Objectives-To evaluate the feasibility of the San Diego Attention-Deficit/Hyperactivity Disorder Project (SANDAP) protocol, a pediatric community-initiated quality improvement effort to foster implementation of the American Academy of Pediatrics (AAP) attention-deficit/hyperactivity disorder (ADHD) diagnostic guidelines, and to identify any additional barriers to providing evidencebased ADHD evaluative care.Methods-Seven research-naïve primary care offices in the San Diego area were recruited to participate. Offices were trained in the SANDAP protocol, which included 1) physician education, 2) a standardized assessment packet for parents and teachers, 3) an ADHD coordinator to assist in collection and collation of the assessment packet components, 4) educational materials for clinicians, parents, and teachers, in the form of handouts and a website, and 5) flowcharts delineating local paths for referral to medical subspecialists, mental health practitioners, and school-based professionals. The assessment packet included the parent and teacher versions of the Vanderbilt ADHD Diagnostic Rating Scales. In this study, we chose a conservative interpretation of the AAP ADHD guidelines for diagnosing ADHD, requiring that a child met criteria for ADHD on both the parent and teacher rating scales. A mixed-method analytic strategy was used to address feasibility and barriers, including quantitative surveys with parents and teachers and qualitative debriefing sessions conducted an average of 3 times per year with pediatricians and office staff members. Results-Between December 2000 and April 2003, 159 children were consecutively enrolled for evaluation of school and/or behavioral problems. Clinically, only 44% of the children met criteria for ADHD on both the parent and teacher scales, and 73.5% of those children were categorized as having the combined subtype. More than 40% of the subjects demonstrated discrepant results on the Vanderbilt scales, with only the parent or teacher endorsing sufficient symptoms to meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Other mental health and learning problems were common in the sample; 58.5% of subjects met screening criteria for oppositional defiant disorder/conduct disorder, 32.7% met screening criteria for anxiety/depression, Address correspondence to Laurel K. Leslie, MD, Child and Adolescent Services Research Center, Children's Hospital, San Diego, 3020 Children's Way, MC 5033, San Diego, CA 92123-0282. E-mail: leslie@casrc.org. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2006 July 25. Published in final edited form as:Pediatrics. 2004 July ; 114(1): 129-140. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscriptand approximately one-third had an active individualized education program in place or had received an individualized education program in the past. On evaluation, the SANDAP protocol was acceptable and feasible for all stakeholders. However, additional barriers to i...

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This study examined aspects of verbal fluency performance of children with Specific Language Impairment (SLI) and typically developing children matched on age and Block Design scores. While children with SLI showed deficits in verbal fluency compared to their peers, they showed the same pattern of performance on phonemic compared to semantic fluency trials. Children with SLI and normally developing children also demonstrated equivalent rates of clustering and switching, measures hypothesized to reflect aspects of frontal lobe functioning, when the overall number of exemplars was taken into account. The absence of a condition by group effect supports general processing limitation accounts of SLI, while the absence of group differences on cluster size and switches supports language-based processing accounts of SLI.

Objectives-To investigate rates of psychotropic medication use by youths served in public service sectors as a function of race/ethnicity.Method-Logistic regression models were used to examine racial/ethnic differences in caregiver report of psychotropic medication use for a random stratified sample of 1,342 children who were served in public service sectors during the second half of fiscal year 1996-97.Results-Race/ethnicity predicted caregiver report of past-year and lifetime psychotropic medication use when all other factors were held constant. Specifically, caregivers of AfricanAmerican and Latino children were less likely to report past-year use compared to white children; caregivers of Latino children and "others" were less likely to report lifetime use. Additional factors predictive of medication use in regression models included younger age, male gender, higher household income, insurance type, active to mental health sector at time of enumeration into the study, impairment and diagnosis of mood, and anxiety or attentional disorder.Conclusions-Racial/ethnic differences in use of psychotropic medication occur in children served in public service sectors and need to be considered in clinical diagnosis and treatment.