EditorialOriginal Research

Attention Deficit/Hyperactivity Disorder (ADHD) Care for Children and Adults: Clinician Services, Barriers, Knowledge, and Training Needs

Kim Newsome, Rebecca T. Leeb, Samuel M. Katz, Angelika H. Claussen, Patricia L. Whalen, Lara R. Robinson, Nicole Stephan and Karyl T. Rattay
The Journal of the American Board of Family Medicine January 2026, 39 (1) 159304; DOI: https://doi.org/10.3122/jabfm.2025.250252R1

Abstract

Introduction Our study describes characteristics of attention deficit/hyperactivity disorder (ADHD) services, barriers, and needs, reported by a diverse population of primary health care clinicians, pediatricians, nurse practitioners, and physician assistants in the United States.

Methods We analyzed cross-sectional data from the web-based Fall 2023 DocStyles survey of healthcare clinicians fielded from September 5 to October 12, 2023. The analytic sample included 1,520 clinicians (531 family physicians, 473 internists, 250 pediatricians, 143 nurse practitioners, and 123 physician assistants). We examined provision of ADHD diagnosis and treatment services, barriers to ADHD care, ADHD knowledge, and clinician training preferences.

Results Under half of adult (46.0%) and pediatric (42.6%) clinicians offer ADHD diagnostic services in their practices; overall, 31.6% of clinicians offer ADHD behavior treatment services and 69.0% offer ADHD medication treatment services. The most reported barriers to ADHD diagnosis were clinicians’ lack of time and comfort; the most reported barriers to medication treatment were side effects, medication shortages, and inability to find effective treatment. For behavior treatment, the most reported barriers were time and effort, cost, and inability to find effective treatment. Overall, only 27.3% of clinicians reported receiving adequate ADHD training in their educational programs, and 53.6% desired more ADHD training.

Conclusions Tailored public health efforts to increase clinicians’ access to evidence-based information on ADHD care, facilitate clinician connections to networks and partnerships for ADHD consultation and referral, and improve coordinated systems-level enhancements could offer important support for clinicians as they promote lifelong health and well-being for people with ADHD.

Introduction

Attention deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. An estimated 7 million, or 11.4% of U.S. children ages 3–17 years, have ever received a diagnosis of ADHD.1 An estimated 15.5 million, or 6.0% of U.S. adults have a current diagnosis of ADHD.2 People with ADHD are more likely to experience poor health, peer and academic problems, unemployment, and premature death.3,4 They are at greater risk for accidental injury, suicide, and substance use.3 Timely and effective care for persons with ADHD can reduce health risk behaviors and health care costs and improve quality of life.3,5,6

Effective ADHD treatment for individuals 6 years and older includes medication and behavior therapy,5,7 but, nationally, around 30% of diagnosed children do not receive ADHD behavior or medication treatment as recommended by the American Academy of Pediatrics (AAP),1,5 and more than a third (35.8%) of adults with a current diagnosis report not receiving ADHD counseling or medication treatment in the last year.2 Parent behavioral training is the first line treatment for preschool aged children with ADHD; however, few community-based pediatric healthcare clinicians refer (11%) or provide (29%) behavioral training during an ADHD-related visit.8

Primary or specialty care clinicians can diagnose and treat ADHD.9 Children most commonly receive ADHD care from pediatricians, and adult ADHD care is most commonly provided by family physicians, nurse practitioners, and psychiatrists.9 Quality of ADHD care may vary by provider characteristics such as type of practice.10 Previous clinician barriers to child and adult ADHD care have been reported,11–16 but few studies have examined ADHD care and barriers for both adult and child diagnosis, medication and behavior treatment, and ADHD knowledge and education needs among a group of diverse primary care clinicians. In addition, the types of ADHD clinicians are changing over time17 highlighting needs to characterize different primary care clinicians’ ADHD knowledge, services, barriers, and needs. We designed this study to address these gaps.

