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Family medicine doctors report insufficient knowledge in diagnosing, managing childhood irritability
Family medicine and pediatric practitioners reported significantly less confidence in their capability to assess some aspects of their young patients’ mental health status, according to findings recently published in Primary Care Companion CNS Disorders.
“Half of mental health care for children and adolescents is delivered in the primary care setting. Based off of this, we wanted to know how primary care providers feel comfortable in diagnosing and treating irritability,” Anna Scandinaro, BS, and fourth year medical student at The Pennsylvania State University, told Healio Family Medicine.
Scandinaro and colleagues asked 17 medical professionals (5 family medicine doctors; 6 primary care pediatricians; and 6 psychiatry providers) the following questions:
- How [do] you define irritability in school-aged children?
- In your clinic, is it more likely that a child will come in with a chief complaint of irritability or that you would observe irritable behaviors during the exam?
- How do you evaluate a child’s irritability?
- Could you describe a memorable patient of yours who had irritability?
- How would you differentiate between normal vs. abnormal comorbid irritability?
- If you were unsure of whether a child’s irritability was normal vs. abnormal, what would you do next?
- Is there anything else you feel is important for us to know about assessing irritability in school-aged children?
A nurse practitioner, a psychiatrist and a research assistant evaluated responses.
“This preliminary study found many primary care providers do not feel comfortable in diagnosing and treating irritability,” Scandinaro said in the interview. “This suggests that more education is needed for PCPs in diagnosing and treating mental health disease in children and adolescents.”
She offered tips for PCPs to know when a pediatric patient’s bad mood is cause for major concern.
“The most important thing is differentiating between an acute event which makes a child irritable and a child who is chronically irritable for no apparent reason. Ask yourself, ‘How long does the child have the bad mood?’ and ‘Is the bad mood disruptive in his or her life?’ If the answer to both is yes, then there should be more investigation and possibly referral.”
One of the study’s co-authors, Usman Hameed, MD, FAPA, DFAACAP, also offered some suggestions on assessing irritability.
“Bad moods are serious when there are associated safety concerns. In addition, moodiness in excess of what may be considered developmentally appropriate for the age, which is triggered by minimal stressors, and which results in impairment in social, interpersonal or academic functioning, may require further exploration,” he said in an interview.
Scandinaro added that based on the findings, as well as the nationwide shortage of child mental and behavioral health specialist, PCPs should not immediately rush to refer these patients out.
“A common theme we saw is that child and adolescent psychiatrists would appreciate more triaging of patients, and for the PCP to try something first instead of immediately referring them if they feel comfortable, such as behavioral therapy or starting a selective serotonin reuptake inhibitor treatment.”
Researchers also suggested future studies employ a larger sample size and several clinics to broaden the knowledge base on pediatric irritability. – by Janel Miller
Disclosure: The authors report no relevant financial disclosures.