Primary care doctors and pediatricians are less confident than child and adolescent psychiatrists in their ability to determine whether irritability in young patients is normal or a deeper mental health issue, according to a new study at Pennsylvania State University.
The findings, published in the Primary Care Companion for CNS Disorders, reveal that primary care providers and pediatricians are also more likely to prescribe medication when they believe there is a problem, while psychiatrists are more likely to start with behavioral therapy.
As problems like bullying and school shootings increase, it’s important for health care providers to be able to identify children and adolescents whose problems may go deeper than typical moodiness, said researcher Anna Scandinaro, a medical student at Penn State College of Medicine. She adds that increasing education for these providers may be a good place to start.
“We need to start asking if there’s anything we can do to prevent these things from happening,” Scandinaro said. “There’s a lot of concern right now about children’s mental health, and we wanted to compare how different practitioners go about trying to figure out who’s going through normal irritability and who may benefit from additional treatment.”
For most children, irritability is seen as quite normal and a regular part of development, but for some, it can be a symptom of a mental health disorder such as disruptive mood dysregulation disorder.
Scandinaro said it can be difficult for doctors to tell the difference between acute irritability — an adolescent being grumpy for a few days because he was grounded — and chronic irritability, which could signal possible problems with mental health.
Study participants were recruited from a large, academic medical center and included family medicine, pediatric and psychiatry providers. The Penn State researchers interviewed 17 providers about how they define irritability in their school-age patients, how they evaluate irritability, and how they tell the difference between normal and abnormal irritability, among other questions.
“We found that family medicine physicians and pediatricians feel as though they don’t have the resources and the training they need to effectively evaluate irritability in the clinic setting, especially in the limited amount of time that they have,” Scandinaro said.
“But at the same time, there is a national shortage of child and adolescent psychiatrists, increasing the need for primary care providers to be more comfortable in determining who needs to see a specialist. So even though the study was preliminary, it shows we need to improve education for primary care providers.”
The findings also show that while family medicine providers looked for anxiety and problems in school as symptoms of irritability, psychiatrists were more likely to check to see if kids exhibited a negative mood or if they had a hard time dealing with frustration.
Family care providers said they were comfortable prescribing medications but would likely refer the patient to a specialist if it appeared that stronger medications and treatment were needed.
All participants agreed that a lack of time with patients, as well as few concrete guidelines about what defined irritability and how to treat it, made diagnosing patients more difficult.
Overall, the findings suggest that primary care providers may not be confident evaluating irritability, even though the majority of children receive mental health care in a primary care setting, according to the National Institute of Mental Health.
Scandinaro says that additional training and education may help primary care providers and pediatricians be more confident in diagnosing their younger patients.
“A possible next step could be to create an educational tool that could be used as a quick way for primary care providers to help evaluate their patient,” Scandinaro said, “and to help them decide if it’s normal irritability or something that requires them to see a specialist.”
Scandinaro also adds that it’s important for parents to follow their gut when they notice something seems wrong with their child, and they should always talk to their doctor if concerned.
“If you think that something is going on, make it a priority to talk to your doctor about it. Don’t be afraid to mention it if something seems not to be right,” Scandinaro said. “Irritability doesn’t always mean that the child is bipolar or has a severe mental illness, and medication doesn’t always have to be the first option. But it’s important to talk about it.”
Drs. Usman Hameed, assistant professor of psychiatry, and Cheryl A. Dellasega, professor of medicine and humanities, also participated in this research.
Source: Penn State