Do you see it my way? The clinical evaluation of ADHD by the different pediatric subspecialties

Background: Three medical disciplines are responsible for assessment, diagnosis and treatment of people with attention deficit hyperactivity disorder (ADHD) in Israel: pediatricians/ family doctors, adult and child neurologists, and adult and child psychiatrists. Objectives: To investigate differences in ADHD diagnostic practices between three different pediatric subspecialties in the clinical setting in order to establish a common ground for a future unified approach. Methods: An anonymous web-based questionnaire was administered to child psychiatrists, pediatric neurologists and general pediatricians who are actively involved in ADHD diagnosis (n=104). Results: Neurologists and pediatricians rarely use the mental status examination, while psychiatrists rarely perform a neurological or physical examination (P < 0.0001). A general clinical impression of learning abilities and/or neurodevelopmental skills was implemented more often by pediatric neurologists (P < 0.04). Conclusions: The significant differences found between the three medical specialties with regard to the clinical evaluation of ADHD could be attributed, at least in part, to the ambiguity of available guidelines concerning the clinical examination, and to the adherence of each specialty to its own “skills.” Larger surveys in other countries should be considered and an effort made to create a common, “inter-disciplinary” ground on this important part of ADHD evaluation, differential diagnosis, and research.