Methods

Data and Study Design

We analyzed cross-sectional data from the Fall 2023 DocStyles survey, a web-based survey of healthcare clinicians developed and fielded by Porter Novelli from September 5 to October 12, 2023, with input and support from governmental agencies, corporations, and nonprofits.18 DocStyles survey respondents are drawn from the M3 Global Research panel19 and compensated $30-$60 dependent upon the number of questions asked of their clinician type. Respondents include 5 healthcare clinician types, each with a minimum target quota (i.e., a minimum of 1,000 either family physicians or internists and of 250 each of pediatricians, obstetricians/gynecologists (OB/GYN), and nurse practitioners or physician assistants).

The Fall 2023 DocStyles survey comprised 120 questions including a 12-item ADHD module and questions on clinicians’ demographic, work setting, and practice characteristics. The ADHD module assessed clinician diagnosis and treatment patterns, clinician barriers to ADHD diagnosis in children and adults, clinician’s reports of their patients’ barriers to behavior and medication treatment, and a 3-question knowledge test. Clinicians were also asked about their preferred ADHD educational sources (see Appendix 1 for ADHD question text).

Analytic Sample

Out of 3,108 clinicians invited to participate in the Fall 2023 DocStyles survey, 1,772 (57%) completed the survey: 531 family physicians, 473 internists, 250 pediatricians, 252 OB/GYNs, 143 nurse practitioners, and 123 physician assistants. Response rates for each clinician type ranged from 53-64%.18 All clinicians received the ADHD module, except OB/GYNs who were excluded from these analyses, resulting in an analytic sample of 1,520. To increase statistical power, data from nurse practitioners and physician assistants were combined for analyses.

A sub-sample (“ADHD clinicians”; n=1,188) of clinicians providing ADHD diagnosis, treatment, or referral services was used for analyses on ADHD referral, diagnostic and treatment barriers, and knowledge (as presented in Tables 3, 4, and 5). These questions were not asked of participants who responded that they do not provide any ADHD services (n=332).

Analysis Methods

We calculated point prevalence estimates and Clopper Pearson 95% confidence intervals (CIs) to describe demographic, work setting, and other practice characteristics of the sample by clinician type. For all items in the ADHD module, we calculated point prevalence estimates and 95% CIs as well as chi-square tests to assess differential responses across subgroups in stratified analyses (when comparing estimates, significance based on non-overlapping 95% CI; for chi-square tests, significance at p<0.05). Clinician ADHD services, clinician barriers to ADHD diagnosis, and clinician-perceived patient barriers to ADHD treatment (See Appendix 1) were calculated overall and by clinician type, age, and geographic location. Clinician training attitudes and preferences for receiving information about ADHD were examined overall and by clinician type. Responses to ADHD knowledge assessment questions were analyzed overall, and by clinician type, age, geographic location, training attitudes, diagnosis barriers related to knowledge and comfort, and ADHD services provided. All analyses were conducted using SAS-callable SUDAAN v. 11.0.1 (RTI International; Cary, NC) and Stata/SE 17.0 (StataCorp LLC. 2021; College Station, TX).

Results

Clinician Characteristics and Practice Setting

Overall, 54.3% of clinicians were male and 44.5% female (Table 1). Among clinician types, most family physicians (64.4%) and internists (64.7%) were male, 50.0% of pediatricians were female, and most NP/PAs (78.2%) were female. Two-thirds (66.4%) of clinicians were under 50 years, ranging from 57.8% of family physicians to 87.6% of NP/PAs. Most clinicians were White (67.7%) and non-Hispanic or Latino (93.6%). Over half practiced in group-outpatient settings and provided pediatric care, except internists, of whom only 39.5% practiced in group-outpatient settings and 72.1% did not provide pediatric care. Practice locations were 48.4% suburban, 40.3% urban, and 11.3% rural.

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Table 1. Demographic and Clinical Practice Characteristics of Responding Clinicians, Overall and by Clinician Type, DocStyles Fall 2023.
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Provision of Any ADHD Diagnosis and Treatment Services

Overall, 21.8% (95% CI: 19.8–24.0) of clinicians did not provide ADHD diagnostic, treatment, referral, or other ADHD services with family physicians less likely than peers to offer no ADHD services (10.9% [95% CI: 8.4–13.9]) (Table 2). Clinicians ≤50 years were more likely than those >50 years to work at practices without any ADHD services (24.0% vs. 17.6%, p=0.01).

