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Variability in ADHD care in community-based pediatrics.

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Summary

Quality of pediatric attention-deficit/hyperactivity disorder (ADHD) care varies significantly. Most children receive medication, but psychosocial treatment and monitoring are infrequent, highlighting a need for systematic improvements in ADHD management.

Keywords:
attention deficit and disruptive behavior disordersbehavioral medicineguidelinespediatricsquality

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Area of Science:

  • Pediatric Healthcare Quality
  • Attention-Deficit/Hyperactivity Disorder (ADHD) Management

Background:

  • Limited data exists on typical ADHD care quality in community pediatrics beyond self-reports.
  • Previous efforts to enhance care have not been fully evaluated in real-world settings.

Purpose of the Study:

  • To determine rates of evidence-based ADHD care in community pediatric settings.
  • To identify sources of variability in ADHD care quality.
  • To examine the impact of patient and practice characteristics on care quality.

Main Methods:

  • Chart reviews of 1594 children with ADHD across 188 pediatricians and 50 practices.
  • Analysis of practice-level, pediatrician-level, and patient-level factors influencing care.
  • Examination of associations between Medicaid status, practice setting, and care quality.

Main Results:

  • Parent/teacher rating scales used in ~50% of ADHD assessments; DSM criteria documented in 70.4%.
  • 93.4% received medication, but only 13.0% received psychosocial treatment; monitoring was infrequent.
  • Less than half of medicated children had follow-up within one month; patient-level factors explained most care variability.

Conclusions:

  • Significant improvements are needed in the quality of pediatric ADHD care.
  • Systematic interventions at practice and policy levels are essential for enhancing ADHD management.