MANAGEMENT OF CHILDREN PRESCRIBED PSYCHOSTIMULANT MEDICATION FOR ATTENTION-DEFICIT HYPERACTIVITY DISORDER IN THE HUNTER REGION OF NSW

Objective: To examine local procedures for assessment of attention def icit hyperactivity disorder (ADHD) and its management with psychostimu lant medication and to compare these with published practice guideline s. Design: Retrospective postal survey. Participants: Parents of child ren living in the Hunter region of New South Wales first prescribed ps ychostimulants between 1992 and 1994. Main outcome measures: Procedure s for diagnostic assessment, treatment monitoring and continuing manag ement. Results: 788 parents (60%) responded. Diagnostic assessment pro cedures complied with published guidelines for about 70%, and detectio n of comorbid conditions was consistent with community prevalence esti mates. There was systematic assessment of treatment response with ques tionnaires in only a third. Some children with academic or behavioural problems (19%-24% and 32%, respectively), almost 50% with emotional p roblems and 63% with motor problems were not receiving treatment for t hese difficulties. Modal interval for review was six months. Trials of f medication were most commonly during school holidays, contrary to re commendations of the New South Wales Health Department. Most parents r eported considerable improvement in their children's quality of life w ith medication. Conclusions: Problems comorbid with ADHD are detected often. Areas of deficiency in management of ADHD include the low rate of contact with schools for diagnostic assessment and determining trea tment efficacy, poor support for comorbid problems, infrequent review, and inadequate methods for determining need to continue treatment.