Provision of ADHD Diagnostic Services

Fewer than half of clinicians offered ADHD diagnostic services, with similar percentages among adults (46.0%) and pediatric (42.6%) clinicians (Table 2). Family physicians (65.0%) were the clinician type most likely to provide adult ADHD diagnostic services; for children, provision of diagnostic services ranged from 15.6% of internists to 75.6% of pediatricians (Table 2). Clinicians > 50 years were more likely than those ≤ 50 years to offer ADHD diagnostic services for both adults (55.7% vs. 41.4%, p<0.01) and children (46.5% vs. 40.7%, p=0.03). Rural clinicians reported the highest prevalence for both adult and child diagnostic services (55.2% [95% CI: 47.5–62.8%] and 58.7%, [95% CI: 51.0–66.2%] respectively), while urban clinicians had the lowest (43.2% [95% CI: 39.3–47.3%] for adults and 36.2% [95% CI: 32.4–40.2%] for children).

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Table 2. ADHD Diagnosis and Treatment Services at Clinician Practice, Overall, and by Selected Characteristics, DocStyles Fall 2023.

Among the 1,188 ADHD clinicians who offered ADHD services or referrals in their practice, 77.4% provided diagnostic services, 17.5% only referred for further or in-depth diagnosis, and 5.1% did not provide diagnosis services and did not refer patients for ADHD diagnostic services (Table 3).

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Table 3. Clinician Services and Referral for ADHD Diagnosis and Treatment*, Overall, and by Selected Characteristics, DocStyles Fall 2023.

Barriers to ADHD Diagnostic Services

Over 1 in 3 ADHD clinicians reported the following barriers to ADHD diagnosis: lack of comfort (adults: 35.7%), lack of time (adults: 39.8%; children: 39.6%); and family resistance for clinicians caring for children (38.7%; Table 4). The frequency of clinicians reporting most barriers was similar for children and adults, except more clinicians identified lack of knowledge as a barrier for diagnosing ADHD in adults compared to children (16.9% [95% CI: 14.6–19.4%] vs 11.9% [95% CI: 9.9–14.2%]) and family resistance was more frequently reported for diagnosing ADHD in children compared to adults (38.7% [95% CI: 35.5–42.0%] vs. 18.2% [95% CI: 15.8–20.7%]). Fewer than 1 in 10 clinicians reported billing as a barrier to diagnosing ADHD in adults (9.2%) and in children (8.7%).

The frequency of barriers to diagnosis of ADHD differed by clinician type. For adult ADHD, lack of places to refer was more commonly reported by internists (17.4%) and least commonly reported by NP/PAs (9.3%). For child ADHD, lack of clinician comfort (range: 20.2% of pediatricians to 35.0% of family physicians, p<0.01), clinician knowledge (range: 6.1% of pediatricians to 16.4% of internists, p=0.02), and lack of places to refer (range: 7.5% of pediatricians to 16.3% of family physicians, p=0.02) differed by clinician type.

Regarding clinician age, clinicians ≤50 years more frequently reported lack of comfort as a barrier to adult ADHD diagnosis than clinicians >50 years (38.9% and 29.9%, respectively, p=0.01). Lack of comfort as a barrier to child ADHD diagnosis ranged from 23.0% in rural practices to 37.8% in urban practices, and lack of time as barrier to adult ADHD diagnosis ranged from 35.5% in suburban to 44.8% in urban practices.

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Table 4. Clinician Barriers to ADHD Identification and Diagnosis in Adults and Children, Overall, and by Selected Characteristics, DocStyles Fall 2023.
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Table 4 (continued).

Provision of ADHD Treatment Services

The ADHD treatment service most offered by clinicians was ADHD stimulant or non-stimulant medication treatment (69.0%), ranging from 51.5% of NP/PAs to 80.6% of family physicians (p<0.01, Table 2). Clinicians >50 years of age more often provided ADHD medication treatment (73.5%) than clinicians ≤50 years (66.7%; p=0.01). Provision of ADHD medication ranged from 64.9% of clinicians in urban practices to 76.7% of clinicians in rural practices (p=0.01). Of all clinicians, 31.6% include behavior treatment for ADHD in their practices, ranging from 24.9% of internists to 37.3% of family physicians (p<0.01). Among ADHD clinicians, 88.3% reported offering ADHD medication treatment services, 7.3% referred patients with ADHD to a specialist for medication treatment, and 4.4% did neither (Table 3). Many ADHD clinicians also provided (40.5%) or referred (39.4%) patients for behavior treatment, but 20.1% did neither.

