PHILADELPHIA — Routine screening of spina bifida patients for attention-deficit hyperactivity disorder should become a standard practice for physicians, Dr. Scott W. Stuart said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.
Dr. Stuart, a developmental pediatrics fellow at the Medical University of South Carolina (MUSC) in Charleston, and his colleagues performed a chart review of 151 children with spina bifida, looking for diagnoses of ADHD and of medication use.
“Children with spina bifida are at significantly higher risk for ADHD behavior and medication treatment” than are those in the general population, he said.
Previous studies of patients with spina bifida have found that they are at risk for multiple neurobehavioral deficits. And clinicians who care for this population have long suspected that there is a high prevalence of ADHD symptoms in this group of patients, Dr. Stuart said.
Dr. Stuart and his colleagues performed a chart review of all patients who received care at the MUSC spina bifida clinic between Jan. 1, 1995, and Nov. 30, 2005, to determine the prevalence of ADHD in a population of spina bifida patients and compare that with general national and state trends for ADHD prevalence.
They set strict inclusion criteria that restricted subjects to those patients who were at least 7 years old at the last documented visit and who had a diagnosis of myelomeningocele or lipomeningocele. The study excluded diagnoses of spina bifida occulta, sacral agenesis, meningocele, and sacral dimple. To be considered a positive case, the diagnosis of ADHD had to be documented in the chart and the patient had to have a past or current history of taking medications for ADHD.
Of 151 patients in the clinic, 96 met the study criteria for diagnosis and age. Of that group, 22 patients also had a history of ADHD medication use and were included as positive ADHD cases.
The researchers found that 24% of the patients at the MUSC spina bifida clinic had a diagnosis of ADHD, compared with an 8% ADHD prevalence nationwide and a 10% prevalence in South Carolina. In addition, 19% of the MUSC sample had a diagnosis of ADHD combined with current medication use. On the national level, the current use of ADHD medication is reported to be 4%; it is 6% statewide.
The researchers also found that a history of ventricular shunt and shunt revision was associated with ADHD behaviors in their sample. For example, among patients whose charts included either documented concerns about ADHD, a confirmed diagnosis, or a history of medication use, all had a history of a ventricular shunt.
The study is limited by its small size, gaps in documentation, and lack of racial diversity, Dr. Stuart said.