Physicians' shared decision-making behaviors in attention-deficit/hyperactivity disorder care

Area of Science:

• Pediatric healthcare
• Behavioral science
• Health services research

Background:

• Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neurodevelopmental disorder.
• Effective treatment planning for pediatric ADHD requires active parental involvement.
• Shared decision-making (SDM) is a collaborative approach to healthcare decisions.

Purpose of the Study:

• To quantify the extent of SDM during treatment planning for newly diagnosed pediatric ADHD.
• To investigate how participant characteristics influence the level of SDM observed.

Main Methods:

• Prospective cohort study involving 10 pediatricians and 26 families of children aged 6-10 years with new ADHD diagnoses.
• Videorecorded clinical encounters were analyzed using the Observing Patient Involvement (OPTION) scale.
• Two independent raters assessed the level of SDM, with scores ranging from 0 to 100.

Main Results:

• The mean total OPTION score for SDM was 28.5 (SD, 11.7), indicating low levels of involvement.
• Higher SDM was associated with white children, private insurance, mothers with some college education, and parents without serious mental illness.
• Significant disparities in SDM were observed across these demographic and clinical factors.

Conclusions:

• SDM during pediatric ADHD treatment planning is currently limited.
• Identified disparities suggest barriers for certain parent groups, including nonwhite race, lower socioeconomic status, lower educational attainment, and parental serious mental illness.
• Interventions are recommended to promote equitable SDM for all parents involved in pediatric ADHD care.