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Identification of attentional and hyperactivity problems in primary care: a report from pediatric research in office
R C Wasserman1, K J Kelleher, A Bocian
1Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont 05401, USA.
Insights
Attentional and hyperactivity problems (AHPs) are common in primary care. Clinicians identify AHPs in children regardless of socioeconomic background, but males and children with older clinicians are more likely to be diagnosed. Standardized assessment tools are underutilized.
Area of Science:
- Pediatric Health
- Behavioral Science
- Clinical Practice
Background:
- Attentional and hyperactivity problems (AHPs) represent a significant concern in child development and primary care settings.
- Understanding the identification patterns of AHPs is crucial for equitable healthcare delivery.
Purpose of the Study:
- To determine the frequency of clinician identification of attentional and hyperactivity problems (AHPs) in children.
- To examine disparities in AHP identification based on child's minority status, socioeconomic background, and family functioning.
Main Methods:
- A prospective cohort study involved 22,059 children aged 4-15 years across 401 pediatric and family practices in North America.
- Data were collected via parent and clinician questionnaires, including demographic information, the Pediatric Symptom Checklist, and problem assessment methods.
Main Results:
- Clinicians identified behavior problems in 18.7% of children, with 9.2% diagnosed with AHPs.
- Minority children and those from disadvantaged backgrounds were not identified with AHPs at higher rates.
- Males (OR, 2.81) and children assessed by older clinicians (OR, 2.09) were more likely to be identified with AHPs.
- Standardized tools like behavioral questionnaires (36.9%) and DSM criteria (38.3%) were infrequently used.
Conclusions:
- Attentional and hyperactivity problems are highly prevalent in primary care.
- Clinicians do not show bias in identifying AHPs in children from disadvantaged backgrounds.
- The assessment of AHPs in primary care lacks standardization, highlighting a need for improved diagnostic practices.
Objectives:
To 1) determine the frequency of identification of attentional and hyperactivity problems (AHPs) by clinicians, and 2) examine whether minority children or children from less well-educated, lower-income, or lower-functioning families would be more likely to be identified as having AHPs.
Design:
Prospective cohort study of 22 059 consecutive children 4 to 15 years of age being seen for acute, chronic, and health supervision visits.
Setting:
Practices of 401 pediatric and family practice clinicians in 44 states, Puerto Rico, and 4 Canadian provinces.
Methods:
Parent questionnaires included demographic information and the Pediatric Symptom Checklist. Clinician questionnaires categorized psychosocial problems and addressed how assessment of problems was made. Analyses compared children with newly identified AHPs with those with other newly identified psychosocial problems.
Results:
Clinicians identified behavior problems in 18.7% of children, with 9.2% of the entire sample identified as having AHPs. Among those with newly assessed AHPs, clinicians identified minority children and those from low-income or poorly functioning families as having AHPs at the same rate as other children. However, even after controlling for symptoms, males were more likely than females (odds ratio, 2.81) to be identified as having AHPs. Older clinicians were significantly more likely to identify children as having AHPs (odds ratio, 2.09). In assessing AHPs, clinicians used standardized tools such as behavioral questionnaires for only 36.9% of children, and Diagnostic and Statistical Manual criteria for 38.3% of children.
Conclusions:
AHPs are highly prevalent in primary care practice. Clinicians do not appear predisposed to label children from disadvantaged backgrounds as having AHPs. Primary care assessment of AHPs lacks standardization.
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