ADHD care not what it should be

Many pediatricians fail to provide diagnosis and treatment that meet American Academy of Pediatrics (AAP) guidelines for children with attention-deficit/hyperactivity disorder (ADHD), a recent study reports. Shortcomings include lack of thorough evaluation and overreliance on drugs to the neglect of psychosocial therapy.

To assess typical ADHD care in community-based pediatric settings, researchers reviewed a random sample of 1594 charts from patients cared for by 188 pediatricians in 50 socioeconomically and demographically diverse practices.

Only 70.4% of diagnostic evaluations documented ADHD criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and only about half included parent and teacher rating scales. Most children with ADHD were on medication-93.4%-whereas only 13% received psychosocial intervention (a combination of the 2 is considered most effective).

Fewer than half of children had contact with the pediatrician during the first month after medication was prescribed; few pediatricians (about 10%) used parent and teacher rating scales to monitor treatment response or adverse effects as recommended by the AAP.

The researchers conclude that despite publication of AAP recommendations for diagnosing and treating ADHD, “adoption of evidence-based ADHD care in community-based pediatric settings remains poor.” They classify deviations from the recommendations into 2 categories: behaviors at the pediatrician or practice level and behaviors attributable mostly to patients. Improving care, they predict, will probably depend on system-wide changes at both the practice and policy levels.