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Screening for inattention, hyperactivity and impulsivity in children with haemophilia: A quality improvement
Jacklyn E Boggs1, Amanda Pullen2, Andrew E Molnar3,4
1Department of Hematology, St. Jude Children's Research, Hospital, Memphis, Tennessee, USA.
Insights
Formal screening for inattention/hyperactivity in children with haemophilia identified a high rate of undiagnosed ADHD. This quality improvement approach improved access to necessary mental health services for these vulnerable children.
Area of Science:
- Pediatric Hematology
- Child Psychology
- Quality Improvement in Healthcare
Background:
- Children with hemophilia exhibit higher rates of inattention and hyperactivity/impulsivity.
- These behavioral issues increase vulnerability to poor social and academic outcomes.
Purpose of the Study:
- To assess the effectiveness of a formal screening process for inattention/hyperactivity (IN/HI) in children with hemophilia.
- To improve diagnosis and intervention pathways using a quality improvement (QI) approach.
Main Methods:
- Implemented the Conners 3rd Edition screening tool during psychosocial assessments.
- Established formal pathways for diagnosis and intervention, including referrals and advocacy.
- Utilized a quality improvement framework to refine the screening and diagnostic process.
Main Results:
- Screening targeted 44 children (age 9.9 ± 4.8 years).
- Modified screening improved caretaker communication and diagnostic streamlining.
- 39.4% of previously undiagnosed patients received a new mental health diagnosis, including ADHD in 24.2%.
- Overall, 54.5% of the cohort had a mental health diagnosis, with a significantly higher ADHD rate (29.5%) than the general population.
Conclusions:
- A QI-driven formal screening process objectively identified IN/HI symptoms in children with hemophilia.
- The process streamlined diagnosis and intervention, improving access to care.
- Undiagnosed disabilities were identified, enhancing service access for affected children.
Introduction:
Children with haemophilia have been reported with increased rates of inattention (IN) and hyperactivity/impulsivity (HI) and, therefore, are particularly vulnerable to poor social and academic outcomes.
Aim:
To examine the benefit of utilizing a formal screening process for IN/HI in children with haemophilia during comprehensive clinic visits using a quality improvement approach.
Methods:
At a single haemophilia treatment centre, screening for psychosocial issues was expanded and formalised to include (1) the Conners 3rd Edition (Conners3) screening tool for IN/HI symptoms administered during the standard psychosocial assessment (SPA) by the social worker and school advocacy coordinator, (2) formal pathways to diagnosis and intervention as indicated including psychology consultation, psychological testing, or referral to community-based mental health professionals, and in-person advocacy assistance in the patient's community school.
Results:
Forty-four patients, age 9.9 ± 4.8 years (range 3-16) were targeted. The initial screening approach was modified to improve the communication with caretakers during assessments and streamline diagnostic pathways if no, moderate or significant behavioural concerns were identified. Eleven patients had pre-existing mental health diagnoses. Thirteen of the remaining 33 patients (39.4%) received a new mental health diagnosis, ADHD in 8/33 (24.2%). Of the total cohort, 54.5% were found to have a mental health diagnosis. The rate of ADHD (29.5%) was significantly higher than reported in the general population.
Conclusion:
The described process, developed through a QI approach, allowed formal and objective screening for IN/HI, streamlined a pathway to diagnosis and intervention, and identified undiagnosed disabilities in children with haemophilia improving their access to services.
