of Relationships With Children in Cases of Hyperactivity Versus Conduct Problems? SCHOOL PSYCHOLOGY REVIEW 2020. [DOI: 10.17105/spr-2018-0086.v48-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gesser-Edelsburg A, Hamade Boukai R. Does the education system serve as a persuasion agent for recommending ADHD diagnosis and medication uptake? A qualitative case study to identify and characterize the persuasion strategies of Israeli teachers and school counselors. BMC Psychiatry 2019; 19:153. [PMID: 31101094 PMCID: PMC6525420 DOI: 10.1186/s12888-019-2120-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a steady rise in the use of medication by Israeli school children to treat ADHD, partly due to what seems like school teachers' and counselors' tendency to express positive attitudes towards its use. Therfore it is important to examine the involvement of the school teachers and counselors in the parents' decision-making about giving their children medication. METHODS This study used a qualitative constructivist research method of semi-structured interviews. It included individual interviews with 36 teachers and school counselors and 11 parents of students ages 9-14 from the Jewish and Arab populations. RESULTS Teachers and school counselors use different strategies to encourage parents to have their children diagnosed for ADHD and medicated. First they suggest diagnosis as a necessary step in the best interest of the child, distinguishing between diagnosis and medication to mitigate parents' concerns. In the second stage, teachers normalize the use of medication, as well as framing it as a drug that provides not only a medical treatment but also emotional wellbeing. CONCLUSIONS Teachers and counselors are involved in parents' decision-making process about medicating their children to treat ADHD, which contradicts the education system's guidelines. It is necessary to set clear and explicit limits and guidelines for education system employees so that they do not cross professional and ethical limits.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel. .,The Health and Risk Communication Research Center, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel.
| | - Rasha Hamade Boukai
- 0000 0004 1937 0562grid.18098.38School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838 Haifa, Israel
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Havey JM. A Comparison of Dutch and US Teachers’ Perceptions of the Incidence and Management of ADHD. SCHOOL PSYCHOLOGY INTERNATIONAL 2016. [DOI: 10.1177/0143034307075679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dutch and US teachers were questioned about their perceptions of the incidence and causes of ADHD, as well as their views of appropriate treatments. Dutch teachers were more likely than US teachers to think the etiology of the disorder lay in biochemistry, while US teachers were more likely to believe in a combination of environmental and biochemical factors. Both sets of teachers believed a combination of medical and behavioral interventions was the most effective treatment. Teachers were also asked to indicate the number of students in their classes who had been diagnosed with ADHD and to estimate the number of students who they thought might have ADHD. Both sets of teachers indicated that they thought there were students with undiagnosed ADHD in their classes, but Dutch teachers reported significantly fewer students in both the actual and perceived categories. Class size was related to US teacher perceptions, but not Dutch perceptions.
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Kern A, Amod Z, Seabi J, Vorster A. South African foundation phase teachers' perceptions of ADHD at private and public schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3042-59. [PMID: 25768242 PMCID: PMC4377951 DOI: 10.3390/ijerph120303042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 11/20/2022]
Abstract
This study investigated foundation phase teachers’ perceptions of Attention Deficit Hyperactivity Disorder (ADHD). The teachers’ views on the aetiology, appropriate interventions and incidence rates of ADHD were examined. A total of 130 foundation phase teachers from mainstream private and public schools completed a self-developed questionnaire that had been piloted by the researchers. Both descriptive and inferential statistics were used to analyse the data, specifically to determine whether there were differences in responses between public and private school teachers. Thematic content analysis was used to identify the themes that emerged from the open-ended questions. It was found that the teachers had a limited understanding of ADHD, in terms of what it is as well as the aetiology. In addition, it emerged that medication was the preferred method of intervention despite the participants’ awareness of alternative intervention methods. A comparison of the private and public school teachers’ results indicated no significant difference in their perceptions regarding the aetiology, interventions or incidence rates of ADHD.
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Affiliation(s)
- Anwynne Kern
- School of Human and Community Development, University of the Witwatersrand, Private Bag 3, WITS, Gauteng 2050, South Africa.
| | - Zaytoon Amod
- School of Human and Community Development, University of the Witwatersrand, Private Bag 3, WITS, Gauteng 2050, South Africa.
| | - Joseph Seabi
- School of Human and Community Development, University of the Witwatersrand, Private Bag 3, WITS, Gauteng 2050, South Africa.
| | - Adri Vorster
- School of Human and Community Development, University of the Witwatersrand, Private Bag 3, WITS, Gauteng 2050, South Africa.
