Diagnosing childhood attention-deficit/hyperactivity disorder. Do family practitioners and pediatricians make the same call?

BACKGROUND: The purpose of this study was to determine whether--and if so, how--primary care physicians in Minnesota differ in diagnosing and treating childhood ADHD. METHODS: A questionnaire was mailed to 200 family physicians (100 urban; 100 rural) and 100 pediatricians (60 urban; 40 rural). The questionnaire asked about assessment, diagnosis, and treatment strategies physicians would use in response to three patient vignettes. RESULTS: While all physicians in both specialities reported similar differential diagnoses, pediatricians used more special tests and assessment scales than family physicians (p < 0.05). More family physicians referred patients for further evaluation (p < 0.05). Eighty-nine percent of pediatricians used DSM-IV criteria compared with 37% of family physicians (p < 0.001). Parents (98%) and teachers (82%) were usually involved in management planning, and methylphenidate (Ritalin) was the most commonly prescribed drug (87%). CONCLUSION: Regardless of specialty, size of community, or distance from mental health services, physicians in this study did not differ in the diagnosis or treatment of ADHD in response to hypothetical cases. Pediatricians reported using DSM-IV criteria in their practices when making diagnoses more often than family physicians.