Doctors in SA using obsolete test for ADHD
Dad given ‘outdated’ check list to test son for hyperactivity
● How accurate are the tools used by experts to diagnose children with attention deficit hyperactivity disorder?
That is a question father-of-two David Nefdt-Epstein is asking after discovering that several South African doctors have been using an outdated questionnaire to assist them in their diagnoses.
Nefdt-Epstein has lodged a complaint against Johannesburg child psychiatrist Brendan Belsham with the Health Professions Council of South Africa for, among other things, fraudulently claiming to use the Conners Ratings Scale.
The scale — used by health professionals internationally — consists of a check list of behaviours that caregivers, teachers, parents and children over the age of eight can complete.
The check list that has come under fire was distributed to health professionals by Novartis South Africa, the makers of the ADHD medication Ritalin, in about 2002.
South African company JvR Psychometrics, the sub-Saharan representative of the copyright holder of Conners, which is based in Canada, said this week the version distributed by Novartis was “an old, short form used many years ago for research” and was no longer internationally accepted.
The company’s MD, Dr Jopie de Beer, said those using it would probably not have the scoring-key manual that was provided and as such would not be able to generate “norm-referenced” scores.
“[These] are very important because they take into account the age of the individual and compare them to a normal population. Without normed scores, there is no reference point to understand the severity of the symptoms.”
De Beer said JvR was aware of health professionals using the outdated questionnaire. “They have been issued with cease-and-desist letters. The use of outdated and photocopied assessments in nonscientific ways violates both the professional and legal requirements.”
Nefdt-Epstein said his son was assessed by Belsham in May last year.
He said Belsham had given him a copy of the Conners ratings forms, which had to be completed by his son’s teachers.
“I had a level of comfort that I would, for the first time, see where my son would fall onto a scale. Was he off the charts and I was remiss not to medicate him? Or was he normal?”
But he said Belsham could not provide him with the scores, because he was not using the legitimate Conners Ratings Scale.
“In fact, he used a set of questions which were supplied to him by Novartis. I went to my general practitioner and asked him for his opinion on ADHD and he gave me a form, which had exactly the same questions as the one supplied by Belsham.”
Said Nefdt-Epstein: “Can he and others claim that they didn’t know they were administering a fake assessment which has no diagnostic value whatsoever? If so, should we then not challenge their credentials and their diagnoses? After all, these are the experts in their field.”
Belsham said this week that he would not comment on the specific Nefdt-Epstein case because of patient confidentiality.
“I always adhere to the internationally accepted evidence-based guidelines in the diagnosis of ADHD, as well as any other psychiatric condition,” he said.
“The diagnosis of ADHD is made clinically and does not rely on a particular rating scale.”
He said the use of any rating scale was done in good faith and in the interests of good patient care.
“After being made aware of the copyright concerns, I have resolved the issue with the licensee. If my attention is drawn to any shortcomings relating to a rating scale, I will take the appropriate advice regarding the scale from the relevant clinical and regulatory authorities.”
The Sunday Times has established that Belsham informed JvR Psychometrics in December last year that he would stop using material resembling the Conners Rating Scale and that he would destroy all existing copies of the material in his possession.
It was also established that he had admitted to JvR Psychometrics that the material was originally provided to him by Novartis between 2000 and 2009.
HPCSA spokeswoman Priscilla Sekhonyana confirmed that a complaint had been lodged against Belsham.
Novartis South Africa spokesman Vaychel Raman said: “We share materials with healthcare professionals regularly to keep them updated on the latest trends in clinical practice. These materials are regularly updated and old materials withdrawn from circulation when updated.
“Novartis is willing to communicate with identified health professionals around the use of the materials.”
Dr Fiona Schulte, chairwoman of the South African Society of Psychiatrists, said a rating scale could aid a diagnosis but that no rating scale should be used in isolation to diagnose ADHD.
“We wish to emphasise that a diagnosis of ADHD is exclusively made on clinical grounds.”