Closing the Gap: Confronting ADHD Diagnosis Disparities in West Virginia

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Closing the Gap: Confronting ADHD Diagnosis Disparities in West Virginia

Understanding ADHD Prevalence in West Virginia

Attention-Deficit/Hyperactivity Disorder (ADHD) affects approximately 14.0% of individuals in West Virginia, significantly surpassing the national average of 10.1% (NSCH, 2022). While genetic factors play a significant role, several other risk factors are more common in our state as well, such as “PRENATAL SUBSTANCE EXPOSURE” to harmful substances and “ADVERSE CHILDHOOD EXPERIENCES.” These factors may contribute to the increased rate of ADHD diagnoses among children and adults in the state.

Stimulant Prescriptions: A Growing Concern

Given the higher prevalence of ADHD, it is not surprising that there are elevated rates of prescriptions for stimulants, such as methylphenidate and amphetamines, in West Virginia. Prescription stimulants, classified as Schedule II substances due to their potential for misuse and risk for dependence, are often the first-line of treatment for ADHD across various age groups due to their known safety and efficacy in treating symptoms in patients with an ADHD diagnosis. Unfortunately, a concerning trend observed in research is the number of prescription stimulants without a corresponding ADHD diagnosis (Sibley, 2018).

Due to the classification of prescription stimulants as a schedule II controlled substance, thorough monitoring and follow-up to ensure the risks and benefits of treatment are regularly evaluated is essential in treatment of ADHD. Prescription stimulants can be an essential part of the ADHD treatment plan for patients who are candidates for use, but there are also other non-stimulant FDA-approved treatments available to ensure patients with ADHD have an available option. Clinicians should appropriately weigh the “RISKS OF UNTREATED ADHD” versus the risks of treatment to develop a plan that does not deter treatment of ADHD as there are various options. Rather, clinicians should be able to address apprehension to treat due to these mentioned risks by ensuring patients are appropriately counseled and evaluated to determine the most appropriate treatment for the individual patient. There are also various “RISK REDUCTION STRATEGIES” to implement to monitor prescription stimulant use when needed.

The Challenge of Limited Mental Health Resources

Unfortunately, West Virginia faces a “LACK OF SPECIALIZED MENTAL HEALTH PROFESSIONALS” to treat patients with ADHD, with more than half of its counties lacking a child and adolescent psychiatrist (AACAP, 2024). This scarcity places a significant burden on primary care physicians, nurse practitioners, and physician assistants to provide care for patients with ADHD and other mental health conditions. The lack of specialized care can hinder accurate diagnosis and effective treatment, resulting in long wait times, and potentially discouraging patients from seeking the care they need.

Empowering Clinicians Through Academic Detailing

Some clinicians may not be familiar with or feel comfortable providing care for a patient with ADHD symptoms. To address this gap in care, the WVU School of Pharmacy’s Rational Drug Therapy Program (RDTP) now has an academic detailing team consisting of clinical pharmacists trained on the – WVACC guidelines: A West Virginia Guide to Evidence-Informed Evaluation, Diagnosis, and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) and Comorbid Concerns – as well as other national and international ADHD guidelines. They also utilize motivational interviewing and academic detailing principles to provide clinicians across West Virginia with the most current, evidence-based information.

Our pharmacists are here to:

Answer questions regarding the WVACC Guidelines.
Provide ADHD-focused presentations.
Distribute educational materials that clinicians can use in practice.

By enhancing the knowledge and confidence of clinicians in managing ADHD, RDTP aims to improve patient outcomes across West Virginia.

Conclusion: A Collaborative Approach to ADHD Care

Addressing the high prevalence of ADHD amidst a shortage of mental health professionals requires a multifaceted approach. This includes improving access to mental healthcare, ensuring accurate diagnoses, and monitoring prescription practices to prevent misuse. Educational initiatives, like RDTP’s Academic Detailing Program, play a vital role in supporting clinicians and enhancing the quality of care for individuals with ADHD, as recommended by the American Academy of Pediatrics (AAP, 2019).

By leveraging the resources and expertise of the RDTP academic detailing team, together, West Virginians can work to improve mental health outcomes.

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Resources

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): org
West Virginia Guide to Evidence-Informed Evaluation, Diagnosis, and Treatment of ADHD and Comorbid Concerns: org
American Academy of Pediatrics Clinical Practice Guidelines for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: https://publications.aap.org/pediatrics/article/144/4/e20192528/81590/Clinical-Practice-Guideline-for-the-Diagnosis?autologincheck=redirected
American Psychiatric Association: https://www.psychiatry.org/patients-families/adhd/what-is-adhd
American Psychological Association: https://effectivechildtherapy.org/concerns-symptoms-disorders/disorders/inattention-and-hyperactivity-adhd
Info About Kids: https://infoaboutkids.org/emotions/common-emotional-conditions/adhd-behavior-problems

References

American Academy of Child and Adolescent Psychiatry. (2024). Workforce maps by state. AACAP. https://www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce_Maps/Home.aspx

NSCH 2021 22: Prevalence of current attention deficit disorder (Add) or attention-deficit hyperactivity disorder (ADHD), nationwide vs. West Virginia. (2022). Retrieved October 16, 2024, from https://www.childhealthdata.org/browse/survey/results?q=10533&r=1&r2=50

Sibley, M. H. (2018). Why are stimulant medication prescriptions rising globally? The Lancet. Psychiatry, 5(10), 774–776. https://doi.org/10.1016/S2215-0366(18)30317-1

Subcommittee on Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, American Academy of Pediatrics (AAP). (2019). SYSTEMIC BARRIERS TO THE CARE OF CHILDREN AND ADOLESCENTS WITH ADHD. PEDIATRICS, 144(4), 29–43. link

About the Author

Ryan Archer graduated from WVU in 2022, earning his PharmD and MBA. Post-graduation, Ryan completed two years of residency training at VA Tennessee Valley Healthcare System, specializing in pain management and palliative care. Currently, he works for the Rational Drug Therapy Program and is eager to serve as the Clinical Educator for the northern region of West Virginia. Outside of work, Ryan enjoys exercising, attending sporting events, and spending quality time with his fiancé and their dog, Ruby.

General disclaimer:
This content is not intended to address all possible diagnosis methods, treatments, follow up, drugs or their related contraindications or side effects. Standards of practice change as new data becomes available. Therefore, it is strongly recommended that practitioners independently assess and verify diagnosis, treatments and drugs for each individual patient. The authors of the WV ACC guidelines assume no liability for any aspect of treatment administered by a practitioner with the aid of this publication.

Drug disclaimer:
The authors do not endorse or recommend the use of any particular drug mentioned in this publication. Before prescribing a new drug to a patient, practitioners are advised to check the product information accompanying each drug to ensure it is appropriate for a specific patient and to identify appropriate dosage, contraindications, side effects and drug-to-drug interactions.

Standard of care disclaimer:
This publication is not intended to establish a standard of care applicable to practitioners who treated patients diagnosed with ADHD. “Standard of care” is a legal term, not a medical term, which refers to the degree of care a reasonable practitioner would exercise under the same or similar circumstances. The standard of care is a continuum and does not imply optimal care. Practitioner discretion and clinical judgment are paramount and this publication is only intended to aid practitioners’ judgment, not to serve as a substitute for said judgment.