Involving medical students in a community-based project on ADHD: a novel learning experience

Editor – In her interesting educational paper, Frearson reports that hospice placements enabled foundation year 1 doctors to improve their communication skills and enhance their recognition of the dying phase.¹ In a very different training environment, we describe involving Australian medical students from the University of Sydney in a community-based study investigating stimulant dose titration in children with attention deficit hyperactivity disorder (ADHD).

Despite its estimated prevalence of around 8%,² medical students often receive little training about ADHD,³ perpetuating the pattern of under-recognition and under-treatment. Under the supervision of Alison Poulton, four medical students tested children with ADHD using ‘Stop Signal Task’, a computer-based test of response inhibition. This involves rapidly pressing a key corresponding to the direction of an arrow on a computer screen; if a tone is presented after the arrow, they should inhibit their response. The test was repeated after four incremental doses of stimulant medication. The mornings of testing also provided an opportunity for students to observe the effects of medication and find out from the parents and children how ADHD affected their lives.

The students tested 13 children (10 boys) aged 5–17 years. Eleven children did the test correctly (scoring ≥90%) at least once; six children managed this even without medication. For 10 children, their best score was after their third or fourth incremental dose of stimulant.

The students observed vast differences in the children's behaviour as the medication took effect. Four children initially did not want to participate and two ran around uncontrollably. Some parents became stressed, expressing their emotion by crying or becoming aggressive. Observing this helped the students understand how ADHD can affect the whole family. The students also gained insight into the difficulties of doing research in the community, including organising families to keep appointments and persuading children to complete cognitive tests when they wanted to play with toys.

Just as hospice placements can have an important educational impact,¹ so our students experienced first-hand the challenges of community-based research and also had an opportunity to learn about children with ADHD.