Date of Publication


Project Team

Ellen Long-Middleton, PhD, APRN, Mary Lahiff, BS


Standardizing the Process for Diagnosing

Attention Deficit Hyperactivity Disorder (ADHD) in the Primary Care Setting

Louise Moon Rosales, MSN, APRN

Purpose. Attention deficit hyperactivity disorder (ADHD) is a common problem that primary care providers diagnose and treat. Yet, there is a current lack of standardization to diagnose ADHD in many primary care settings. This purpose of this project was to standardize the process of diagnosing ADHD through introduction of screening instruments. Objectives included: assessment of clinician knowledge and attitudes about ADHD, implementation of a clinician-directed educational intervention, and development of a work flow procedure to standardize the diagnostic process.

Methods. Clinicians at a family practice participated in a project to standardize the ADHD diagnostic process. Knowledge and attitude assessments via informal interviews and pre-intervention surveys were conducted with the five practice clinicians; three physicians and two nurse practitioners. An ADHD educational intervention was implemented followed by post-intervention surveys. A work flow procedure was implemented to assist in diagnosing ADHD through the use of psychometrically proven instruments embedded into the electronic health record (EHR). The scales used were the Vanderbilt ADHD Assessment Scale and Wender Utah Rating Scale. To measure clinician and subsequent patient outcomes, a data collection plan was created.

Results. All five clinicians completed the pre and post knowledge and attitudinal surveys. The results demonstrated increased provider knowledge and confidence in diagnosing ADHD. A standardized process to diagnose ADHD was successfully developed, and scales to aid in the diagnosis of ADHD were embedded into the EHR. A data collection plan to monitor ongoing clinician and patient outcomes was implemented.

Conclusions. An educational intervention and standardized workflow procedure by which to diagnose ADHD were successfully implemented in a family practice, thereby laying the foundation for continued quality improvement in the diagnosis of ADHD. To refine the process and gain a better appreciation of the impact of the intervention on clinicians and patients, data collection on established outcome measures continues.

Keywords. Attention deficit hyperactivity disorder, ADHD, diagnosis, rating scales, primary care.

Document Type


Available for download on Wednesday, November 27, 2019