Pediatricians' reported practices in the assessment and treatment of attention deficit disorders

This study examined, in a national survey, the assessment and treatment practices of pediatricians who care for children with attention deficit disorders (ADD). A questionnaire was sent to randomly selected members of the American Academy of Pediatrics (AAP), stratified by state. Of 417 (52%) responses returned, there were 290 (38%) completed questionnaires. It was found that most pediatricians did not utilize specific DSM-III criteria for ADD; however, they do rely on symptoms of distractibility, overactivity, and impulsivity, which are the behaviors central to the DSM-III diagnosis. In addition, learning difficulties were felt to be contributory. Parents were the most frequently reported sources of information about a child's behavior, but the histories provided by teachers, and psychoeducational reports, also were sought frequently. Many pediatricians still use diagnostic procedures that have recently come under question, such as soft neurologic signs, activity level in the office, and response to stimulant medication. Methylphenidate and behavior modification were the most frequent therapies employed. Over half of the respondents use periodic reevaluation with rating scales to determine medication efficacy, but very few use placebo trials. More recently trained pediatricians tended to rely more on behavioral treatments than did earlier trained physicians.