Perceived Barriers to ADHD Treatment Services

The most common ADHD clinician-reported patient barriers to medication treatment were ADHD medication side effects (60.1%) and prescription ADHD medication shortages (54.4%; Table 5). For behavior treatment, the most common clinician-reported patient barriers were time and effort required for behavior treatment (60.8%), cost (58.5%), and inability to find effective treatment (56.4%). More ADHD clinicians overall reported cost as a barrier for their patients for behavior treatment than for medication treatment (58.5% [95% CI: 55.6–61.3%] vs. 47.5% [95% CI: 44.6–50.4%]) with a similar pattern for inability to find effective treatment (56.4% [95% CI: 53.5–59.2%] vs. 42.4% [95% CI: 39.6%–45.3%]).

Some ADHD clinician characteristics were associated with patient barriers to both medication and behavior treatment. Perceived patient worries about stigma regarding behavior and medication treatment were highest for NP/PAs and lowest among pediatricians (for behavior treatment) and family physicians (for medication treatment). More than half of pediatricians (53.1% [95% CI: 46.1–59.9%]) cited patient inability to find effective medication as a barrier, compared to fewer family physicians and internists (39.5% [95% CI: 35.1–44.1%] and 38.2% [95% CI: 33.0–43.6%], respectively). Time and effort for behavior treatment was reported as a patient barrier for 70.0% of pediatricians and 53.2% of internists. Medication side effects were reported as a patient barrier by 72.3% of pediatricians and over half (57.1% to 63.0%) of other clinician types.

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Table 5. Perceived Patient Barriers to Behavior and Medication Treatment, Overall, and by Selected Characteristics, DocStyles Fall 2023.
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Table 5 (continued).

Clinician age and practice location was also associated with differences in perceived patient barriers to ADHD treatment. More clinicians ≤ 50 years reported their patients worried about ADHD medication stigma than clinicians >50 years (37.2% vs. 30.2%, p=0.02). Conversely, fewer younger clinicians than older clinicians said their patients reported shortages of prescription ADHD medication (56.6% vs. 50.2%, p=0.03). Prescription shortages as a patient barrier were also more commonly reported by clinicians in suburban practices (58.9%) than those in urban practices (48.3%, p<0.01).

For behavior treatment, some clinician types reported the patient barrier of cost more than others (62.6% of family physicians to 53.1% of pediatricians, p=0.03), as well as time and effort (70.0% of pediatricians to 53.2% of internists, p<0.01). Fewer older clinicians than younger clinicians said their patients reported time and effort for behavior treatment (55.5% vs. 63.7%, p<0.01) as a barrier. Practice location was associated with patient barriers to behavior treatment, including stigma (32.1% rural to 43.5% urban, p<0.01) and cost (52.8% urban to 62.8% suburban, p=0.01).

Clinician’s Education Preferences

Of all clinicians, 27.3% reported receiving adequate ADHD training in their advanced degree programs, 34.9% reported receiving adequate training post-degree, and 53.6% wanted more training (Table 6). About twice as many pediatricians (49.6% [95% CI: 43.2-56.0%]) and family physicians (42.2% [95% CI: 37.9-46.5%]) as internists (23.0% [95% CI: 19.3-27.1%]) and NP/PAs (27.8% [95% CI: 22.5-33.6%]) reported receiving adequate ADHD training post degree. The most preferred modalities for ADHD learning reported by clinicians overall were continuing education (CE) ADHD classes on demand (41.1%) and scientific articles (40.6%).

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Table 6. Clinician Training Attitudes and Preferences for Receiving Information, Overall and by Clinician Type, DocStyles Fall 2023.

