Family Physicians Not Always Complying with AAP Guidelines for Diagnosing ADHD, Report Finds

A new report — confirming earlier CDC research — finds that many family physicians are not doing enough to conform to AAP guidelines when diagnosing and treating ADHD.
ADHD News Feed | posted by Devon Frye

June 30, 2016

ADHD is already among the most common of childhood disorders, and diagnoses continue to rise among kids and adults every year. Despite its ubiquity, however, some physicians still do not diagnose and treat ADHD in accordance with the American Academy of Pediatrics (AAP) guidelines — particularly when it comes to assessing for comorbid conditions and recommending behavioral therapy, according to a new report.

The AAP guidelines for ADHD were published in 2011, and though some researchers disagree with their core conclusions, they remain the most universally accepted groundwork for diagnosing and treating children with attention deficit in the United States. Among the key AAP recommendations are behavioral therapy before medication in children younger than 6, and the need for children of any age who have been diagnosed with ADHD to have consistent and long-term support from parents, teachers, and doctors.

This new report was published June 6 in the Southern Medical Journal, and focused on how well a single family medicine clinic — which saw 60 ADHD patients between 2012 and 2014 — adhered to the AAP guidelines from diagnosis to treatment. Of the 60 patients who were seen, doctors correctly documented at least one core symptom of ADHD in 57 of them — or about 95 percent. This adheres to AAP guidelines and was a promising start, but the results that followed were much more concerning. For starters, a key criterion for properly diagnosing ADHD is the documentation of symptoms in at least two important life settings — but the clinic only managed to do this for 45 percent of the children it saw.

The AAP guidelines also call for the assessment of ADHD patients for comorbid conditions, since at least one occurs alongside ADHD more often than not. Disappointingly, the clinic only looked for comorbid conditions in 50 percent of the kids — even though it found one in two-thirds of them — and rarely factored in a possible comorbid condition when prescribing ADHD medications.

While the doctors followed the guidelines related to prescribing ADHD medication for 86.7 percent of the patients, the rate of adherence to the behavioral therapy guidelines was shockingly low: only one in nine of the preschool-aged children who should have gotten access to behavioral therapy had done so.

The report was small — it only focused on one clinic with fewer than 100 ADHD patients — but it syncs up with a previous CDC study that found a majority of pediatricians were disregarding the AAP guidelines for the treatment of ADHD. Combined with this previous research, it suggests that more physicians need ADHD education than are currently receiving it — particularly when it comes to the complex areas of comorbid conditions and long-term management of ADHD. Doctors are great at prescribing medication, it’s true — but in order for children with ADHD to thrive, they need an accurate diagnosis, comprehensive treatment, and lifelong support.


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