VARIATIONS IN TREATMENT PRACTICES FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER: A NATIONAL SURVEY OF PRIMARY CARE PHYSICIANS Eugenia Chan, Marianne Hopkins, James M. Perrin, Carla Herrerias, Charles J. Homer Division of General Pediatrics, Children's Hospital, Boston, MA; American Academy of Pediatrics, Elk Grove Village, IL; Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, MA; National Initiative for Children's Healthcare Quality, Institute for Healthcare Improvement, Boston, MA

BACKGROUND: The new 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 how physicians diagnose ADHD, more recent data are needed to assess the guideline?s impact on practice.

OBJECTIVE: To describe current practice patterns of primary care physicians evaluating school-aged children for ADHD, and compare them to AAP guidelines in order to target areas for improvement.

DESIGN/METHODS: We conducted a national, cross-sectional survey of 2000 primary care pediatricians and family physicians in 1999-2000. 1076 surveys (54%) were returned, with 905 (84%) meeting data quality criteria. We tabulated frequencies for each survey item, and used chi-square analysis to examine relationships between survey items and physicians? experience with ADHD evaluations.

RESULTS: Primary care physicians reported a mean of 3 ± 1.7 evaluations for ADHD per month, the majority spending 15-45 minutes and at least 2 office visits to confirm a diagnosis of ADHD. Although 60% of physicians used formal diagnostic criteria, only 28% reported using DSM criteria. 50-70% reported using any teacher or school information such as report cards and rating scales. Approximately 70% of physicians used ADHD-specific rating scales, and 60% used global behavior scales. Half the respondents obtained vision and audiologic tests, while a quarter obtained laboratory tests such as hematocrit, lead, and thyroid function profile. Most physicians reported routinely assessing for co-existing conditions, ranging from 74% for tic disorders to 91% for depression and conduct disorder.

CONCLUSIONS: Primary care physicians? evaluation practices for school-aged children with ADHD vary widely and differ from recent AAP guidelines by infrequent use of DSM diagnostic criteria and school information, and inappropriate diagnostic tests. These data help identify areas for improvement and provide a baseline from which to assess the impact of the practice guidelines.