Adherence to clinical guidelines for dose finding and monitoring methylphenidate use: a medical record audit in child and adolescent mental health care and pediatric settings
Open accessAbstract
Background: Guideline adherence is important to ensure optimal and safe use of methylphenidate for children and adolescents with attention-deficit/hyperactivity disorder (ADHD). We investigated adherence to Dutch guidelines regarding dosing and monitoring of methylphenidate in child and adolescent mental health care and pediatric treatment settings. Methods: Five hundred six medical records of children and adolescents were investigated in 2015 and 2016. We assessed adherence to the following guideline recommendations: (1) at least four visits during the dose-finding phase; (2) monitoring thereafter at least every 6 months; (3) measuring height and weight at least annually; and (4) the use of validated questionnaires to assess treatment response. Pearson's chi-squared test statistics were used to examine differences between settings. Results: Only a small portion of patients had at least four visits during the dose-finding phase (5.1% in the first 4 weeks to 12.4% in the first 6 weeks). Also, less than half of the patients (48.4%) were seen at least every 6 months. Height was recorded at least annually in 42.0% of patients, weight in 44.9%, and both recorded in a growth chart in 19.5%. Questionnaires to assess treatment response were only used in 2.3% of all visits. When comparing both settings, more patients in the pediatric settings were seen every 6 months, although height and weight were recorded more often in the mental health care setting. Conclusion: Overall, guideline adherence was low. Training of clinicians and adding guideline recommendations to electronic medical records templates may improve adherence. Additionally, we should aim to close the gap between guidelines and clinical practice by looking critically at the feasibility of guidelines.
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Our results highlight important gaps between evidence-based recommendations and guidelines and clinical reality, particularly regarding the limitations of relying solely on RCT evidence to inform clinical decision making and guidelines and policies.
“Overall, in line with previous evidence, our results highlight important gaps between evidence-based recommendations and guidelines and clinical reality,18 particularly regarding the limitations of relying solely on RCT evidence to inform clinical decision making and guidelines and policies.”
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Garcia-Argibay, M., Chang, Z., Brikell, I., Kuja-Halkola, R., D'Onofrio, B. M., Lichtenstein, P., Newcorn, J. H., Faraone, S. V., Larsson, H., & Cortese, S. (2025) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00396-1 · Cited by 31 · see citing works
- Authors
- Rosenau, P. T., Dietrich, A., Matthijssen, A.-F. M., Kleine-Deters, R., van de Loo-Neus, G. H. H., Buitelaar, J. K., van den Hoofdakker, B. J., & Hoekstra, P. J.
- Affiliations
- University Medical Center Groningen (NL)
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Karakter Child and Adolescent Psychiatry Center Nijmegen, Nijmegen, The Netherlands.
- Radboud University Nijmegen (NL)
- Corresponding author
- Rosenau, Paul T.
- ORCID
- Venue
- Journal of Child and Adolescent Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2023-06
- Volume
- 33
- Issue
- 5
- Pages
- 183-189
- ISSN
- 1044-5463 (ISSN-L)
- 1557-8992
- OpenAlex
- W4381331383
- Cited by
- 5
- References
- 0
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 1
- FWCI
- 1.02
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of Child and Adolescent Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- ZonMw (836011014)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- methylphenidate, attention deficit hyperactivity disorder, guideline adherence, dose-finding, therapeutic drug monitoring, child and adolescent mental health services, growth monitoring, height and weight measurement, treatment response assessment, electronic health records
- MeSH terms
- Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Humans, Mental Health, Methylphenidate, Surveys and Questionnaires, Electronic Health Records
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