Authors:
Efron D, Sciberras E, Hiscock H, Jongeling B, Lycett K, Bisset M, Smith G.
Authors notes:
Journal of Paediatrics and Child Health. 2016;52(4):410-6.
Keywords:
ADHD, behavioural medicine, guidline adherence, paediatrics, quality of health care
Abstract:
Aims: In a sample of newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD), the aims were to examine:
(1) paediatrician assessment and management practices;
(2) previous assessments and interventions;
(3) correspondence between parent-report and paediatrician identification of comorbidities; and
(4) parent agreement with diagnosis of ADHD.
Methods Design: cross-sectional, multi-site practice audit with questionnaires completed by paediatricians and parents at the point of ADHD diagnosis.
Setting: private/public paediatric practices in Western Australia and Victoria, Australia.
Main outcome measures: paediatricians: elements of assessment and management were indicated on a study-designed data form.
Parents: ADHD symptoms and comorbidities were measured using the Conners 3 ADHD Index and Strengths and Difficulties Questionnaire, respectively.
Sleep problems, previous assessments and interventions, and agreement with ADHD diagnosis were measured by questionnaire.
Results: Twenty-four paediatricians participated, providing data on 137 patients (77% men, mean age 8.1 years).
Parent and teacher questionnaires were used in 88% and 85% of assessments, respectively.
Medication was prescribed in 75% of cases.
Comorbidities were commonly diagnosed (70%); however, the proportion of patients identified by paediatricians with internalising problems (18%), externalising problems (15%) and sleep problems (4%) was less than by parent report (51%, 66% and 39%).
One in seven parents did not agree with the diagnosis of ADHD.
Conclusions Australian paediatric practice in relation to ADHD assessment is generally consistent with best practice guidelines; however, improvements are needed in relation to the routine use of questionnaires and the identification of comorbidities.
A proportion of parents do not agree with the diagnosis of ADHD made by their paediatrician.