Trace Marie E, Feygin Yana B, Williams Patricia G, Winders Davis Deborah, Brothers Kyle B, Sullivan Janice E, Calhoun Aaron W
Center for Developmental Pediatrics, Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, OH.
Child and Adolescent Health Research Design and Support Unit, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY.
J Dev Behav Pediatr. 2022 May 1;43(4):233-239. doi: 10.1097/DBP.0000000000001037. Epub 2021 Nov 17.
Kentucky ranks among the highest in the nation for attention-deficit/hyperactivity disorder (ADHD) prevalence in children aged 4 to 17 years. In 2011, the American Academy of Pediatrics (AAP) released a clinical practice guideline based on the DSM-IV. A guideline revision based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) was released in October 2019. In this study, we assess and describe pediatric providers' ADHD practices using the 2011 guideline and DSM-5 diagnostic criteria.
This was a cross-sectional, survey-based descriptive study. Kentucky Chapter of the AAP (KY AAP) members were anonymously surveyed. The results were examined for trends in routine practice.
Fifty-eight general pediatricians and pediatric residents responded to the survey, yielding a 38% (58/154) response rate. Among respondents performing routine diagnosis of ADHD (N = 51), 73% (37/51) used DSM-5 criteria. Most providers usually or always initially assessed for coexisting behavioral conditions (96%; 49/51), developmental conditions (78%; 39/51), and adverse childhood experiences (73%; 37/51). Among respondents performing routine management of ADHD (N = 55), only 11% (6/55) of respondents indicated that they titrated stimulant medications every 3 to 7 days. After initiation of medication, 78% of providers scheduled a follow-up visit within 2 to 4 weeks. During subsequent visits, only half indicated discussing behavioral interventions, screening for coexisting conditions, and reviewing follow-up teacher-rated ADHD scales.
Pediatricians in the KY AAP adhere to the DSM-5 criteria for diagnosing ADHD. Pediatric providers' practices would benefit from education in improvements in pharmacotherapy titration, surveillance of coexisting conditions associated with ADHD, discussion of psychosocial interventions, and school support strategies.
肯塔基州4至17岁儿童注意力缺陷多动障碍（ADHD）患病率在全美名列前茅。2011年，美国儿科学会（AAP）发布了基于《精神疾病诊断与统计手册》第四版（DSM-IV）的临床实践指南。2019年10月发布了基于《精神疾病诊断与统计手册》第五版（DSM-5）的指南修订版。在本研究中，我们使用2011年指南和DSM-5诊断标准评估并描述儿科医疗服务提供者对ADHD的诊疗实践。
这是一项基于调查的横断面描述性研究。对AAP肯塔基州分会（KY AAP）成员进行了匿名调查。对结果进行了常规诊疗趋势检查。
58名普通儿科医生和儿科住院医师回复了调查，回复率为38%（58/154）。在进行ADHD常规诊断的受访者中（N = 51），73%（37/51）使用DSM-5标准。大多数医疗服务提供者通常或总是首先评估是否存在共病行为状况（96%；49/51）、发育状况（78%；39/51）和儿童期不良经历（73%；37/51）。在进行ADHD常规管理的受访者中（N = 55），只有11%（6/55）的受访者表示他们每3至7天调整一次兴奋剂药物剂量。开始用药后，78%的医疗服务提供者安排在2至4周内进行随访。在随后的随访中，只有一半的人表示会讨论行为干预措施、筛查共病状况以及复查教师评定的ADHD量表。
KY AAP中的儿科医生在诊断ADHD时遵循DSM-5标准。儿科医疗服务提供者的诊疗实践将受益于药物治疗滴定调整、与ADHD相关的共病监测、心理社会干预措施讨论以及学校支持策略等方面的教育。