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Pani SC, Hillis H, Chaballout T, Al Enazi W, AlAttar Y, Aboramadan M. Knowledge and attitude of Saudi teachers of students with attention-deficit hyperactivity disorder towards traumatic dental injuries. Dent Traumatol 2013; 30:222-6. [DOI: 10.1111/edt.12065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Sharat Chandra Pani
- Division of Pediatric and Preventive Dentistry; Riyadh Colleges of Dentistry and Pharmacy; Riyadh Saudi Arabia
| | - Hannan Hillis
- Riyadh Colleges of Dentistry and Pharmacy; Riyadh Saudi Arabia
| | | | - Wedad Al Enazi
- Riyadh Colleges of Dentistry and Pharmacy; Riyadh Saudi Arabia
| | - Youmna AlAttar
- Riyadh Colleges of Dentistry and Pharmacy; Riyadh Saudi Arabia
| | - Mona Aboramadan
- Riyadh Colleges of Dentistry and Pharmacy; Riyadh Saudi Arabia
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Elementary and Middle School Teacher Perceptions of Attention-Deficit/Hyperactivity Disorder Prevalence. CHILD & YOUTH CARE FORUM 2013. [DOI: 10.1007/s10566-013-9194-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Benko CR, Farias AC, Farias LG, Pereira EF, Louzada FM, Cordeiro ML. Potential link between caffeine consumption and pediatric depression: A case-control study. BMC Pediatr 2011; 11:73. [PMID: 21867528 PMCID: PMC3180267 DOI: 10.1186/1471-2431-11-73] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 08/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early-onset depressive disorders can have severe consequences both from developmental and functional aspects. The etiology of depressive disorders is complex and multi-factorial, with an intricate interaction among environmental factors and genetic predisposition. While data from studies on adults suggest that caffeine is fairly safe, effects of caffeine in children, who are in period of rapid brain development, are currently unknown. Furthermore, systematic research addressing the relationship between depressive symptoms in children and caffeine consumption is lacking.The present study examined the effects of caffeine consumption on depressed mood in children with depression and non-depressed participants. METHODS Children and adolescents (n = 51) already enrolled in an ongoing longitudinal study, aged 9-12 years, were assessed for depressive symptoms with the Children Depressive Inventory (CDI). Psychopathological symptoms were assessed with the Child Behavioral Checklist (CBCL) and eating habits were assessed with the Nutrition-Behavior Inventory (NBI) 1. The children were compared to control children without psychopathology attending public schools in a Southern Brazilian city. RESULTS Participants with CDI scores ≥ 15 (mean = 19; S.D. = 4) also had high NBI scores (mean = 52; S.D. = 19, p < 0.001) suggestive of a relationship between depressive symptoms and environmental factors, in this case nutrition/behavior. Additional linear regression adjusted statistical analysis, considering the factors of consumption of sweets and caffeine individually, showed that caffeine, but not sweets, was associated with depressive symptoms. CONCLUSIONS These findings indicate that depressed children consume more caffeinated drinks than non-depressed children. Nonetheless while a strong association between depressive symptoms and caffeine consumption among children was found, further research should investigate whether or not this association is due to a cause and effect relationship.
