Conflicts of interest: None reported CORRESPONDING AUTHOR

PURPOSE We wanted to survey physicians in the Washington, DC, metropolitan area regarding the frequency with which physicians, teachers, parents, and others first suggest the diagnosis of attention-deficit/hyperactivity disorder (ADHD). METHODS A questionnaire was mailed to all family physicians, primary care pediatricians, and child psychiatrists in greater Washington, DC. In answer to the question, “Who first suggests the diagnosis of ADHD?” respondents assigned percentages to primary care physicians, consultants, parents, teachers, etc. RESULTS Teachers were most likely to be first to suggest the diagnosis of ADHD (46.4%; 95% CI, 44.1%-48.7%), followed by parents (30.2%; 95% CI, 28.3%-32.0%), primary care physicians (11.3%; 95% CI, 9.7%-12.8%), school personnel other than teachers (6.0%; 95% CI, 4.9%-7.2%), consultants such as child psychiatrists or psychologists (3.1%; 95% CI, 2.3%-3.9%) and other specified categories (3.0%; 95% CI, 2.4%-3.6%). CONCLUSIONS Teachers and other school personnel are often the first to suggest the diagnosis of ADHD in children in the greater Washington, DC, area. Regional variations in the prescribing of medication for ADHD may be caused at least in part by variations in the likelihood of a teacher suggesting the diagnosis of ADHD.