New Initiative Boosts ADHD Detection and Management in Pediatric Care


Attention-Deficit Hyperactivity Disorder (ADHD) is a significant challenge in pediatric health, affecting about 7%-10% of school-age children globally. Characterized by symptoms such as inattention, hyperactivity, and impulsivity, ADHD can profoundly impact academic performance, social interactions, and later professional success. Researchers at Boston University Chobanian & Avedisian School of Medicine have launched a pioneering quality improvement initiative aimed at enhancing the detection and evaluation of ADHD in pediatric primary care settings.

New Initiative Boosts ADHD Detection and Management in Pediatric Care 1

The Challenge of ADHD

ADHD is not only the most prevalent neurobehavioral disorder among children but also one with long-term consequences that can extend into adulthood. Affected individuals are at a higher risk for secondary psychopathology, substance use, involvement with the justice system, and even suicide. Despite its profound impact, ADHD often remains undiagnosed and untreated, particularly among children from lower income backgrounds and racial and ethnic minorities, leading to adverse outcomes.

Initiative for Change

The ADHD Detection Quality Improvement (ADQI) initiative at Boston Medical Center, the largest safety net hospital in New England, targets these challenges head-on. Dr. Mona S. Doss Roberts, the assistant professor of pediatrics at Boston University and the first author of the study, highlights that many children displaying attention problems were previously overlooked without further diagnostic evaluation for ADHD.

Methodology and Implementation

The ADQI initiative encompasses several strategic components:

  1. Development of a Provider Decision-Making Algorithm: This tool assists healthcare providers in making informed decisions regarding ADHD screening outcomes.
  2. Adjustment of Clinic Operations/Workflow: Modifications were made to streamline processes within the clinic, enhancing the efficiency of ADHD screening and follow-up evaluations.
  3. Optimization of Electronic Medical Record Features: These adjustments ensure that positive screens are flagged promptly, and appropriate steps are initiated for a detailed evaluation.

Results and Findings

The implementation of the ADQI initiative led to significant improvements in the detection and documentation of ADHD symptoms. Providers were better able to recognize and respond to positive Attention Subscale scores on the Pediatric Symptom Checklist (PSC-17), a universally used behavioral health screening tool. The study, published in the Journal of Developmental & Behavioral Pediatrics, demonstrates how even well-performing clinics can optimize ADHD screening and evaluation to ensure children receive timely and evidence-based care.

Future Directions

Despite the successes of the ADQI initiative, ongoing efforts are necessary to ensure that ADHD evaluations are completed and that children receive appropriate interventions. Dr. Andrea Spencer, the last author of the study, notes the importance of continued improvements in primary care practices to meet the needs of all children, particularly those at high risk.

Implications for Pediatric Health

This initiative not only highlights the potential for quality improvement efforts in pediatric healthcare but also sets a precedent for other clinics dealing with similar challenges. By refining detection methods and ensuring effective evaluations, healthcare providers can offer better support to children with ADHD, ultimately improving their long-term health and quality of life.


The ADHD Detection Quality Improvement initiative represents a crucial step forward in the management of ADHD in pediatric settings. By enhancing the accuracy and efficiency of ADHD screening and follow-ups, Boston University’s approach provides a model that can be replicated in other healthcare settings, potentially transforming the landscape of pediatric mental health care.

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