Chronic Care for Attention-Deficit/Hyperactivity Disorder: Clinical Management from Childhood Through Adolescence.
Cierra M Moss, Kristina B Metzger, Meghan E Carey and 3 others
PMID 31996572WHAT IT FOUND
Primary care records for 262 adolescents with childhood ADHD showed ADHD visits, symptom checks, medication use, and school-plan documentation decreased with age, while depression and suicide monitoring rose.
Driver readiness and diversion talks were rare.
Key findings
01ADHD visit diagnosis and symptom assessment were documented less often as patients aged, from 63.0% and 59.5% at ages 9 to 11 years to 40.8% and 38.2% at ages 15 to 18 years.
02Psychotropic medication use fell from 70.2% at ages 9 to 11 years to 56.9% at ages 15 to 18 years, and documented behavior interventions remained low at 15% to 21%.
03Monitoring for depression and suicide increased from 37.4% and 34.7% at ages 9 to 11 years to 93.9% and 93.5% at ages 12 to 14 years, while driver-readiness discussions were documented for only 2 patients and diversion discussions for 1 patient.
STILL TO COME
How it was doneWhat they found
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What it does not show
This is a chart review, so care that happened but was not written in the record may be missed. The sample came from 3 New Jersey practices and was mostly male, non-Hispanic white, and privately insured, so it may not apply to other patient groups. Patients included in the analysis were more likely to be white, non-Hispanic, and privately insured than excluded patients with ADHD who were not seen in primary care during adolescence. The study included only patients diagnosed before age 10 and seen in primary care as adolescents, so it does not address later diagnoses or patients lost to primary care. ADHD diagnoses were sometimes made by primary care providers without full best-practice assessment, although the code-based classification had high sensitivity and specificity. The study describes documentation, not patient outcomes, and cannot say whether declining ADHD documentation was appropriate or harmful.
Declared interests
The authors declare no conflict of interest.
The easy way to misread this
Do not read the decline in ADHD visit diagnosis, symptom checks, medication use, and school-plan documentation as proof that adolescents stopped receiving care or that care was inadequate. The study only shows what was recorded in primary care charts, not what was delivered, and it did not measure patient outcomes.