ADHD treatment with methylphenidate in children and adolescents poses an important challenge for health care professionals, parents and educators alike. One challenge is the risk of self-medication with inappropriate or illicit drugs, another challenge is the difficullty to reach a dosage of methylphenidate which not only provides stability but a functional status that enables the child or adolescent to fully participate in the activities requested by the curriculum, including cooperation with other pupils in team work sessions. In diabetes type 1 of children and adolescents, after three decades of comprehensive efforts to enhance self-efficacy through therapeutic patient education (TPE) and advanced technologies for self-controll of metabolic status, e.g. by continuous glucose monitoring (CGM) combined with diary-keeping by the patient, and/or automated insulin delivery, there is now overwhelming evidence of the efficacy of the effort, both in terms of metabolic stability, functional status QoL and outcome.
The most important feature of this progress has been the reduction of metabolic and functional instability (due e.g. to hyper- or hypoglycaemia) and its negative effect on participation in sports, social activities and school performance.
Another feature of the transformation was the shift from long-acting insulin preparations to short-acting insulins and to a narrow link of their dose to food and physical activity patterns. TPE - with approaches adapted to the age group of the patient - is a core element for a successful implementation of the technological tools. Specific apps that address the daily challegnes are another element.
Is it licit to speculate that a specific patient diary (in the form of an app) that reflects the variations of the functional status of a child or adolescent treated with methylphenidate could help both health care providers (physicians, psychologists, school nurses), parents and educators to understand whether the dosage schedule (both quantitative and over time) is appropriate for the individual patient? Such a diary might help transform the relationship between health care providers, parents and educators and the patient in a similar way it has transformed this relation in type 1 diabetes.
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António José Rodrigues Rebelo
thank you so much for your answer which opened to me new, so far unknown perspectives. My question was conceived in a specific educational context of a public secondary school which works on an atelier basis with 60 adolescents aged between 13 and 16 working in the same room at least once a day. If only three or four of them aren't capable of controlling their impulses, teaching is severely disrupted. The demonstration by Smith et al. (2018) that you cite, that methylphenidate treatment does not enhance executive function, such as working memory and problem solving, does not support my hypothesis (derived from personal experiences in type 1 diabetes) that a refined dosage scheme of methylphenidate could lead to enhanced learning performance. However, I would not abandon completely the hypothesis that the instauration of a systematic self-efficacy feedback mechanism could help stabilize the collective learning process and the social integration of neuro-diverse individuals in a school environment. In summary, your input might also be an ergument to rethink the concept of the type of atelier teaching in a public school which has a mission to integrate children from a multi-ethnic. multi-cultural background.- Badges
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