Identification of attentional and hyperactivity problems in primary care: A report from pediatric research in office settings and the ambulatory sentinel practice network

Objectives. To 1) determine the frequency of identification of attentional and hyperactivity frequency of identification of attentional and hyperactiv ity problems (AHPs) by clinicians, and 2) examine whether minority children or children from less well-educated, lower-income, or lower-functioning fa milies would be more likely to be identified as having AHPs. Design. Prospective cohort study of 22 059 consecutive children 4 to 15 yea ts of age being seen far acute, chronic, and health supervision visits. Set ting. Practices of 401 pediatric and family practice clinicians in 44 state s, Puerto Rico, and 4 Canadian provinces. Methods. Parent questionnaires included demographic information and the Ped iatric Symptom Checklist. Clinician questionnaires categorized psychosocial problems and addressed how assessment of problems was made. Analyses compa red children with newly identified AHPs with those with other newly identif ied psychosocial problems. Results. Clinicians identified behavior problems in 18.7% of children, with 9.2% of the entire sample identified as having AHPs. Among those with newl y assessed AHPs, clinicians identified minority children and those from low -income or poorly functioning families as having AHPs at the same rate as o ther children. However, even after controlling for symptoms, males were mor e likely than females (odds ratio, 2.81) to be identified as having AHPs. O lder clinicians were significantly more likely to identify children as havi ng AHPs (odds ratio, 2.09). In assessing AHPs, clinicians used standardized tools such as behavioral questionnaires for only 36.9% of children, and Di agnostic and Statistical Manual criteria for 38.3% of children. Conclusions. AHPs are highly prevalent in primary care practice. Clinicians do not appear predisposed to label children from disadvantaged backgrounds as having AHPs. Primary care assessment of AHPs lacks standardization.