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

2. 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

3. 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

4. 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

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

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

7. Optional Measures: Follow-up documentation and ADHD Registry

8. DSM-V Criteria

9. 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

10. 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

11. 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

12. 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).

13. Discussion: Welcome and Follow-up Packets and Screeners