How Mental Health Screening Shapes Pediatricians' Diagnostic Decision Making

Pediatricians underidentify mental health diagnoses in primary care settings. Incorporating mental health screening tools into practice may improve identification and diagnostic accuracy of mental health diagnoses. However, there is a lack of research into how pediatricians should best incorporate mental health screening into diagnostic decision making.

We deployed 2 series of clinical vignettes depicting child patients with attention-deficit hyperactivity disorder (ADHD) and anxiety by electronic survey. Each series presented sequential data including DSM-5 criteria, criteria with narrow-band screening tools, and criteria with screening tools and diagnostic probability. After each vignette, clinicians reported their certainty of diagnosis and whether there was enough information to justify referral or medication management.

Of 715 contacted community pediatricians, 74 completed at least 50% of the survey. The addition of mental health screening tools significantly increased clinicians' diagnostic certainty (p < 0.001 for ADHD, p < 0.001 for anxiety). Diagnostic probability did not significantly alter clinicians' diagnostic certainty. However, 54% (40/74) of clinicians agreed that diagnostic probability would support mental health decision making, with a suggested probability threshold of 73% to 78%.

Most (51.4%) community-based pediatricians surveyed were using screening measures to support identification of common pediatric mental health problems. Providing clearly interpretable diagnostic probabilities may offer additional value by contextualizing screening results and supporting pediatrician's mental health decision making in primary care.