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Affiliation(s)
- Cássia R Benko
- Department of Neuropsychopharmacology - Pelé Pequeno Príncipe Research Institute, Av. Silva Jardim 1632, Curitiba, 80250-200 PR, Brazil
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Curitiba, 80230-020, PR, Brazil
- Department of Psychology, Children's Hospital Pequeno Príncipe, Av. Desembargador Motta 1070, Curitiba, 80250-060, PR, Brazil
| | - Antonio C Farias
- Department of Neuropsychopharmacology - Pelé Pequeno Príncipe Research Institute, Av. Silva Jardim 1632, Curitiba, 80250-200 PR, Brazil
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Curitiba, 80230-020, PR, Brazil
- Department of Neuropediatrics, Children's Hospital Pequeno Príncipe, Av. Desembargador Motta 1070, Curitiba, 80250-060, PR, Brazil
| | - Lucilene G Farias
- Department of Neuropsychopharmacology - Pelé Pequeno Príncipe Research Institute, Av. Silva Jardim 1632, Curitiba, 80250-200 PR, Brazil
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Curitiba, 80230-020, PR, Brazil
| | - Erico F Pereira
- Department of Physiology, Federal University of Parana, Curitiba, 81531-990, PR, Brazil
| | - Fernando M Louzada
- Department of Physiology, Federal University of Parana, Curitiba, 81531-990, PR, Brazil
| | - Mara L Cordeiro
- Department of Neuropsychopharmacology - Pelé Pequeno Príncipe Research Institute, Av. Silva Jardim 1632, Curitiba, 80250-200 PR, Brazil
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Curitiba, 80230-020, PR, Brazil
- Department of Psychiatry and Biobehavioral Sciences of the David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 700 Westwood Plaza, Los Angeles, 90025, CA, USA
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Sherman EMS, Brooks BL, Akdag S, Connolly MB, Wiebe S. Parents report more ADHD symptoms than do teachers in children with epilepsy. Epilepsy Behav 2010; 19:428-35. [PMID: 20926354 DOI: 10.1016/j.yebeh.2010.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 08/10/2010] [Accepted: 08/11/2010] [Indexed: 11/28/2022]
Abstract
Children with epilepsy have a high rate of attention deficit/hyperactivity disorder (ADHD), yet parent-teacher agreement on ADHD symptoms in epilepsy is unknown despite the need to assess symptoms across settings such as home and school. Parent-teacher agreement on ADHD ratings was investigated in 208 children with epilepsy (mean age = 11.2, SD = 3.6) using the ADHD Rating Scale IV, along with associations with demographic variables, epilepsy severity, adaptive level, and quality of life. Children were four times more likely to be identified as having clinically elevated ADHD symptoms when parent ratings were the benchmark versus teachers. Agreement was highest for children with more severe ADHD symptoms, for the Hyperactivity-Impulsivity dimension of behavior, and for children with broadly normal adaptive behavior. Higher parent and teacher ADHD ratings were related to reduced quality of life, but unrelated to epilepsy severity. Exclusive reliance on parent or teacher ratings may yield variable rates of ADHD symptoms in children with epilepsy.
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Weyandt LL, Fulton KM, Schepman SB, Verdi GR, Wilson KG. Assessment of teacher and school psychologist knowledge of Attention-Deficit/Hyperactivity Disorder. PSYCHOLOGY IN THE SCHOOLS 2009. [DOI: 10.1002/pits.20436] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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EGELAND JENS, JOHANSEN SUSANNENORDBY, UELAND TORILL. Differentiating between ADHD sub-types on CCPT measures of sustained attention and vigilance. Scand J Psychol 2009; 50:347-54. [DOI: 10.1111/j.1467-9450.2009.00717.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Oliveira CG, Albuquerque PB. Diversidade de resultados no estudo do transtorno de déficit de atenção e hiperatividade. PSICOLOGIA: TEORIA E PESQUISA 2009. [DOI: 10.1590/s0102-37722009000100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Com este artigo pretende-se abordar a problemática da diversidade de dados na investigação do Transtorno de Déficit de Atenção e Hiperatividade (TDAH). Apresenta-se uma revisão da literatura centrada na heterogeneidade de conclusões relativas à caracterização do transtorno, à distinção dos subtipos, aos contextos de informação, às diferenças de gênero e à comorbidade. Na tentativa de compreender a disparidade de conclusões, salientam-se potenciais fatores explicativos, nomeadamente a heterogeneidade das amostras, a diversidade de metodologias e de procedimentos de investigação, entre outros. A revisão efetuada baseou-se, majoritariamente, em publicações referenciadas pelas bases de dados PsycInfo e ERIC, e, pontualmente, PubMed e Elsevier Direct.
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) holds the distinction of being the most extensively studied pediatric mental disorder and one of the most controversial, in part because it is also the most commonly diagnosed mental disorder among minors. Currently, almost 8% of youth aged 4 to 17 years have a diagnosis of ADHD, and approximately 4.5% both have the diagnosis and are using a stimulant (methylphenidate or amphetamine) as treatment for the disorder. Yet a diagnosis of ADHD is not simply a private medical finding; it carries with it a host of policy ramifications. The enduring controversy over ADHD in the public arena therefore reflects the discomfort over what happens when science is translated into policies and rules that govern how children will be treated medically, educationally, and legally. This article (1) summarizes the existing knowledge of ADHD, (2) provides the relevant history and trends, (3) explains the controversy, (4) discusses what is and is not unique about ADHD and stimulant pharmacotherapy, (5) outlines future directions of research, and (6) concludes with a brief analysis of how two North Carolina counties have established community protocols that have improved the screening, treatment, and societal consensus over ADHD and stimulants.
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Affiliation(s)
- Rick Mayes
- Department of Political Science, University of Richmond, Richmond, VA 23173, USA.
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