Diagnostic practices for attention deficit hyperactivity disorder: a national survey of primary care physicians.
BACKGROUND
The American Academy of Pediatrics (AAP) clinical practice guideline emphasizes the appropriate diagnosis of attention deficit hyperactivity disorder (ADHD) in school-aged children. Although previous studies have shown wide variation in diagnostic practices for ADHD, few recent studies have examined nationally representative samples.


OBJECTIVE
To describe practice patterns of primary care physicians evaluating school-aged children for ADHD in the late 1990s and compare the patterns with subsequently published AAP guidelines.


METHODS
We surveyed a national sample of 2000 primary care pediatricians and family physicians. Of the 1076 returned surveys, 861 (43%) met data quality criteria and were included in the analysis. We tabulated frequencies for each item and used a chi2 test to examine relationships between survey items and physician characteristics.


RESULTS
Primary care physicians most commonly reported conducting 1-2 new evaluations for ADHD per month, the majority spending 15-45 minutes and at least 2 office visits to confirm a diagnosis of ADHD. Although 58% of physicians used formal diagnostic criteria, only 28% reported using criteria according to the Diagnostic and Statistical Manual of Mental Disorders. Eighty-three percent reported using any teacher or school information such as report cards and rating scales. Approximately 70% used ADHD-specific rating scales, and 60% used global behavior scales. A quarter of respondents obtained laboratory tests such as hematocrit, lead, and thyroid function profile. Most physicians reported routinely assessing for coexisting conditions, ranging from 74% for tic disorders to 91% for depression and conduct disorder.


CONCLUSIONS
Before the publication of AAP guidelines, primary care physicians' evaluation practices for school-aged children with ADHD varied widely, especially with respect to use of Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria and inappropriate diagnostic tests.
Chan
Eugenia
E
Division of General Pediatrics, Children's Hospital, Boston, MA 02115, USA. Eugenia.chan@childrens.harvard.edu
Hopkins
Marianne R
MR
Perrin
James M
JM
Herrerias
Carla
C
Homer
Charles J
CJ
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis*; D002648:Child; D002983:Clinical Competence; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009819:Office Visits; D010372:Pediatrics / Q000193:education / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011365:Professional Practice Location; D013997:Time Factors; D014481:United States