Diagnosis and treatment of attention deficit disorder in two general hospital clinics.

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.