{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T01:52:51Z","timestamp":1788400371856,"version":"build-2803163510"},"reference-count":20,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,7,1]]},"abstract":"<jats:p>Objectives. Several guidelines have been published for the care of children with attention-deficit\/hyperactivity disorder (ADHD); however, few data describe adoption of practice guidelines. Our study sought 1) to describe primary care diagnosis and management of ADHD, 2) to determine whether the care is in accordance with American Academy of Pediatrics (AAP) practice guidelines, and 3) to describe factors associated with guideline adherence.<\/jats:p><jats:p>Methods. We conducted a mail survey of 1374 primary care physicians in Michigan. Main outcome measures were reported adherence to practices specified in the AAP guidelines; ADHD practice patterns; and other measures, including attitudes about parent, teacher, and community influences on ADHD diagnosis and treatment. Bivariate and multivariate analyses were performed to assess patient and physician factors associated with adherence to guideline components.<\/jats:p><jats:p>Results. The overall response rate was 60%. The majority (77.4%) of primary care physicians were familiar with AAP guidelines on ADHD, and many (61.1%) reported incorporating the guidelines into their practice. Differences were apparent by specialty: 91.5% of pediatricians were familiar with the guidelines in contrast to 59.8% of family physicians. The majority of clinicians reported practices consistent with individual components of the diagnostic and treatment guidelines. However, when adherence to multiple components was analyzed together, only 25.8% of clinicians reported routine use of all 4 diagnostic components in the survey. In addition, some physicians continue to use diagnostic modalities that are currently not recommended for routine evaluation of school-aged children with ADHD\u2014continuous performance testing, neuroimaging, and laboratory tests (eg, thyroid, lead, or iron testing). With regard to ADHD treatment, the majority (66.6%) of respondents reported routine recommendation of pharmacotherapy and titration of medications in the first month when prescribed (81.3%). However, just over half (53.1%) reported routine follow-up visits (3\u20134 times per year) for children who have ADHD and are taking medications. Most (53.4%) clinicians also recommended behavioral therapy for children who had a diagnosis of ADHD. Patterns of specialty differences were less consistent for treatment components: pediatricians were more likely to recommend medications, but family physicians reported more frequent follow-up evaluations for children who receive medications. There were no specialty differences in recommendations for behavioral therapy. In addition to physician specialty variations, differences in management were apparent by practice type and other demographic characteristics. There were few significant associations between adherence to guideline components and physician attitudes about parent, teacher, or community influences. However, these factors were noted by many respondents. Only 32.5% agreed that their community had adequate, accessible mental health resources. Half (50.1%) of the physicians reported that insurers limit coverage for assessment and treatment of ADHD.<\/jats:p><jats:p>Conclusions. Primary care physicians generally report awareness of pediatric ADHD guidelines and follow these clinical practice recommendations. However, some physician variations are apparent, and areas for improvement are noted. Many primary care physicians report poor access to mental health services, limited insurance coverage, and other potential system barriers to the delivery of ADHD care. Additional study is needed to confirm provider-reported data; to determine what constitutes high-quality, long-term management of this chronic condition; and to confirm how reported practices associate with long-term outcomes for children with ADHD.<\/jats:p>","DOI":"10.1542\/peds.114.1.e23","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:53:04Z","timestamp":1092444784000},"page":"e23-e28","source":"Crossref","is-referenced-by-count":134,"title":["Use of Practice Guidelines in the Primary Care of Children With Attention-Deficit\/Hyperactivity Disorder"],"prefix":"10.1542","volume":"114","author":[{"given":"Jerry L.","family":"Rushton","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Indiana University School Of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn E.","family":"Fant","sequence":"additional","affiliation":[{"name":"Child Health Evaluation and Research Unit, Division Of General Pediatrics, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J.","family":"Clark","sequence":"additional","affiliation":[{"name":"Child Health Evaluation and Research Unit, Division Of General Pediatrics, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2004,7,1]]},"reference":[{"key":"2021121006501396800_R1","doi-asserted-by":"crossref","unstructured":"Hoagwood K, Kelleher KJ, Feil M, Comer DM. Treatment services for children with ADHD: a national perspective. J Am Acad Child Adolesc Psychiatry.\u20082000;39:198\u2013206","DOI":"10.1097\/00004583-200002000-00020"},{"key":"2021121006501396800_R2","doi-asserted-by":"crossref","unstructured":"Zito JM, Safer DJ, dosReis S, et al. Psychotherapeutic medication patterns for youths with attention-deficit\/hyperactivity disorder. Arch Pediatr Adolesc Med.