Background: There is underdiagnosis of and low use of specialist services for attention-deficit hyperactivity disorder (ADHD). Aims: To quantify the filters in the help-seeking pathway through primary care and to investigate factors influencing progress for children at risk of ADHD. Method: A total of 127 children (5-11 years old) with pervasive hyperactivity who passed each filter (primary care attendance and general practitioner (GP) recognition of disorder) were compared with those who had not. Results: Primary care attendance was only associated with parental perception of the behaviour as problematic (OR 2.11; 95% CI 1.11-4.03). However, GP recognition was related to both parent and child factors — parental request for referral (OR 20.83; 95% CI 3.05-142.08) and conduct problems (OR 1.48; 95% CI 1.04-2.12). GP non-recognition was the main barrier in the pathway to care; following recognition, most children were referred. Conclusions: Parents can be regarded as the main gatekeepers for access to specialist services
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