Diagnostic Practices for Attention Deficit Hyperactivity Disorder: A National Survey of Primary Care Physicians

Chan, Eugenia; Hopkins, Marianne R.; Perrin, James M.; Herrerias, Carla; Homer, Charles J.

doi:10.1367/A04-054R1.1

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Volume 5, Issue 4 , Pages 201-208, July 2005

Diagnostic Practices for Attention Deficit Hyperactivity Disorder: A National Survey of Primary Care Physicians

Eugenia Chan, MD, MPH
- Address correspondence to Eugenia Chan, MD, MPH, Division of General Pediatrics Children's Hospital Boston, 300 Longwood Ave, Boston, MA 0211
Marianne R. Hopkins, MD, MPH
- From the Division of General Pediatrics (Dr Chan), Children's Hospital, Boston, Mass; the Division of Child and Adolescent Psychiatry (Dr Hopkins), Maine Medical Center, Portland, Maine; the Center for Child and Adolescent Health Policy (Dr Perrin), MassGeneral Hospital for Children, Boston, Mass; the American Academy of Pediatrics (Ms Herrerias), Elk Grove Village, Ill; and the National Initiative for Children's Healthcare Quality (Dr Homer), Boston, Mass
James M. Perrin, MD
- From the Division of General Pediatrics (Dr Chan), Children's Hospital, Boston, Mass; the Division of Child and Adolescent Psychiatry (Dr Hopkins), Maine Medical Center, Portland, Maine; the Center for Child and Adolescent Health Policy (Dr Perrin), MassGeneral Hospital for Children, Boston, Mass; the American Academy of Pediatrics (Ms Herrerias), Elk Grove Village, Ill; and the National Initiative for Children's Healthcare Quality (Dr Homer), Boston, Mass
Carla Herrerias, MPH
- From the Division of General Pediatrics (Dr Chan), Children's Hospital, Boston, Mass; the Division of Child and Adolescent Psychiatry (Dr Hopkins), Maine Medical Center, Portland, Maine; the Center for Child and Adolescent Health Policy (Dr Perrin), MassGeneral Hospital for Children, Boston, Mass; the American Academy of Pediatrics (Ms Herrerias), Elk Grove Village, Ill; and the National Initiative for Children's Healthcare Quality (Dr Homer), Boston, Mass
Charles J. Homer, MD, MPH
- From the Division of General Pediatrics (Dr Chan), Children's Hospital, Boston, Mass; the Division of Child and Adolescent Psychiatry (Dr Hopkins), Maine Medical Center, Portland, Maine; the Center for Child and Adolescent Health Policy (Dr Perrin), MassGeneral Hospital for Children, Boston, Mass; the American Academy of Pediatrics (Ms Herrerias), Elk Grove Village, Ill; and the National Initiative for Children's Healthcare Quality (Dr Homer), Boston, Mass

Received 31 March 2004; accepted 10 February 2005.

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 χ² 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.

KEY WORDS: attention deficit hyperactivity disorder , clinical practice guideline , practice variation , primary care