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BackgroundThere is underdiagnosis of and low use of specialist services for attention-deficit hyperactivity disorder (ADHD).AimsTo quantify the filters in the help-seeking pathway through primary care and to investigate factors influencing progress for children at risk of ADHD.MethodA 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.ResultsPrimary 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 …