title: Current Australian pediatric practice in the assessment and treatment of ADHD.
abstract: OBJECTIVE
  To study the characteristics of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Australia, and the assessment and management practices of their pediatricians.
  
  
  METHODS
  A 2-week practice audit was conducted in a large representative sample of Australian general/community pediatricians. Pediatricians completed an audit form for all patients seen. Demographic details, diagnoses, treatments, and referrals made were recorded for each consultation.
  
  
  RESULTS
  A total of 199 pediatricians completed the audit (response rate 66%). There were 1528 consultations with patients with ADHD. Eighty percent of the subjects were male, and mean age at diagnosis was 9.1 years (range 3-19 years). Most patients (60%) had 1 or more comorbidity identified, although the reported rates of anxiety (8%) and oppositional defiant disorder (15%) were lower than expected. Patients with ADHD were more likely than patients with other diagnoses to be seen in private practice settings (76% vs. 65%; P < .001). Children with ADHD were referred to numerous services at diagnosis, most commonly psychology (32%). Stimulant medication or atomoxetine was prescribed for 40% at initial diagnosis and 80% at continuing consultation. Overall, methylphenidate was the most common medication prescribed (63%), with a minority prescribed dexamphetamine, atomoxetine, or clonidine. Eighteen percent were prescribed 2 or more medications. Medication prescription was predicted by age but not by gender or socioeconomic status.
  
  
  CONCLUSIONS
  ADHD is the most frequent diagnosis seen by Australian pediatricians, with some patients being seen into early adult life. Comorbidities appear to be inconsistently identified, with some possibly underdiagnosed. Older children are more likely to be prescribed medication.
authors.affiliation: Centre for Community Child Health, Royal Children's Hospital, Melbourne, Australia. daryl.efron@rch.org.au
authors.forename: Daryl
authors.initials: D
authors.lastname: Efron
authors.forename: Sarah
authors.initials: S
authors.lastname: Davies
authors.forename: Emma
authors.initials: E
authors.lastname: Sciberras
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000367:Age Factors; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000628:therapy; D001315:Australia; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011437:Propylamines / Q000627:therapeutic use; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride
keywords: assessment; attention-deficit/hyperactivity disorder (ADHD); audit; pediatrician; stimulant medications