Cesar Ochoa-Lubinoff, MD, discusses practical strategies for ADHD care in the primary care setting

ADHD affects nearly 1 in 10 children in the United States, but evaluation and management often compete with time and scheduling pressures in pediatric practices. Cesar Ochoa-Lubinoff, MD, Cesar Ochoa-Lubinoff, MD, MPH, director of Developmental-Behavioral Pediatrics at Cedars-Sinai Guerin Children's, noted that creating structured systems can help.

“One of the important approaches is to develop a system in the office where you can plan a diagnostic visit, where you can explain to the family the diagnosis and the treatment options, and then regular follow-ups, because this is a chronic condition that is changing all the time,” Ochoa-Lubinoff said.

He emphasized the importance of follow-up every 3 months and the use of ADHD rating scales, such as Vanderbilt forms, to gather teacher input efficiently. “If we get families used to taking the Vanderbilts or other rating scales filled by the teachers before every other visit, that can give us the perspective from the teacher on how the child is doing at that time,” he said.

Key takeaways from AAP guidelines

Ochoa-Lubinoff highlighted the utility of the American Academy of Pediatrics (AAP) ADHD clinical practice guideline and toolkit for streamlining care. The guidelines recommend using DSM-5 criteria embedded in parent and teacher rating scales, which can support efficient diagnosis without extensive additional time.

“They explain how the use of the rating scales for parents and for teachers can help make an effective diagnosis of ADHD without dedicating too much time,” Ochoa-Lubinoff said. The guidelines also emphasize the chronic nature of ADHD, with treatment strategies tailored by age group.

Addressing barriers to reimbursement

Managing ADHD care in primary practice can be complex and time-consuming, particularly with payment and reimbursement challenges. Ochoa-Lubinoff pointed to strategies such as office organization, collaboration with behavioral health specialists, and proactive communication with schools. Some larger practices have incorporated on-site mental health specialists to streamline care.

“It’s really necessary to develop partnerships and communication with school systems, with community resources, and being aware of those providers in the community and having a relationship with them ahead of time,” Ochoa-Lubinoff said.

Training gaps in ADHD care

Ochoa-Lubinoff noted significant variability in pediatricians’ comfort and training with ADHD. Some feel confident managing complex cases, while others seek more support. “Everyone should be interested, because ADHD is a very prevalent condition and it takes a big toll on the developmental trajectories of our patients,” he said.

He encouraged pediatricians to strengthen diagnostic confidence, manage straightforward cases, and know when to refer more complex presentations. Treatment, he said, requires ongoing monitoring and adjustment. “Many times I see a patient and we diagnose, we start treatment, and everyone is super happy because the child is doing so much better. But something I tell parents is, this is just the beginning, because things can change over time,” Ochoa-Lubinoff said.

Disclosure:

Ochoa-Lubinoff reports no relevant disclosures.

Reference:

1. Ochoa-Lubinoff C. How to Diagnose and Treat ADHD in a Busy Practice. Presentation. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.