Management of ADHD in children and adolescents: clinical audit in a South African setting

Objectives: Attention deficit hyperactivity disorder (ADHD) is common, yet under-recognised and undertreated, particularly in low socio-economic settings. Little is known about compliance to evidence- based guidelines in low- and middle-income countries, and no clinical audits have been published in Africa. We undertook to measure compliance in a South African setting using the National Institute for Clinical Excellence (NICE) guidelines for ADHD as the gold standard to compare compliance and socio-demographic characteristics between two treatment locations in Cape Town and to generate an audit checklist for standardising care.Methods: The study used a sample of 100 randomly selected cases of school-age patients diagnosed with ADHD, at the Division of Child & Adolescent Psychiatry, Red Cross War Memorial Children's Hospital and University of Cape Town, South Africa. Fifty cases each from a central and a peripheral clinic location were reviewed retrospectively using audit tools, including 17 audit standards derived from NICE guidelines. We defined compliance as good with 80%, fair with 50-79%, and poor with <50% adherence.Results: Compliance was low, with only four audit standards rated as good. Physical monitoring was especially poor. The central group received more treatment options and relatively safer monitoring.Conclusions: We recommend introducing structured protocols followed by re-auditing to improve service delivery, and present a checklist for use in future audit cycles.