(PS6-79) Implementing an Innovative One Visit Diagnostic Model for Evaluation of Pediatric Attention-deficit/hyperactivity Disorder and Related Conditions

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by persistent patterns of inattention, impulsivity, and hyperactivity that significantly impact daily functioning (American Psychiatric Association, 2013). ADHD is the most common childhood-onset neurodevelopmental disorder with estimated prevalence of 10% among youth ages 4 to 17 (Li, et al., 2023). Untreated, ADHD can adversely impact social and emotional well-being, interpersonal relationships, academic and career trajectories, and quality of life. ADHD is also associated with increased risk of developing conduct and personality disorders, substance misuse, and poses challenges in social adjustment into adulthood (Nigg, et al., 2023; Wolraich, 2019). Factors such as gender, socioeconomic status, and geographical location contribute to disparities in ADHD prevalence (Li, et al., 2023; Xu, et al., 2018). Challenges in the supply and distribution of workforce, structural issues in health care, and financial burden on consumers creates complexities for underserved communities, enabling inequalities in both rural and racially diverse contexts in access to early care for ADHD (Bisset, et al., 2023).

Despite advances in clinical practice guidelines outlining evidenced-based diagnosis of ADHD, families continue to experience barriers to high quality services, including long wait times to initial visit, lengthy diagnostic procedures, and difficulty navigating resources for follow-up (Bisset et al. 2023; Wright et al. 2015). Early identification and treatment are crucial to mitigate barriers and long-term consequences. To improve access care, an innovative clinical model for diagnosis of pediatric ADHD was developed. This diagnostic screening model allowed for streamlined entry to a one visit evidenced-based assessment with anticipated high ratings of patient/family and referring provider satisfaction. Upon an initial pilot of this model, children ages 6-12 with suspected ADHD in addition to mild to moderate disruptive behaviors, school difficulties, and/or anxiety were eligible.

270 patients (67.4% male) aged 5-15 (M age = 7.7 years) were seen for a one-time visit in a hospital-based clinic setting over a 21-month period. The average wait time from intake to appointment was 89.5 days (range = 11 – 321 days). Patients were evaluated using a semi-structured clinical interview, standardized parent and teacher rating scales, behavioral observations, and in some cases, a computerized continuous performance task.

Of these 270 youth, 82.9% were diagnosed with ADHD during their initial visit. Additionally, 47% of patients were also diagnosed with another mental or behavioral disorder (disruptive behavior disorders = 24.8%; anxiety disorders = 21.1%; depressive disorders = 1.8%; adjustment disorders = 4.1%; other disorders = 3.7%). A minority of patients (4.4%) were referred for additional testing. Patient experience data demonstrated high rates of satisfaction with services (e.g., 90% would recommend care to others, 88% feeling carefully listened to).

Future directions to improve the care model are being explored, including utilizing electronic rating scales to further reduce wait time and measuring referring provider satisfaction with services.