Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 248-255 (doi:10.1542/peds.2007-3198)
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ARTICLE

Attention-Deficit/Hyperactivity Disorder: How Much Responsibility Are Pediatricians Taking?

Ruth E.K. Stein, MDa, Sarah McCue Horwitz, PhDb, Amy Storfer-Isser, MSc, Amy M. Heneghan, MDd, Kimberly Eaton Hoagwood, PhDe, Kelly J. Kelleher, MD, MPHf, Karen G. O'Connor, BSg and Lynn Olson, PhDg

a Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York
b Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
c Center for Clinical Investigation
d Department of Pediatrics, Case Western Reserve School of Medicine, Cleveland, Ohio
e Department of Psychiatry, Columbia University, New York, New York
f Department of Pediatrics, College of Medicine and Public Health, Ohio State University, Columbus, Ohio
g Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois

BACKGROUND. Attention-deficit/hyperactivity disorder, the most common childhood behavioral condition, is one that pediatricians think they should identify and treat/manage.

OBJECTIVE. Our goals were to explore the relationships between pediatricians' self-reports of their practice behaviors concerning usually inquiring about and treating/managing attention-deficit/hyperactivity disorder and (1) attitudes regarding perceived responsibility for attention-deficit/hyperactivity disorder and (2) personal and practice characteristics.

METHODS. We analyzed data from the 59th Periodic Survey of the American Academy of Pediatrics for the 447 respondents who practice exclusively in general pediatrics. Bivariate and logistic regression analyses were used to identify attitudes and personal and practice characteristics associated with usually identifying and treating/managing attention-deficit/hyperactivity disorder.

RESULTS. A total of 67% reported that they usually inquire about and 65% reported that they usually treat/manage attention-deficit/hyperactivity disorder. Factors positively associated with usually inquiring about attention-deficit/hyperactivity disorder in adjusted multivariable analyses include perceived high prevalence among current patients, attendance at a lecture/conference on child mental health in the past 2 years, having patients who are assigned or can select a specific pediatrician, practicing in suburban communities, practicing for ≥10 years, and being female. Pediatricians' attitudes about responsibility for identification of attention-deficit/hyperactivity disorder were not associated with usually inquiring about attention-deficit/hyperactivity disorder in either unadjusted or adjusted analyses. Attitudes about treating/managing attention-deficit/hyperactivity disorder were significantly associated with usually treating/managing attention-deficit/hyperactivity disorder in unadjusted and adjusted analyses. Those who perceived that pediatricians should be responsible for treating/managing had almost 12 times the odds of reporting treating/managing attention-deficit/hyperactivity disorder, whereas those who believe physicians should refer had threefold decreased odds of treating/managing. Other physician/practice characteristics significantly associated with the odds of usually treating/managing attention-deficit/hyperactivity disorder include belief that attention-deficit/hyperactivity disorder is very prevalent among current patients, seeing patients who are assigned or can select a specific pediatrician, and practice location.

CONCLUSIONS. Taking responsibility for treating attention-deficit/hyperactivity disorder and practice characteristics seem to be important correlates of pediatrician self-reported behavior toward caring for children with attention-deficit/hyperactivity disorder.

Key Words: attention-deficit/hyperactivity disorder • child behavior • pediatricians • physician practice patterns • treatment

Abbreviations: AAP—American Academy of Pediatrics • ADHD—attention-deficit/hyperactivity disorder

Accepted Apr 22, 2008.


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