ADHD Health Survey | Driscoll Health Plan

Do you prescribe medications for simple ADHD according to AAP guidelines?*

Yes
No

Why not?*

Time Constraints
Inexperience
Disagree with AAP guidelines
Other

You selected "Other", please let us know why else you do not prescribe medications for simple ADHA according to AAP guidelines:*

Do you utilize a parent rating scale (Vanderbilt/Conners) to make a diagnosis?*

Yes
No

Do you utilize a rating scale from two different sources i.e. From Teacher AND Parent?*

Yes
No

What barriers do you see to utilizing a rating scale/tool?*

(Please select all that apply)

Time
Inexperience
Cumbersome
Practice Constraints
Not needed
Other

You selected "Other", what other barriers do you see to utilizing a rating/scale tool?*

When would you refer patient to a specialist, i.e. Psychiatrist, Neurologist, or Developmental Behavioral Pediatrician?*

If there are comorbidities
For Initial Diagnosis
Treatment Failure (Two or more trials)
Would not refer
Other

You selected "Other", when else do you refer a patient to a specialist?*

Before making medication adjustments, do you utilize a rating scale to assess symptoms?*

Yes
No

Do you find difficulty collaborating with school personnel?*

Yes
No

Do you find difficulty collaborating with parents?*

Yes
No

Do you feel you have adequate support from your community psychologist for diagnostic dilemmas?*

(i.e. discrepant parent/teacher reporting)

Yes
No

In your opinion, do parents have reasonable expectations for age-appropriate behavior?*

Yes
No

In your opinion, do teachers/daycare have reasonable expectations for age appropriate behavior?*

Yes
No

Do you feel pressure by parents to make the diagnosis of ADHD?*

Yes
No

In your opinion, do parents have reasonable expectations regarding response to medications?*

Yes
No

Do you refer members for BEHAVIORAL HEALTH therapy?*

More than 50%
Less than 50%

Do your referred members attend BEHAVIORAL HEALTH therapy?*

Yes
No

Are there barriers to BEHAVIORAL HEALTH therapy?*

Transportation
Parent’s beliefs
Lack of resources
Other

You selected "Other", what other barriers are there to Behavioral Health Therapy?*

What education would be helpful in regards to ADHD management?*

Diagnosis
Medication Adjustments
Treatment Resistance
Clinical Pearls
When to refer out
Other

You selected "Other", what other education would be helpful in regards to ADHD management?*

Would you be interested in participating in an ADHD MOC 4 QI (quality improvement) project?*

Yes
No

Participant Contact Information

Please provide the contact information for the person who will participate in the project.

First Last

Email*

Phone*

Practice Name

Your Information

Person completing form:*

First Last

Email*

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