Cincinnati Children's Develops Task Force to Combat ADHD in Children

Answers Community's Cry for Help

Wednesday, August 03, 2005

CINCINNATI -- Cincinnati Children's Hospital Medical Center has teamed up with local pediatricians and family practitioners to treat children with attention deficit hyperactivity disorder (ADHD). The newly launched effort, which is funded by a $1.8 million grant from the Cincinnati Children's Patient Innovation Fund, is designed to improve access to care for children with ADHD.

ADHD is one of the most common behavioral disorders affecting children. Approximately 9 percent of males and 3 percent of females are affected by the disorder which is marked by inattention, hyperactivity, lack of concentration and impulsivity. It can affect a child's self-esteem, relationships with family and peers and school performance.

Under a pilot, the task force is now assisting community-based primary care physicians in providing front-line care for children with ADHD and to ensure that care is evidence-based. In 2004, Cincinnati Children's developed their first evidence-based mental health guidelines for the diagnosis and management of ADHD based on similar guidelines issued by the American Academy of Pediatrics (AAP) in October 2001. Cincinnati Children's guidelines included recommendations for the management of ADHD that were based on new evidence not available at the time the AAP guidelines were published.

"What's unique about the ADHD Task Force initiative is that community physicians and families came to us asking for help. There's evidence that more parents are going to their pediatricians with mental health concerns than ever before so it's obvious there was a problem we needed to address," said Phil Lichtenstein, MD, a community physician at the Dixie Pike Family Health Center (Covington, Ky.) hired as the physician coordinator for the task force.

An interdisciplinary group of doctors from the divisions of General and Community Pediatrics, Behavioral Medicine and Clinical Psychology, Child and Adolescent Psychiatry and Developmental Disabilities at Cincinnati Children's have teamed up to form the ADHD Task Force with local pediatricians and their practices. Many community pediatricians have been involved from the start of the task force but the following five will be involved in the second pilot scheduled to begin August 3, 2005: Drs. Rick Berger (Boone County), Petra Hackenberg-Bauer (Anderson Hills), Matt Harden (West Chester), Kate O'Malley (Mason) and Greg Wallace (Norwood).

Currently, ADHD patients who come to Cincinnati Children's account for 25 percent of psychology's referrals, 33 percent of psychiatry's referrals, and 30 to 35 percent referrals to developmental disabilities. Of those, 50 percent of psychology, 25 percent of psychiatry and 30-35 percent of developmental disabilities' patients waiting to be seen are just to determine an ADHD diagnosis, according to task force findings.

Helping community physicians to develop more accuracy and confidence in making ADHD diagnoses could reduce wait time for patients otherwise being referred to Cincinnati Children's for their condition. "Family's wait time for a work up of ADHD could potentially be cut to as little as two weeks, whereas if they were referred to us, it could take at least seven weeks for a diagnosis," says Lori Stark, PhD, director of the division of Behavioral Medicine and Clinical Psychology at Cincinnati Children's.

During the pilot, the pediatrician consultation team, with expertise in the diagnosis and management of ADHD, will be available to provide peer-to-peer advice, including on-site consultation. So that the diagnosis and treatment of ADHD may be easily accommodated by busy practices, the ADHD Task Force at Cincinnati Children's will provide guidelines for facilitating workflow and for coding and billing for these services.

The task force has established a consult phone line through the Psychiatry Intake Response Center at Cincinnati Children's. The line was set up to assist the primary care physician in obtaining appropriate assistance and services for children with ADHD and their families. For children with ADHD and co-morbid conditions, the consult line will facilitate access to the appropriate subspecialty service for further evaluation and consultation or treatment.

In addition, the collaborators have implemented a fast track service at Cincinnati Children's during the pilot which promises to see patients within two weeks if the child being treated has not improved or is getting worse after receiving treatment by their primary care physician.

Since 50 percent of graduates from the University of Cincinnati, College of Medicine choose to go into private practice, the ADHD Task Force will also provide medical residents in pediatrics at Cincinnati Children's interactive training focused on triage and the mental health of children on the second Wednesday of each month beginning in August. This training and additional training for community pediatricians has been funded through a five-year grant from four pharmaceutical companies.

Once the program is fully implemented, it is expected that the community physicians will have the knowledge, skills and tools available to accurately assess ADHD and co-morbid conditions such as depression, anxiety and learning disabilities, offer appropriate medical management, including medication, behavioral therapy or both, set treatment goals, and coordinate care with the child's school.

"Symptoms of ADHD can be detected before any other mental health disorder and with accurate diagnostic tools. Studies show that community physicians will be able to detect ADHD in children with 80 to 85 percent accuracy," said Dr. Lichtenstein. "I believe the additional training for community pediatricians about how to detect ADHD will help with earlier treatment and improved quality of life for children in the Tristate."

Cincinnati Children's is a 423-bed institution devoted to bringing the world the joy of healthier kids. Cincinnati Children's is dedicated to transforming the way health care is delivered by providing care that is timely, efficient, effective, family-centered, equitable and safe. It ranks third nationally among all pediatric centers in research grants from the National Institutes of Health. The Cincinnati Children's vision is to be the leader in improving child health.