Kentucky pediatric providers report ADHD practice not consistent with clinical practice guidelines

Researchers advocate for education efforts to improve diagnosis, management and pharmaceutical treatment of pediatric attention-deficit/hyperactivity disorder.

Researchers with Cleveland Clinic, the University of Louisville School of Medicine and Norton Children’s recently conducted a survey of pediatric attention-deficit/hyperactivity disorder (ADHD) care in Kentucky and found areas of deviation from established practice patterns for diagnosing and managing ADHD and for pharmacotherapy strategies.

“The results indicate that some key recommended practice guidelines were not followed,” the authors wrote. “This difference between reported satisfaction and actual patterns of practice strongly suggest the need for improved provider education.”

The study, “Attention-Deficit/Hyperactivity Disorder Practice Patterns: A Survey of Kentucky Pediatric Providers,” was published by the Journal of Developmental & Behavioral Pediatrics in November 2021.

The following summarizes the study.


Determine the consistency of ADHD practice patterns compared with national guidelines and assess areas for improvement.

Survey method

Researchers emailed a link to the survey to members of the Kentucky Chapter of the American Academy of Pediatrics (AAP). Invitations were sent to general pediatricians, pediatric nurse practitioners, physician assistants and pediatric subspecialists who diagnose and/or manage ADHD. The online survey was live for two weeks.

A paper version of the survey was available for screened attendees to the Kentucky AAP annual meeting. Paper results were manually entered into the same database as the online survey.

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Respondents were filtered down to 51 providers who reported routinely diagnosing ADHD and 55 who reported routinely managing ADHD.


The data suggest most of the Kentucky AAP providers follow many of the current guidelines. Kentucky providers diverged from current guidance by not routinely offering a family-centered approach to ADHD management, providing ongoing surveillance of ADHD comorbidities, or discussing school services and strategies to support youth with ADHD. Areas for improvement also include strengthening pharmacotherapy practices and placing an emphasis on psychosocial therapy.


The data clearly suggest an urgent need within Kentucky to better understand the factors associated with deviations from clinical practice guidelines.

Shortcomings revealed by the survey are not unique to Kentucky, the authors wrote.

“The state’s economic, health and educational standings, combined with a higher-than-average prevalence of ADHD, provide a platform within which research in practice improvements related to ADHD diagnosis and management can be implemented,” they said.

Study authors

Marie E. Trace, M.D., Center for Developmental Pediatrics, Cleveland Clinic Children’s Hospital for Rehabilitation, Cleveland, Ohio, and trainee at Norton Children’s Development Center, affiliated with the UofL School of Medicine, during study period
Yana B. Feygin, M.S., Child and Adolescent Health Research Design and Support Unit, Norton Children’s Research Institute, affiliated with the UofL School of Medicine
Patricia G. Williams, M.D., Norton Children’s Development Center
Deborah Winders Davis, Ph.D., director, Child and Adolescent Health Research Design and Support Unit, Norton Children’s Research Institute

Kyle B. Brothers, M.D., Ph.D., chief scientific officer, Norton Children’s Research Institute; Norton Children’s endowed chair in pediatric clinical and translational research; and pediatrician at Norton Children’s Medical Group – Novak Center.

Janice E. Sullivan, M.D., assistant chief scientific officer, Norton Children’s Research Institute

Aaron W. Calhoun, M.D., Norton Children’s Critical Care, affiliated with the UofL School of Medicine

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