Can a Logic Model support us Clinicians to become a Learning System?

Desperate clinical circumstances often lead to deviations from common prescription recommendations (e.g. off-label prescription of melatonin, anti-histamines, stimulants, or antipsychotics leading to overmedication and/or poly-pharmacy). Unrecognized drug interactions and adverse drug reactions, such as akathisia, worsen H-behaviours (hyper-arousability and hyper-motor-restlessness in wake and sleep states) and may lead to the exacerbation of existing, and development of new behavioural challenges. Therefore, symptoms need to be interpreted within the contextual framework of a logic model in order to make them recognizable already at the referral stage.

Our working group agreed on a grid or logic model, which allows us to re-visit diagnostic interconnections, functional diagnoses, which might drive medication practices, as well as medication and non-medication based intervention strategies.

The model sets categorical day and nighttime related diagnoses (e.g. ADHD and insomnia, respectively) in equal relation to functional diagnoses and probable root causes (e.g. iron or Vit D3 deficiencies), while also incorporating effects of medication (e.g., antipsychotics) and non-medication based interventions (e.g. cognitive behavioral therapy). Evaluation is enabled with the use of Sleep Disturbances Scale for Children (Bruni et al. 1996), which allows harmonization and quantification of the sleep assessment and follow-ups, and, as suggested by WHO, the International Classification of Functioning (https://www.who.int/classifications/icf/en/) allowing the creation of a mathematical model.