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Improving Communication in ADHD Care: Results from In-office Linguistic Research

Published online by Cambridge University Press:  01 April 2011

Greg Mattingly ,
Craig B. Surman ,
Alice R. Mao ,
Corey A. Eagan ,
Meaghan Onofrey  and
Marc Lerner
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Abstract

Introduction

An in-office linguistic study was conducted to help improve understanding of how to better evaluate and treat attention-deficit/hyperactivity disorder (ADHD).

Methods

Naturally occurring interactions were recorded among 7 psychiatrists and 23 patients and 8 pediatricians along with 22 patients and their parents. Participants were interviewed separately post-visit. Transcripts of interactions and interviews were analyzed using sociolinguistic techniques.

Results

Visits were variable in length and lacked concrete treatment plans. In the pediatric setting, children were typically excluded from dialogues, accounting for only 8% of words spoken. School was the primary metric used to evaluate symptoms. Pediatricians allayed parents' concerns about stimulant therapy by promising to prescribe the lowest possible dose, rather than discussing titrating to an optimal dose. Adults were evaluated idiosyncratically without the use of scales or tools. Stimulants were positioned as short-term “trials” without strong physician recommendations.

Discussion

Conversations about stimulant therapy lacked goal- and expectation-setting. Also missing from conversations was a definitive treatment plan based on the core symptoms of ADHD. Incorporating open-ended questions and tools or rating scales may result in a more effective and efficient in-office dialogue.

Conclusion

Further research is warranted to assess the efficacy of communication strategies to enhance in-office discussions of ADHD and stimulant therapy.

Type
Original Research
Information
CNS Spectrums , Volume 16 , Issue 4 , April 2011 , pp. 85 - 94
Copyright
Copyright © Cambridge University Press 2012

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Footnotes

Faculty Disclosures: Dr. Mattingly has been a consultant for Eli Lilly, Forest Laboratories, McNeil, Pfizer, Shire, and Vanda; has been on speakers' bureaus for Abbott, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen, McNeil, and Shire; and receives research support from AstraZeneca, Dainnpon-Sumitomo, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen, Johnson & Johnson, Lundbeck, McNeil, Merck, New River, Novartis, Organon, Pfizer, sanofi-aventis, Schwabe/Ingenix, Sepracor, Shire, Solvay, Takeda, Vanda, and Wyeth. Dr. Surman has been a consultant/advisor to McNeil, Shire, and Takeda; has received support for speaking and other educational activities from Janssen-Ortho, McNeil, Novartis, and Shire; has received research support from Abbott, Alza, Cephalon, Eli Lilly, the Hilda and Preston Davis Foundation, McNeil, Merck, New River, the National Institutes of Health, Organon, Pfizer, Shire, and Takeda; and has received honoraria from Reed Medical Education (a logistics collaborator for the MGH Psychiatry Academy). Dr. Mao has received honoraria for being on the speaker bureaus for Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer, and Shire. Dr. Lerner is a consultant to McNeil and Shire; is on the speakers' bureaus for Eli Lilly, McNeil, and Shire; and receives research support from Addrenex, Eli Lilly, McNeil, the NIMH, Next Wave, Psychgenics, Quintile, Shionogi, and Shire. Ms. Onofrey has received research support from McNeil Pediatrics. Ms. Eagan reports no affiliations with or financial interest in any organization that may pose a conflict of interest.

Study Design: Study design and subsequent publication were a joint effort by Ogilvy CommonHealth Insights & Analytics, academic co-authors, and McNeil Pediatrics, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. All data collection and analysis was conducted by Ogilvy CommonHealth Insights & Analytics. Funding was provided by McNeil Pediatrics, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.

References

Faculty Disclosures: Dr. Mattingly has been a consultant for Eli Lilly, Forest Laboratories, McNeil, Pfizer, Shire, and Vanda; has been on speakers' bureaus for Abbott, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen, McNeil, and Shire; and receives research support from AstraZeneca, Dainnpon-Sumitomo, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen, Johnson & Johnson, Lundbeck, McNeil, Merck, New River, Novartis, Organon, Pfizer, sanofi-aventis, Schwabe/Ingenix, Sepracor, Shire, Solvay, Takeda, Vanda, and Wyeth. Dr. Surman has been a consultant/advisor to McNeil, Shire, and Takeda; has received support for speaking and other educational activities from Janssen-Ortho, McNeil, Novartis, and Shire; has received research support from Abbott, Alza, Cephalon, Eli Lilly, the Hilda and Preston Davis Foundation, McNeil, Merck, New River, the National Institutes of Health, Organon, Pfizer, Shire, and Takeda; and has received honoraria from Reed Medical Education (a logistics collaborator for the MGH Psychiatry Academy). Dr. Mao has received honoraria for being on the speaker bureaus for Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer, and Shire. Dr. Lerner is a consultant to McNeil and Shire; is on the speakers' bureaus for Eli Lilly, McNeil, and Shire; and receives research support from Addrenex, Eli Lilly, McNeil, the NIMH, Next Wave, Psychgenics, Quintile, Shionogi, and Shire. Ms. Onofrey has received research support from McNeil Pediatrics. Ms. Eagan reports no affiliations with or financial interest in any organization that may pose a conflict of interest.

Study Design: Study design and subsequent publication were a joint effort by Ogilvy CommonHealth Insights & Analytics, academic co-authors, and McNeil Pediatrics, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. All data collection and analysis was conducted by Ogilvy CommonHealth Insights & Analytics. Funding was provided by McNeil Pediatrics, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.