Clinician ADHD Diagnosis/Treatment Knowledge

Two-thirds (65.9%) of clinicians correctly identified that medication is not the recommended primary treatment for ADHD in children of all ages, and 73.0% correctly indicated that ADHD treatment for children aged 6‒12 years includes both medication and behavior treatment. However, only 20.2% of clinicians correctly answered that symptom onset must be prior to age 12 years for an ADHD diagnosis (see Appendix 1 for question text and correct answers).

Clinicians of different types, ages, urbanization of the practice locations, and other characteristics generally performed similarly on knowledge tests with a few exceptions. Pediatricians were more likely to correctly identify the recommended primary treatment for children with ADHD (76.5% [95% CI: 70.3–82.0%]) compared to family physicians (63.0% [95% CI: 58.5–67.4%]) and internists (61.2% [95% CI: 55.8–66.4%]). Fewer internists 58.5% (95% CI: 53.1–63.8%) than pediatricians 85.0% (95% CI: 79.5–89.5%) correctly answered the recommended care for children 6‒12 years. More clinicians age 50 and younger, compared to those >50 years, correctly answered the age at symptom onset question (24.0% [95% CI: 21.0-27.1%] and 13.3% [95% CI: 10.2-17.0%], respectively. Reporting lack of comfort or knowledge as barriers for diagnosis were not associated with correctly answering knowledge questions.

Discussion

Overall, less than half of providers reported offering ADHD diagnostic services for children or adults, reinforcing previous findings of receipt of ADHD treatment.1,2 More than twice as many providers offered ADHD medication in their practices than ADHD behavior treatment.

Barriers to ADHD Services

In alignment with previous research, clinicians in our study identified multiple barriers to ADHD diagnostic and treatment services.12,13,20 The most common clinician-reported barriers for diagnosis, regardless of patient age, were lack of time and lack of comfort in conducting ADHD evaluations. Time was a commonly reported patient barrier to behavior treatment, especially noted by pediatricians and over half of all clinician types.

Commonly identified barriers to medication treatment included concerns about medication side effects and access to ADHD medication. Medication side effects have been reported previously as a barrier to ADHD treatment,21 and over half of ADHD clinicians in our study reported patient concerns about ADHD medication side effects.

More than half of providers in our study reported that their patients were concerned about the time and effort required of behavior treatment, the cost of behavior treatment, and finding effective behavior treatment. Even including referral, fewer clinicians offered behavior treatment for their patients than medication treatment, suggesting that behavior treatment may not be feasible in many primary care settings.

Gaps in Clinician Knowledge

Consistent with previous studies, many clinicians in our study reported lacking sufficient knowledge to provide ADHD services in their weekly practice.13,15 More than half of clinicians reported a desire for more training, reinforcing previous reports of clinician concerns about lacking experience and feeling unprepared for ADHD diagnosis, behavior, and medication management.11,15,20 Most clinicians in our study performed well on ADHD knowledge questions, but across clinician types, over three-quarters answered the question about current diagnostic criteria for age of ADHD symptom onset incorrectly regardless of whether they provided ADHD care. Clinicians over 50 years of age, who might have received training before the DSM-5 updates to the age of ADHD onset,22 were less likely to answer correctly than their younger peers, highlighting a possible need for DSM-5 training in this group. Although clinicians 50 years and under more often answered some knowledge questions correctly, clinicians in this age group also more commonly listed comfort as a barrier for ADHD care than older peers, suggesting complex associations between knowledge of a condition and comfort with providing care. The presence of ADHD treatment knowledge deficits reinforces previously reported clinician concerns about knowledge of pediatric ADHD clinical guidelines and discomfort among clinicians who treat adults.12,13

Opportunities to Improve ADHD Care

Across many provider characteristics, we found more similarities than differences for our key outcomes. For almost all provider types, ages, and practice locations, identification and diagnosis services and medication treatment were more commonly offered than behavior treatment, with around 1 in 5 neither offering behavior therapy in their practices nor referral to a specialist for behavior treatment.

