Selection of patients for management of attention deficit hyperactivity disorder in a private practice setting

Attention deficit hyperactivity disorder (ADHD) is a syndrome characterized by age-inappropriate levels of motor activity, impulsivity, and inattention. A system of triage was developed to select an ADHD patient population which was manageable in a private practice setting. Seventy-four subjects with symptoms suggestive of ADHD were evaluated and diagnosed with ADHD and followed for 2 years. All subjects included in the study were shown a teaching videotape, received a full physical examination, and were counseled for approximately 1 hour. The diagnosis of ADHD was made based on the presence of eight of 14 criteria described in DSM-III, elevated Connors Rating Scale (CRS) scores, physical examination, observation, and historical information. A treatment plan involving behavioral therapy and medication was implemented with frequent follow-up. Ninety-six percent of the patients showed improvement in behavior (parental report and decreased CRS scores) and/or grades (one letter grade in two classes for 12 weeks). Fifteen percent of the treated subjects were suspected of having coexistent disorders and 4% did not respond to treatment. By implementing a simple triage system and protocol for diagnosis, treatment, and follow-up, a manageable patient population with ADHD and similar disorders was selected and successfully treated in a private practice setting.