Diagnosis and Treatment of Attention Deficit Disorder in Two General Hospital Clinics
Peter S. Jensen M.D.,M.C.1,
Stephen N. Xenakis M.D.,M.C.2,
Robert E. Shervette III M.D.,M.C.3,
Michael W. Bain M.D.,M.C.4, and
Harry Davis M.S.5
1 Department of Military Psychiatry at the Walter Reed Army Institute of Research , Washington, D.C. 20307
2 Clinical Services at the Eisenhower Army Medical Center in Fort Gordon, Georgia
3 Department of Psychiatry at Womack Army Hospital in Fayetteville, North Carolina
4 Walter Reed Army Medical Center
5 Division of Research and Computing Sciences at the Medical College of Georgia in Augusta
In two clinics in military general hospitals, the charts of all children with a presumptive diagnosis of attention deficit disorder who were prescribed psychostimulants (N=68) were audited to assess the quality of the primary physicians' evaluation and treatment. The audit instrument, constructed by a multidisciplinary team, indicated high interrater reliabilities, high face and concurrent validity, and moderate internal consistency. The audit found that only 51.5 percent of the children being treated with psychostimulants met the audit criteria for attention deficit disorder. A school intervention plan was documented in only 16.2 percent of the cases, and a psychotherapy intervention in only 19.1 percent; low rates were also found for other treatment and follow-up criteria. Overall , the assessment, the follow-up care, and the overall quality of care were found to be inadequate or less than adequate in about two-thirds of the cases.