Barriers to quality and evidence-based ADHD diagnosis and treatment may be addressed from a systems perspective by focusing on levers that could reduce clinician time and effort, increase accessibility of treatment options, and expand access to services. Electronic health records that automate behavioral service referrals for patients may reduce burden on clinicians and clinic staff and potentially increase access to treatment aligned with guidelines.23 Similarly, co-locating behavioral health services in primary care practice can reduce time burden and increase access to and use of behavior treatment services.24,25

Models integrating behavioral health or coordinating care in primary care can increase access to behavior treatment, improve clinical outcomes, and can promote acceptability and family engagement.26 Approaches for payment have been described.27

Our findings also underscore the need for ongoing ADHD education across clinician types. Efforts to improve education around ADHD identification and diagnosis for clinicians, including improved training in medical and nursing school where only around 1 in 4 clinicians in our study reported receiving adequate training, may improve the availability of ADHD diagnosis for families and adults who need it. Education about treatment options, including preventing and managing medication side-effects and advantages of combined medication and behavior treatment for older children, adolescents and adults, may optimize effectiveness of symptom relief, adherence to medication treatment, and prevent treatment discontinuation.5,21,28,29 Strengthening ADHD clinician connections to other ADHD clinicians and to persons seeking care through ADHD partnership organizations like Children and Adults with ADHD (CHADD) is an example of another systems level approach that could improve access to care, ADHD expertise/knowledge, and referral. The anticipated publication of clinical guidelines for adult ADHD30 is another opportunity for education for clinicians who see adult patients.

Respondents indicated a desire for more training and a preference for continuing education courses, especially those available on demand. Previous findings showed that on demand resources can increase clinicians’ knowledge and comfort with adult ADHD care.31 The Centers for Disease Control and Prevention (CDC) supports CHADD and the American Academy of Pediatrics to provide free training for pediatricians and other healthcare clinicians (Pocket MD podcasts, PediaLink “Identifying and Caring for Children with ADHD (https://www.aap.org/Identifying-and-Caring-for-Children-and-Adolescents-with-ADHD-Enduring),” and PediaLink “Identifying and Managing ADHD with Co-occurring Conditions (https://www.aap.org/Identifying-and-Managing-ADHD-with-Co-occurring-Conditions)”).

CDC also supports CHADD’s National Resource Center on ADHD (https://chadd.org/about/about-nrc/) to provide evidence-based ADHD information and support for parents of children with ADHD. This support includes an ADHD organizational directory, evidence-based ADHD information, and professional directories.

Limitations

These findings have several limitations. DocStyles survey data are subject to misreporting. Respondents were drawn from an opt-in panel and are not representative of all clinicians. The proportion of primary care physicians (35% family physicians, 31% internists, and 16% pediatricians) is similar to proportions in the U.S. in 2024 (39% family physicians, 38% internists, and 21% pediatricians),32 but demographic information about survey non-respondents was not available. In addition, the survey did not collect data on contextual factors that may influence findings. For instance, the survey format did not allow us to ascertain quality of care provided, nor understand how participants defined behavior treatment, nor the specific types of behavior treatment offered. Behavior therapy or behavior treatment is a general term that encompasses many different modalities, from co-located behavioral health consultants, to parent training for behavior management, to behavioral health collaborative care. We are not able to determine for respondents who answered they offered a service in their practice, whether they meant their personal practice, their group’s practice, or a collaborative care practice. Similarly, the survey design limited our ability to understand the type of other ADHD related services that were offered when clinicians stated they offered other ADHD related services or referral in their practices. To increase statistical power, we combined data from nurse practitioners and physician’s assistants, limiting our ability to understand the unique role of each group of health care professionals.

Summary

Addressing clinician training and ADHD care barriers may help primary care clinicians promote lifelong health and well-being for people with ADHD. Fewer than half of clinicians overall offered ADHD diagnostic services in their practices, around one-third offered ADHD behavior treatment, and approximately two-thirds offered ADHD medication treatment. While recommended, many ADHD clinicians did not consistently refer for behavioral services not provided. Surveyed clinicians reported practice barriers of lack of time and comfort, and patient barriers of medication side effects, prescription ADHD medication shortages, and inability to find effective treatment. Clinicians would like more education and training for ADHD service provision, consistent with the knowledge assessment. Dissemination of the anticipated guideline release for ADHD adult treatment (US Guidelines for Adults with ADHD | APSARD) presents an opportunity for education to improve identification of adults with ADHD and ensure appropriate care.30 Other educational efforts could improve primary care clinicians’ access to evidence-based information on ADHD care and connection to networks and partnerships for consultation and referral. Given that millions of U.S. children and adults have an ADHD diagnosis,1,2 ongoing efforts to address barriers to ADHD care can support optimal health and well-being for many people in the U.S.

