Management and co-morbidities in children and adolescents with attention deficit hyperactivity disorder diagnosis: A clinical audit in the Eastern Cape province, South Africa.

Background: Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder, with a prevalence rate of 5% - 8%. Clinical practice guidelines have been developed internationally to standardise the care and management of patients with ADHD. Aim: To assess compliance with clinical guidelines on the management of children with ADHD in two hospitals in the Eastern Cape province using the National Institute for Health and Care Excellence (NICE) guidelines as the gold standard. Setting: Paediatric departments of two hospitals in the Buffalo City Municipality, Eastern Cape province, South Africa. Methods: A clinical audit was conducted on children and adolescents diagnosed with ADHD attending neurodevelopmental clinics (NDCs). Patient folders were reviewed between June 2021 and December 2021, and data were collected using a 16-point audit tool based on the NICE guidelines for ADHD. Results: A total of 111 patient folders met the inclusion criteria. Of the 16 audit standards, 8 demonstrated over 80% compliance, while 2 achieved fair compliance (50% - 79%). Significant gaps were identified in the 6 standards with poor compliance (< 50%). Co-morbidities were highly prevalent, with 83% of patients presenting with at least one co-existing condition. Conclusion: The audit demonstrated overall good clinical compliance with the NICE guidelines for ADHD management, but it also exposed gaps in psycho-social interventions, caregiver support and the availability of structured support groups. Contribution: This study highlights service gaps in resource-limited settings and is expected to further inform government policy planning in developing auxiliary services and multidisciplinary support for children with ADHD and their families in such settings.