Wednesday, February 19, 2014

Attention-deficit hyperactive disorder is more common in some rural-heavy Eastern states

Pediatricians in the U.S. far outnumber child psychiatrists, and "Some rural families must drive 100 miles or more for an appointment with a child psychiatrist or neurologist, who often have long waiting lists and accept insurance less often than a family pediatrician," Alan Schwarz reports for The New York Times. One in seven children—and 20 percent of all boys—are diagnosed with attention-deficit hyperactive disorder by the time they turn 18, according to the Centers for Disease Control and Prevention.

A 2012 study in the journal Academic Pediatrics found pediatricians and family doctors handle most office visits for children medicated for ADHD, Schwarz writes. According to their professional organizations, there are 8,300 child psychiatrists in the country, but there are 54,000 board-certified general pediatricians. "Yet many practicing pediatricians, family doctors and certified nurse practitioners say they have received little training to prepare for today’s rising number of families asking that their children receive mental-health evaluations." In a similar case of people requesting that family doctors take on more than they might be qualified to handle, Penn State researchers found that rural women were more likely to seek mental health care from their physician, as opposed to a specialist.

According to the federal Centers for Disease Control and Prevention, the highest rates of ADHD for children aged 4-17 in 2011-12 were in states with relatively large rural populations: Kentucky, 18.7 percent; Arkansas, 17 percent; Louisiana, 15.8 percent; South Carolina and Indiana, 15.7 percent; Tennessee, 15.2 percent; and North Carolina, 14.4 percent. Next came Delaware, 14.3 percent; Ohio, 14.2 percent; Iowa, 13.7 percent; Rhode Island, 13.4 percent; and Michigan, 12.8 percent. (Read more) (CDC map: Percent of children diagnosed with ADHD in 2011-12. For an interactive state map,  click here)

The non-profit Reach Institute is one group trying to educate medical professionals—through a three-day seminar that teaches how to diagnose and treat ADHD. In addition to the seminar, "Attendees are allowed 12 hour-long conference calls with institute trainers and other trainees over the next six months to discuss real-life cases," Schwarz writes. "A 9-to-5 hotline allows for further consultation with an expert on call."

But medical professionals who don't have access to the seminar or cannot afford the fees are left trying to diagnose ADHD on their own. Dr. William Wittert, a pediatrician in Libertyville, Ill., who attended one of the seminars, told Schwarz, “When I trained, most of pediatrics was treating infectious disease. But we don’t treat bacterial meningitis anymore. We are being asked to evaluate and handle mental-health issues in kids like ADHD. We have to get up to speed.” (Read more)

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