Pediatricians' attitudes and practices on ADHD before and after the development of ADHD pediatric practice guidelines.

Purpose: The study aims to assess the changes in attitudes and practices about ADHD reported by AAP fellows between 1999 and 2005 during which AAP ADHD guidelines, training, and quality improvement initiatives occurred.

Method: The study assesses AAP-initiated surveys that were conducted between 1999 and 2005 and involving a random sample of 1,000 and 1,603 pediatricians, respectively.

Results: The findings reveal that significant, although modest, increases occurred in pediatric practitioners' self-reported adherence to the guidelines. About 81% of respondents reported routine use of formal diagnostic criteria (up from 67%), and 67% of the respondents routinely use ADHD teacher rating scales (compared to 49% in the 1999 survey). Findings further reveal that treatment with stimulant medications was used extensively by pediatricians from both surveys; more pediatricians in the 2005 survey reported use of a second stimulant if the first did not work, and still more reported almost always providing parent training, although the estimated number remained only about a quarter of the total; and greater familiarity with the initiatives predicted better reported adherence to the guidelines.

Conclusion: The reported behaviors of practitioners have moved in the direction of greater adherence with the recommended AAP ADHD guidelines, and there was a positive response to, and a greater use of, the materials developed to enhance practice. The authors infer that practice changes may be due to many factors, including AAP guidelines and associated implementation efforts. Changing physician practices needs to be sustained through a continuing process that requires multiple, varying, sustained efforts directed at physicians, other providers, and families.