Management of children prescribed psychostimulant medication for attention deficit hyperactivity disorder in the Hunter region of NSW

Objective: To examine local procedures for assessment of attention deficit hyperactivity disorder (ADHD) and its management with psychostimulant medication and to compare these with published practice guidelines. Design: Retrospective postal survey. Participants: Parents of children living in the Hunter region of New South Wales first prescribed psychostimulants between 1992 and 1994. Main outcome measures: Procedures for diagnostic assessment, treatment monitoring and continuing management. Results: 788 parents (60%) responded. Diagnostic assessment procedures complied with published guidelines for about 70%, and detection of comorbid conditions was consistent with community prevalence estimates. There was systematic assessment of treatment response with questionnaires in only a third. Some children with academic or behavioural problems (19%-24% and 32%, respectively), almost 50% with emotional problems and 63% with motor problems were not receiving treatment for these difficulties. Modal interval for review was six months. Trials off medication were most commonly during school holidays, contrary to recommendations of the New South Wales Health Department. Most parents reported considerable improvement in their children's quality of life with medication. Conclusions: Problems comorbid with ADHD are detected often. Areas of deficiency in management of ADHD include the low rate of contact with schools for diagnostic assessment and determining treatment efficacy, poor support for comorbid problems, infrequent review, and inadequate methods for determining need to continue treatment.