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Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neurobehavioral disorder in school-age children, affecting various aspects of life and potentially leading to secondary issues such as substance abuse and legal problems. However, ADHD is treatable with medication, therapy, and support. Unfortunately, many children with ADHD go without diagnosis and treatment, especially those from lower-income or minority backgrounds. Universal screening for ADHD in pediatric care settings could help identify and treat ADHD early on.

Many pediatric practices have implemented behavioral health screening with the Pediatric Symptom Checklist (PSC-17) to identify potential issues. However, there is a need to optimize the use of the Attention Subscale of the PSC-17 in primary care pediatrics to improve ADHD screening. Researchers at Boston University implemented a quality improvement initiative at Boston Medical Center to enhance screening for ADHD in their pediatric clinic. They found that many children with attention problems were not receiving a proper evaluation for ADHD, highlighting the importance of early diagnosis and treatment.

The ADHD Detection Quality Improvement (ADQI) initiative focused on developing provider decision-making algorithms, adjusting clinic operations, and optimizing electronic medical records to flag positive screens for attention problems. The initiative aimed to improve the recognition of ADHD symptoms and ensure that appropriate evaluations were conducted for positive screens. The researchers found that their efforts led to better recognition of positive screens and more follow-up evaluations for ADHD, ultimately improving the likelihood of proper diagnosis and treatment.

Despite the success of the ADQI initiative, the researchers believe that additional interventions are needed to ensure that children receive appropriate evaluations and evidence-based care for ADHD in primary care settings. By distributing diagnostic rating scales to families with positive screens for attention problems, the clinic was able to increase the likelihood of providers recognizing and addressing possible ADHD in children. The study highlights the importance of ongoing efforts to improve ADHD screening and treatment in pediatric primary care.

The findings of this quality improvement initiative were published in the Journal of Developmental & Behavioral Pediatrics. Last author Andrea Spencer, MD, disclosed receiving grant funding from various sources, while other authors had no conflicts of interest. The study emphasizes the need for continued efforts to enhance ADHD screening and evaluation in primary care settings to ensure that all children with ADHD receive appropriate care and support. With early identification and treatment, children with ADHD can have better academic, social, and occupational outcomes.

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