title: Assessing the standard of care for child and adolescent attention-deficit hyperactivity disorder in Elgin County, Ontario: a pilot study.
abstract: OBJECTIVE
  To examine the current practice of rural family physicians in managing children with attention-deficit hyperactivity disorder (ADHD).
  
  
  METHODS
  Chart review of children and adolescents with a recorded diagnosis of ADHD. The data collected include the patient's age at diagnosis, the diagnosing physician, the number and type of presenting symptoms, whether the Diagnostic Statistical Manual, 4th ed (DSM-IV) criteria were met, pertinent treatment regimens, family history and comorbid conditions. Participating physicians were asked to complete a questionnaire.
  
  
  METHODS
  Elgin County, Ontario.
  
  
  RESULTS
  Thirty-six family physicians were contacted and 11 agreed to participate. Thirty-nine charts were reviewed. The average number of presenting symptoms was 2.9 for ADHD-inattentive subtype and 2.1 for ADHD-hyperactivity subtype. A diagnostic protocol was included in 20.5% of the charts. Of the 39 charts reviewed, 25.6% had sufficient information for the patients to meet the ADHD criteria. Family physicians diagnosed 5.1% of the cases, and the duration of time between referral to specialist and appointment was 47.2 weeks.
  
  
  CONCLUSIONS
  Together the lack of symptom recording, the long duration between referrals, and the low percentage of family physicians diagnosing ADHD all suggest the need for developing diagnostic protocols for family physicians and increasing their knowledge of diagnosing and managing ADHD.
authors.affiliation: Faculty of Medicine, University of Western Ontario, London, Ont.
authors.forename: Natalie
authors.initials: N
authors.lastname: Kotowycz
authors.forename: Susan
authors.initials: S
authors.lastname: Crampton
authors.forename: Margaret
authors.initials: M
authors.lastname: Steele
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence / Q000592:standards; D019091:Critical Pathways / Q000592:standards*; D003937:Diagnosis, Differential; D005194:Family Practice / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000706:statistics & numerical data*; D009864:Ontario; D010865:Pilot Projects; D011368:Professional-Family Relations; D012423:Rural Health; D019035:Rural Health Services / Q000592:standards*; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires