Improving Attention Deficit Hyperactivity Disorder Treatment Adherence and Outcome in Primary Care Settings

Study Overview
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Brief Summary
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This study will determine the effectiveness of educating pediatricians about attention deficit hyperactivity disorder treatment guidelines in improving child behavior and pediatricians' adherence to medication guidelines.

Detailed Description
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The most effective treatment for improving the core symptoms of inattention, impulsivity and hyperactivity in children with attention deficit hyperactivity disorder (ADHD) involves the use of stimulant medications. Most children with ADHD are treated by pediatricians, but the treatment provided is often less than optimal. This study is designed to see if training for pediatricians in following guidelines for management of first-line medicines for ADHD leads to improvement in child behavior, and whether the physicians can adhere to the guidelines. Over 100 studies have shown that stimulant medications are effective for improving the core symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Approximately 70% of children who receive ADHD medications are treated by their primary care pediatrician, but studies show that management is not always optimal. The present study is designed to see if child behavior can be improved by training pediatricians in the use of guidelines for treating ADHD, and whether the physicians can adhere to the guidelines. Twenty-four pediatric practices were randomized to a treatment as usual or specialized care (receiving training in guidelines and computer assisted monitoring of patient progress and medication titration). Children are assessed with parent and teacher reports at baseline, 4-, 9-, and 12-months post initiation of treatment, and classroom observations of behavior are assessed at baseline, 6-, and 12-months. Approximately 400 children are to be enrolled.

Official Title
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Improving Medication Use for ADHD in Primary Care

Conditions
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Attention Deficit Disorder With Hyperactivity

Intervention / Treatment
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* Behavioral: Physician training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Presence of ADHD Not currently on medication Exclusion Criteria: No serious neurological disorders of sever mental health problems (suicidal behavior, autism)

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 11 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1 Physician training<br>Physician participants will receive training in guidelines and medication monitoring | Behavioral: Physician training<br>* Physicians are trained in guidelines for medication management.<br>|
| No Intervention: 2<br>Physician participants will provide usual care and no special intervention | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Behavior changes as rated by teachers |  | Measured at Month 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Behavior change as rated by parents |  | Measured at Month 12 | 
| Behavior changes as rated by classroom observation |  | Measured at Month 12 | 
| Relation between adherence to protocol and behavior change |  | Measured at Month 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ADHD, Attention Deficit Hyperactivity Disorder