In this month's Pediatrics electronic pages is an important report by Wasserman and associates entitled "Identification of Attentional and Hyperactivity Problems in Primary Care: A Report From PROS and ASPN." This extensive, valuable study describes how a sample of 401 primary care pediatricians and family practice physicians with a patient cohort of over 22 000 children found that 18.7% of them had behavioral difficulties and about half of these, or 9.2% of the total sample, showed evidence of attentional or hyperactivity problems (AHPs). Another main conclusion of the project was that the diagnosis was not made more frequently with children from "disadvantaged backgrounds." This commentary explores the third principal result of the work, that "primary care assessment of AHPs lacks standardization."

A great strength of the report is the large and diverse sample of children studied. If anyone needs proof of the value of the Pediatric Research in Office Settings (PROS) Network, here it is. It makes available an enormous cohort of the general population. Instead of the generally skewed samples typically used in studies based at tertiary academic centers, the Network provides a more realistic cross section of children in the community. Questions of incidence and prevalence are among the issues that can be investigated more accurately in primary care than at referral centers.¹

Another important conclusion of the report is that pediatricians can and do pick up a substantial number of behavioral problems in their practices.² Perhaps this detection is sometimes not as thorough as it should be, but it is probably not as negligent as some nonpediatric critics have claimed.³

One need not dwell at length on the methodologic issues in the study, because every such effort has them. The fact that the physician participants were volunteers may have meant that they were not a representative sample of their . . . [Full Text of this Article]