Comparative Effectiveness of Primary Care-based Interventions for Pediatric ADHD
Condition: Attention Deficit Hyperactivity Disorder
MeSH terms: Hyperkinesis; Attention Deficit Disorder with Hyperactivity
Study type: Interventional

Summary: 
      Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder
      of childhood, affecting approximately 8% of youth. Children with ADHD often have problems
      sustaining attention and completing multi-step commands and tasks of daily living, such as
      homework. Pediatricians are often the first physicians to identify problems with children's
      functioning at home and at school. However, because of limited visit time, pediatricians
      often struggle with managing ADHD while trying to also cover a vast array of other primary
      care issues. Moreover, as there is a nationwide shortage of pediatric mental health
      specialists and access to parenting programs is limited, a critical need exists to develop
      interventions that form partnerships between behavioral and mental health specialists and the
      primary care pediatrician. One approach is to base interventions in the pediatric clinic to
      ensure children have access to appropriate treatment. Thus far, only a limited number of
      sites have this pediatric-mental health partnership.

      Health information technology (HIT) has been used to enhance primary care management of ADHD.
      HIT can improve pediatricians' ability not only to adhere to recommended guidelines, but also
      to screen for co-existing disorders and provide timely parental education. An alternative
      strategy might be to use group visits (GV). GV afford more time with families and allows the
      pediatrician to facilitate more in-depth discussions. More importantly, the group model
      allows parents to learn from one another, normalizes parenting expectations, and addresses
      shared experiences of medication side effects and other factors related to adherence.
      Moreover, a group visit can be conducted in a physical location, such as the pediatric
      clinic, or be brought into the virtual world with the aid of social media. Virtual support
      groups for chronic care diseases have become an increasingly popular way for a community of
      individuals to exchange information and offer emotional support.

      Prior to the adoption of these interventions into primary care practice, investigators must
      know which is best. Rigorous comparative effectiveness research (CER) can help to determine
      this. This proposal will compare a HIT based intervention to a GV strategy, with and without
      the use of social media. These 3 interventions will be compared based not only on clinical
      measures of interest but also on parent-defined patient outcomes. Prior research has largely
      focused on measuring clinical outcomes such as treatment adherence and ADHD symptom reduction
      with little emphasis on understanding how patient-centered outcomes, such as the quality of
      life of families dealing with ADHD, are affected.

      Building on previous work, the specific aims for this study are:

      Aim 1. Compare the preliminary efficacy of three interventions to improve treatment of ADHD
      in the primary care setting Aim 1a) Compare the effectiveness of the three interventions on
      clinical measures such as parent and teacher rated ADHD symptoms and adaptive functioning Aim
      1b) Compare the effectiveness of the three interventions on patient-centered outcomes such as
      quality of life and parental satisfaction with the intervention The three interventions will
      be: 1) Child Health Improvement through Computer Automation (CHICA) which is the health
      information technology innovation arm; 2) Group visits (GV); or 3) Group visits plus online
      discussion portal (GV+DP).
    


Intervention name(s): ADHD Group Visits; ADHD Group Visits plus Online Discussion Portal; Computer Decision Support
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Parents and children attend separate but concurrently run group visits every three months; groups are facilitated by general pediatricians; Parents and children attend separate but concurrently run group visits every three months; groups are facilitated by general pediatricians. Parent participants will be granted access to the online discussion portal to allow for communication in between in-person group visits.; ADHD Module of the Child Health Improvement through Computer Automation (CHICA) system Designed to facilitate physician adherence to clinical care guidelines for ADHD identification and chronic care management
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Attention deficit hyperactivity disorder; Interventions; Primary care; Pediatric