The diagnosis of attention-deficit/hyperactivity disorder in Australian children: Current paediatric practice and parent perspective

Daryl Efron; Emma Sciberras; Harriet Hiscock; Brad Jongeling; Kate Lycett; Matthew Bisset; Grant Smith

doi:10.1111/jpc.13091

The diagnosis of attention-deficit/hyperactivity disorder in Australian children: Current paediatric practice and parent perspective

J Paediatr Child Health. 2016 Apr;52(4):410-6. doi: 10.1111/jpc.13091.

Authors

Daryl Efron^{1

2

3}, Emma Sciberras^{1

2

3}, Harriet Hiscock^{1

2

3}, Brad Jongeling^{4

5}, Kate Lycett^{1

2

3}, Matthew Bisset¹, Grant Smith⁶

Affiliations

¹ Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
² Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.
³ The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Child Development Service, Joondalup, Western Australia, Australia.
⁵ The University of Western Australia, Perth, Western Australia, Australia.
⁶ Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.

PMID: 27145504
DOI: 10.1111/jpc.13091

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.

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.

Keywords: ADHD; behavioural medicine; guidline adherence; paediatrics; quality of health care.

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity / diagnosis*
Attention Deficit Disorder with Hyperactivity / therapy*
Attitude of Health Personnel*
Child
Child, Preschool
Cross-Sectional Studies
Female
Humans
Male
Parents / psychology*
Pediatricians / psychology*
Pediatrics / standards
Pediatrics / trends
Practice Patterns, Physicians' / standards
Practice Patterns, Physicians' / trends
Quality Improvement*
Surveys and Questionnaires
Treatment Outcome
Western Australia