Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood and adolescence affecting between 8% and 12% of all US children. The 2013 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), expanded the age for first symptoms from before 7 to before 12 years of age, and the 2015 to 2016 National Health Interview Survey (NHIS) showed a significant increase from 6% to 10% in parent-reported diagnosis of ADHD in children between 4 and 17 years when compared with the 1997 to 1998 NHIS (JAMA Netw Open 2018;1:e181471). Rates of prescription of stimulant medications have led to frequent gnashing of teeth in the lay media and some of that concern may be warranted given the possibility that stimulant medications are prescribed without appropriate evaluation and diagnosis. Epidemiological studies of patient and physician factors that are associated with the prescription of stimulant and non-stimulant therapies for ADHD have provided mixed and contradictory results. In this volume of The Journal, Kamimura-Nishimura et al provide a “real world” evaluation of a variety of patient clinical and demographic and physician characteristics associated with the prescription of medications in the first year after referral for a concern for ADHD. This study enrolled 50 of 128 pediatric practices in central and northern Ohio that elected to participate in an ADHD Quality Improvement project between 2010-2012 to improve care to children diagnosed with ADHD. We chose to publish this study for a variety of reasons including some novel findings from a population health perspective (higher parental inattention ratings rather than hyperactivity and living in a neighborhood with higher medical expenditures were predictive of prescription) and a concerning finding from physician and practice ADHD evaluation perspective (only 79% of referred patients completed narrow or broad band assessments for ADHD). As noted by the authors, this study straddled the 2011 publication of the updated AAP guidelines on the evaluation and treatment of children with ADHD that outlined an evidence-based approach to the diagnosis including thorough medical, family, and social histories as well as the application of one of several assessment tools (Pediatrics 2011;128:1007-22). If these findings, in particular the non-uniform adherence to established diagnostic procedures, are generalizable to other primary care populations in the US, this study is a clarion call to professional societies (AAP, AAFP) and residency program directors that there is a lot of room for improvement. In addition to expanding research into the factors that are associated with prescription of medications for ADHD, it is equally important that the pediatric research community pursue investigations into factors that lead to non-prescription when diagnostic criteria are fulfilled or prescription when criteria are not fulfilled. Article page 155▸ Factors Associated with Attention Deficit Hyperactivity Disorder Medication Use in Community Care SettingsThe Journal of PediatricsVol. 213PreviewTo examine patient- and provider-level factors associated with receiving attention-deficit/hyperactivity disorder (ADHD) medication treatment in a community care setting. We hypothesized that the likelihood of ADHD medication receipt would be lower in groups with specific patient sociodemographic (eg, female sex, race other than white) and clinical (eg, comorbid conditions) characteristics as well as physician characteristics (eg, older age, more years since completing training). Full-Text PDF