Improving Diagnosis and Management of ADHD Team Lead Call #2 Diane Liu, MD Assistant Professor, Pediatrics Co-Director, UPIQ

Welcome Practice Teams! Families First Pediatrics Intermountain Moroni Clinic Mountain West Pediatrics Ogden Clinic Southwest Children’s Clinic South Jordan Health Clinic Utah Valley Pediatrics- Provo North University Pediatrics Clinic Wasatch Pediatrics – Draper Please note the number next to your practice as the label for the graphs to follow. In the future the graphs will be labeled by your practice’s name

Agenda Mute responsibly . Project update: review practice aggregate December and January data Review DSM-V criteria Discuss Welcome and Follow-up Packets and screeners Challenges and successes

Percentage of encounters for initial diagnosis and follow-up for ADHD where there is documentation of the screening tool in 2 settings documented in the chart

Percentage of encounters for Initial Diagnosis where there is documentation of DSM-V criteria and Co-Existing Conditions

Percentage of encounters for Initial Diagnosis and ADHD follow-up where there is documentation of medication follow-up within the recommended time of 30-45 days for new Rx and 6 months for maintenance Rx

Optional Measures: Follow-up documentation and ADHD Registry

DSM-V Criteria

Key Action Statement 2 (2011) To make a diagnosis of ADHD, the primary care clinician should determine that DSM-IV-TR (*now DSMV) have been met (including documentation of impairment in more than 1 major setting), and information should be obtained primarily from reports from parents or guardians, teachers, and other school and mental health clinicians involved in the child’s care. The primary care clinician should also rule out any alternative cause Quality of evidence B/strong recommendation

Criteria differences in key areas DSM-IV-TR DSM-V Age of onset of symptoms Before age 7 years Before age 12 years Symptoms vs. Impairment Impairment present in more than one setting Symptoms present in more than one setting Age-based criteria 6 of 9 symptoms regardless of age For ages 17 and older, 5 of 9 symptoms

DSM-V Criteria concerning the symptoms 9 symptoms listed under inattention and under hyperactive-impulsive Must be present for at least 6 months (noted in Vanderbilt) Must be inappropriate for developmental level For children up to age 16, need 6 of 9 symptoms in either group to meet criteria For individuals age 17 and older, need 5 of 9 symptoms in either group to meet criteria

Additional criteria Several inattentive or hyperactive-impulsive symptoms were present before age 12 years Several symptoms are present in 2 or more settings There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning The symptoms do not happen only during the course of schizophrenia or other psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

Discussion: Welcome and Follow-up Packets and Screeners