Tuesday, November 2, 2010

Everyone Claims To Be An Expert On ADHD: Recognizing Bias

This week's guest blogger is Michael J. Labellarte Sr., MD.

Bias can be an obstacle to getting appropriate help for a child with ADHD. My session at CHADD’s conference will focus on how to recognize and minimize bias among the various professionals and family members involved in the child’s life.

Psychiatrists often discuss bias in terms of research and statistics, in the attempt to protect the scientific integrity of research data from factors that can erode the accuracy of research findings. Psychiatrists rarely discuss bias in terms of factors that can erode accuracy of diagnosis.

With a disorder as controversial as ADHD, a discussion of bias as it pertains to professional educators and treatment personnel is a can of worms. However, a discussion of clinical bias regarding ADHD will help parents navigate a complicated system where everyone claims to be an expert, from grandparents to international scholars. The goal here is illuminate how a variety of individuals tend to think, feel, behave, and make decisions, the better to predict and avoid common mistakes.

As soon as parents, pundits, and ADHD “experts” try to judge someone else’s thoughts, beliefs, and behaviors, they risk the introduction of observer bias. The most important observer bias is called fundamental attribution error which helps drive the controversy around ADHD. Fundamental attribution error describes this observer attitude: that another person’s behavior reflects their character or personality and not their circumstances; whereas the observer’s behavior depends on circumstances and not character or personality.

This kind of bias is lethal to accurate diagnosis and management of ADHD (or any other psychiatric disorder) whether it comes from parents, educators, psychiatrists, or whomever. Bias opens the door to easy distortions (such as oversimplification or overgeneralization) and more destructive factors such as insufficient data, insufficient comprehension, misinterpretations, misattributions, desperation, misinformation, deception, and mistrust between professionals and patients and families.

My conference session will detail steps parents can take to minimize bias in all its various forms as an obstacle to getting appropriate help for their child, including:

1. Assemble an experienced team for short-term consultation and longer-term management.
2. Get the “lay of the land” by identifying all of the various professional and familial “stakeholders” involved in the child’s life.
3. Gather information systematically, through a variety of sources.
4. Focus the information in the medical model style: A consultation begins with a presenting problem, it does not begin with a conclusion to rule in or rule out a diagnosis.
5. Observe for evidence of professional bias, including shortcuts, forced conclusions, and clich├ęs.
6. Demand enough feedback for informed consent before making a decision about treating or not treating ADHD, if it is present. True expertise will manifest during the informed consent process, which usually includes the rationale for diagnosis, a plan for further assessment, treatment options that include medical, psychological, and school-based interventions, the risks and benefits of treatment or withholding treatment, and the expected course of ADHD if treated or if not treated in your child.

I hope you will join me for this important discussion at the CHADD conference in Atlanta from November 11 through November 13.

Michael J. Labellarte Sr., MD, is a board-certified child and adolescent psychiatrist who treats children and families at his CPE Clinic, LLC, in Towson, Columbia, and Severna Park, Maryland, as well as Vero Beach, Florida. He is an assistant professor of psychiatry at the Johns Hopkins University School of Medicine, the University of Maryland School of Medicine, and the University of Florida College of Medicine.