Study: Adolescent Health Risks Associated with ADHD Go Unmonitored by Doctors
The health risks facing adolescents with ADHD — teen pregnancy, unsafe driving, medication diversion, and more — are well documented. Yet, according to new research, primary care doctors still largely fail to address and monitor these urgent topics during their patients’ transition from childhood to young adulthood.
February 27, 2020
Teens with attention deficit hyperactivity disorder (ADHD or ADD) face an elevated risk for associated health dangers ranging from unsafe intercourse and distracted driving to illegal drug use and medication diversion. These risks are well documented by scientific research, yet a new study finds that primary care physicians largely ignore these critical topics when talking with and treating adolescent patients with ADHD.1
Published in the Journal of Developmental and Behavioral Pediatrics, this new study uncovers how primary care physicians overlook the urgent health risks for teens with ADHD. According to the research, fewer than half of doctors screen their teen patients with ADHD for unsafe sexual activity, and virtually none of them discuss driving dangers or medication diversion.
“We have found that clinicians are more skilled in addressing ADHD in childhood than in adolescence,” said the study’s senior author Thomas Power, Ph. D., ABPP, the Director of the Center for Management of ADHD.2 However, given the significant risks specifically facing adolescents with ADHD — including higher rates of high school dropout, teen pregnancies, car accidents, and development of comorbid mental health conditions — clear-eyed and pro-active treatment should be a higher priority, as the consequences of failing to adequately treat teens with ADHD could be fatal.1
In this retrospective, longitudinal cohort study, researchers examined the frequency with which primary care providers offer ADHD-related care and implement ADHD treatments for patients. Researchers also studied patient encounters to understand the range of concerns — such as depression, suicide, substance abuse, driving preparedness, safe sex, and unlawful medication distribution — aired during doctor visits. This study followed these variables across three age periods: Preadolescence (ages 9 through 11), early adolescence (ages 12 through 14), and late adolescence (ages 15 through 18).
This study’s participant group included 262 patients with a diagnosis of ADHD before age 10 who had documented doctor’s visits during all three age periods. Patients in this study sample were significantly more likely to be white (66%) and male (78%). One-third of participants had a comorbid learning disability, almost one-fourth had a comorbid disruptive behavior disorder, 28% had a comorbid anxiety or mood disorder, and 9% had comorbid autism spectrum disorder.1
Researchers took data from three New Jersey primary care practices located at six different sites with 23 primary care physicians participating in total. The electronic health record (Epicare™) allowed researchers to analyze the quality and contents of the patient’s care visits.1
Overall, physicians did well in monitoring their patients with ADHD for the development of comorbid conditions. Namely, researchers found that monitoring for depression increased from 37% to at least 90% in early and late adolescent visits.1 Likewise, physicians tended to monitor their patients for warning signs of suicide and substance abuse with greater regularity during the teen years.1
Similarly, the rate at which primary care physicians monitored the sexual activity of their patients with ADHD increased from 9% in early adolescence to 47% in late adolescence.1 This is a positive increase, but researchers found that only half of patients engaged in conversations with doctors regarding risky sexual behavior. Given the heavy documentation of sexual health risks for adolescents with ADHD — including increased risk for teen pregnancy and STI contraction — increased clinical care poses a significant potential benefit.
Adolescents with ADHD are at greater-than-average risk for negative outcomes from driving incidents. Specific risks include motor vehicle crashes and citations for driving infractions: In fact, a new study found that drivers with ADHD are about 60% more likely to be involved in a motor vehicle crash during their first month of licensed driving than are their neurotypical peers.1
Despite growing evidence for this risk, researchers found only two instances where primary care physicians discussed driver readiness with patients with ADHD. Researchers suggest that driver readiness should be included in standardized screening templates, similar to depression, suicide, and substance abuse.1
Furthermore, medication abuse and diversion remains a public health concern and a serious, yet widely misunderstood, legal infraction. Despite recent studies showing growing rates of illegal medication diversion, researchers found only one instance across all age groups of a primary care doctor discussing this topic with a patient.1
While physicians discussed school performance in over 90% of all visits, the incidence of school interventions like IEPs or 504 Plans dropped from 36% to less than 20% as patients moved from elementary to middle to high school.1 Since ADHD is a chronic condition that persists through multiple settings, youth with ADHD largely require school accommodations throughout the transition to adolescence; there is no research supporting the suspension of accommodations in middle or high school.
Though the health risks associated with ADHD intensify with time, researchers found that primary care visits for ADHD-related concerns largely diminish as a child matures into adolescence. The study found that 61% of patients had a documented visit for ADHD in preadolescence, and only 41% of patients had a documented for ADHD during late adolescence.1
“These findings identify opportunities to improve the care of adolescents with a history of ADHD,” said Dr. Power, “Additional resources and training are needed so we can ensure primary care clinicians are providing the best care for patients with ADHD as they develop through their teenage years.”2
1Moss CM, Metzger KB, Carey ME, Blum NJ, Curry AE, Power TJ. Chronic care for attention-deficit/hyperactivity disorder: clinical management from childhood through adolescence. Journal of Developmental & Behavioral Pediatrics. 2020;41 Suppl 2S:S99-S10.
2Teens with a history of ADHD need stronger monitoring of health risks [press release]. Philadelphia, Pennsylvania: Children’s Hospital of Philadelphia; February 11, 2020.https://www.newswise.com/articles/teens-with-a-history-of-adhd-need-stronger-monitoring-of-health-risks?sc=dwhr&xy=5029296