Conflicts of Interest

Authors have no conflicts or competing interests to report.

Peer Review

This article was externally peer reviewed.

Corresponding Author

Kim Newsome, BSN, MPH, Centers for Disease Control and Prevention, kan3{at}cdc.gov

Appendix

Appendix 1. ADHD DocStyles Questions 2023.

Q1. What ADHD related services do you offer in your practice? Select all that apply.

  • Diagnose children with ADHD

  • Diagnose adults with ADHD

  • Treat with stimulant ADHD medication

  • Treat with non-stimulant ADHD medication

  • Treat with behavior therapy for ADHD

  • Other ADHD related services or referrals

  • I do not provide ADHD services [if selected, cannot make any other selections, and respondents are not asked Q2- Q6]

Q2. When do you refer patients with known or suspected ADHD to a specialist? Select all that apply.

  • For initial ADHD diagnosis

  • For further, in-depth ADHD diagnosis

  • For evaluation of co-occurring conditions

  • For medication treatment

  • For psychological/behavioral treatment

  • For other reasons not listed

  • I do not refer these patients to a specialist

Q3. What do your patients report as barriers to psychological/behavior treatment for ADHD? Select all that apply.

  • Worries about stigma (patient or family)

  • Inability to find effective treatment

  • Cost

  • Time and effort

  • None of these [if selected, cannot make any other selections]

Q4. What do your patients report as barriers to ADHD medication treatment? Select all that apply.

  • Worries about stigma (patient or family)

  • Side effects

  • Identifying an effective medication

  • Lack of provider to manage medications

  • Cost

  • Availability of medication/shortage

  • None of these [if selected, cannot make any other selections]

Q5. Which of the following are your barriers to identification and/or diagnosis of ADHD in children?

Select all that apply (note: not asked if weekly number of pediatric patients seen is zero as noted in Table 1)

  • My comfort level evaluating these patients

  • My knowledge of ADHD

  • I don’t have anyone to refer the patient to

  • Lack of time to evaluate the patient

  • Unable to bill for this type of evaluation

  • Family resistance to evaluation/referral

  • None of these [if selected, cannot make any other selections]

Q6. Which of the following are your barriers to identification and/or diagnosis of ADHD in adults? Select all that apply (note: not asked of pediatricians)

  • My comfort level evaluating these patients

  • My knowledge of ADHD

  • I don’t have anyone to refer the patient to

  • Lack of time to evaluate the patient

  • Unable to bill for this type of evaluation

  • Family/partner resistance

  • None of these [if selected, cannot make any other selections]

Q7. Not included

Q8. Which of the following are true about you regarding training for ADHD diagnosis and treatment? Select all that apply.

  • I received adequate training in medical/nursing school

  • I received adequate training post-degree

  • I would like more training

  • None of these [if selected, cannot make any other selections]

Q9. Not included

Q10. Which of the following do you think would be most effective in helping you learn about ADHD in the FUTURE?

Select all that apply.

  • Physical/printed resources

  • CE training in person

  • CE training virtual on demand

  • CE training virtual live

  • Peer to peer in person training

  • Peer to peer virtual training

  • Podcasts by clinicians

  • Grand Rounds

  • Medical/Nursing school training

  • Social Media

  • Webpages

  • Scientific articles

  • None of these [if selected, cannot make any other selections]

Q11. Based on current diagnostic criteria, at what age must symptoms first be present to receive an ADHD diagnosis?

  • 7 years

  • 12 years (correct answer)

  • 18 years

  • Any age, including adulthood

  • Don’t know

Q12. Are the following statements true or false?

  • Medication is the recommended first line of ADHD treatment for children of all ages (false)

  • For children 6-12 years of age with ADHD, primary care clinicians are recommended to prescribe ADHD medications along with parent training and/or behavioral classroom intervention (true)

  • Received for publication July 3, 2025.
  • Accepted for publication October 6, 2025.

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