PCPs do not recommend parent behavior management training often enough


Primary care physicians more often recommend medication than behavior management training (PTBM) to parents of children with Attention Deficit Hyperactivity Disorder (ADHD) within the Packard Children’s Health Alliance, a network pediatric health care community in San Francisco, California. PTBM is a first-line treatment for children 4 to 5 years old with ADHD. A research letter published in JAMA Pediatrics emphasizes the need for early access to behavioral treatment for preschool children with ADHD.

The physicians who wrote the letter scanned primary care professional (PCP) documentation from electronic health records (EHRs) to find out the referral rate of PTBM for patients aged 4 to 5 years with a diagnosis of ADHD, symptoms of ADHD or who has been prescribed ADHD. medication.

Of a total of 22,714 children, 192 had a diagnosis of ADHD or symptoms of ADHD. Of these 32 (17%) were prescribed medication for ADHD.

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The most common treatment recommendations (41%) involved changes in habits: dietary changes such as reduced sugar intake, fatty acid supplements, better sleep hygiene, and limited screen time. . A total of 21 (11%) of patients received a referral of PTBM and 29% received a mention of PTBM; for example, receiving a brochure. Of the 32 patients who received medication, 9 (28%) also received a PTBM recommendation.

Patients with public insurance were less likely to receive a PTBM referral compared to those with private insurance. This underscores “the need to identify the barriers that lead to disparities in recommended treatments,” say the authors.

The data query had its limits. Using an ADHD diagnosis and symptom codes during research may have limited results, as may relying on the PCP literature and limiting the search to the Packard Children’s Health Alliance.

“These study results provide an opportunity for quality improvement initiatives to increase PCP’s adherence to clinical practice guidelines – thus establishing early access to behavioral treatment for patients diagnosed with ADHD or symptoms of ADHD.” ADHD – with the aim of reducing long-term morbidity. “


Bannett Y, Gardner RM, Posada J, Huffman LC, Feldman HM. Rate of pediatric recommendations for behavioral treatment of preschool children diagnosed with Attention Deficit Hyperactivity Disorder or related symptoms. JAMA Pediatrician. Published online October 18, 2021. doi: 10.1001 / jamapediatrics.2021.4093


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