A Clinical Audit of The Management of Children Diagnosed With Adhd In East London, South Africa

BACKGROUND: Attention Deficit Hyperactivity Disorder is a common childhood disorder, with a prevalence rate of 5-8%. Clinical guidelines have been developed to standardize care and management of ADHD patients. AIM: To assess compliance to clinical guidelines on management of children with ADHD in East London, Eastern Cape, using the NICE guidelines as the gold-standard. METHOD: A clinical audit was conducted at two hospitals in East London on children diagnosed with ADHD attending the neurodevelopmental clinics via retrospective folder review for 6 months in 2021. A total of 111 folders were meeting the inclusion criteria and data were collected through an auditing tool. RESULTS: Overall, out of the 16 audit standards, 8 met at least 80% compliance, while gaps were identified in 6 standards: specification of severity, referral to ADHD parent group, written psycho-education offered to patients, written psycho-education offered to caregivers, point of view of the child documented and treatment response monitoring. This study found a high prevalence of comorbidities with 92 (83%) participants having a comorbidity. The most common comorbidity was cognitive impairment, accounting for 46 cases (41%). The second most common comorbidity amongst participants was autism spectrum disorder followed by oppositional defiance disorder at 20% and 12% respectively. CONCLUSIONS: The audit showed, overall, fair compliance to the NICE guidelines. A checklist is proposed to standardize management and to improve the audit standards, which scored low. As in others studies a high comorbidity rate was seen, those need also to be addressed at every visit.