\u20081999;153:1257\u20131263","DOI":"10.1001\/archpedi.153.12.1257"},{"key":"2021121006501396800_R3","doi-asserted-by":"crossref","unstructured":"Robison LM, Sclar DA, Skaer TL, Galin RS. National trends in the prevalence of attention-deficit\/hyperactivity disorder and the prescribing of methylphenidate among school-age children: 1990\u20131995. Clin Pediatr.\u20081999;38:209\u2013217","DOI":"10.1177\/000992289903800402"},{"key":"2021121006501396800_R4","doi-asserted-by":"crossref","unstructured":"Rushton JL, Whitmire T. Pediatric stimulant and SSRI prescription trends: 1992\u20131998. Arch Pediatr Adolesc Med.\u20082001;155:560\u2013565","DOI":"10.1001\/archpedi.155.5.560"},{"key":"2021121006501396800_R5","doi-asserted-by":"crossref","unstructured":"Safer DJ, Zito JM, Fine EM. Increased methylphenidate usage for attention deficit disorder in the 1990s. Pediatrics.\u20081996;98:1084\u20131088","DOI":"10.1542\/peds.98.6.1084"},{"key":"2021121006501396800_R6","doi-asserted-by":"crossref","unstructured":"Jensen PS, Kettle L, Roper MT, et al. Are stimulants overprescribed? Treatment of ADHD in four U.S. communities. J Am Acad Child Adolesc Psychiatry.\u20081999;38:797\u2013804","DOI":"10.1097\/00004583-199907000-00008"},{"key":"2021121006501396800_R7","doi-asserted-by":"crossref","unstructured":"Shaywitz SE, Shaywitz BA. Increased medication use in attention-deficit hyperactivity disorder: regressive or appropriate?JAMA.\u20081988;260:2270\u20132272","DOI":"10.1001\/jama.260.15.2270"},{"key":"2021121006501396800_R8","doi-asserted-by":"crossref","unstructured":"Rappley MD, Mullan PB, Alvarez FJ, et al. Diagnosis of attention-deficit\/hyperactivity disorder and use of psychotropic medication in very young children. Arch Pediatr Adolesc Med.\u20081999;153:1039\u20131045","DOI":"10.1001\/archpedi.153.10.1039"},{"key":"2021121006501396800_R9","doi-asserted-by":"crossref","unstructured":"MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit\/hyperactivity disorder. Arch Gen Psychiatry.\u20081999;56:1073\u20131086","DOI":"10.1001\/archpsyc.56.12.1073"},{"key":"2021121006501396800_R10","doi-asserted-by":"crossref","unstructured":"Dulcan M. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit\/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry.\u20081997;36:85S\u2013121S","DOI":"10.1097\/00004583-199710001-00007"},{"key":"2021121006501396800_R11","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit\/hyperactivity disorder. Pediatrics.\u20082000;105:1158\u20131170","DOI":"10.1542\/peds.105.5.1158"},{"key":"2021121006501396800_R12","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics. Clinical practice guideline: treatment of the school-aged child with attention-deficit\/hyperactivity disorder. Pediatrics.\u20082001;108:1033\u20131044","DOI":"10.1542\/peds.108.4.1033"},{"key":"2021121006501396800_R13","doi-asserted-by":"crossref","unstructured":"Stein MT, Perrin JM. Diagnosis and treatment of ADHD in school-age children in primary care settings: a synopsis of the AAP practice guidelines. Pediatr Rev.\u20082003;24:92\u201398","DOI":"10.1542\/pir.24-3-92"},{"key":"2021121006501396800_R14","unstructured":"Herrerias CT, Perrin JM, Stein MT. The child with ADHD: using the AAP clinical practice guideline. American Academy of Pediatrics. Am Fam Physician.\u20082001;63:1803\u20131810"},{"key":"2021121006501396800_R15","unstructured":"STATA Reference Manual: Release 7. College Station, TX: Stata Press; 2003"},{"key":"2021121006501396800_R16","doi-asserted-by":"crossref","unstructured":"Tunis SR, Hayward R, Wilson MC, et al. Internists\u2019 attitudes about clinical practice guidelines. Ann Intern Med.\u20081994;120:956\u2013963","DOI":"10.7326\/0003-4819-120-11-199406010-00008"},{"key":"2021121006501396800_R17","doi-asserted-by":"crossref","unstructured":"Cabana MD, Rand CS, Powe NR, et al. Why don\u2019t physicians follow clinical practice guidelines? A framework for improvement. JAMA.\u20081999;282:1458\u20131465","DOI":"10.1001\/jama.282.15.1458"},{"key":"2021121006501396800_R18","doi-asserted-by":"crossref","unstructured":"Montano DE, Phillips WR. Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit. Am J Public Health.\u20081995;85:795\u2013800","DOI":"10.2105\/AJPH.85.6.795"},{"key":"2021121006501396800_R19","doi-asserted-by":"crossref","unstructured":"Weingarten S, Stone E, Hayward R, et al. The adoption of preventive care practice guidelines by primary care physicians: do actions match intentions?J Gen Intern Med.\u20081995;10:138\u2013144","DOI":"10.1007\/BF02599668"},{"key":"2021121006501396800_R20","doi-asserted-by":"crossref","unstructured":"Stein MT. The role of attention-deficit\/hyperactivity disorder diagnostic and treatment guidelines in changing physician practices. Pediatr Ann.\u20082002;31:496\u2013504","DOI":"10.3928\/0090-4481-20020801-09"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/1\/e23\/1006443\/zpe00704000e23.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/1\/e23\/1006443\/zpe00704000e23.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:38:11Z","timestamp":1682746691000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/114\/1\/e23\/64767\/Use-of-Practice-Guidelines-in-the-Primary-Care-of"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,7,1]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2004,7,1]]},"published-print":{"date-parts":[[2004,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.114.1.e23","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,7,1]]}}}