Improving ADHD Behavioral Care Quality in Community-Based Pediatric Settings
Grant Number: R18 HS024690
PI: Jeffery Epstein, PhD
Collaborators: Bill Brinkman, MD; Kevin Hommel, PhD; Leanne Tamm, PhD; Aaron Vaughn, PhD; James Peugh, PhD; Joshua Langberg, PhD. (VCU)
Though the most effective treatment for children with Attention Deficit Hyperactivity Disorder (ADHD) consists of combined medication and behavioral strategies, the vast majority of children with ADHD are treated with medication only. While effective, medication primarily targets ADHD symptoms and typically has little to no impact on ADHD-related areas of functional impairment such as academic underachievement, impaired social relationships, and disrupted family functioning. One reason for the low rates of behavioral treatment is that primary care pediatricians, not mental health professionals, are responsible for treating the vast majority of children with ADHD.
We have developed, tested, and are beginning to disseminate web-based software that has been shown in randomized clinical trials to improve the quality of ADHD medication care delivered by pediatricians. However, the current software functionality is limited entirely to medication management. The goal of the proposed study is to develop and test the integration of behavioral tools into the evidence-based software in order to improve access to behavioral treatment strategies, and ultimately improve outcomes for children with ADHD. The automated algorithms and decision rules we will develop for creating and monitoring the behavioral tools will ensure that behavioral treatments like daily report cards and token economies are delivered in a manner that is consistent with the evidence-base.
Initially, we will design, build, and integrate behavioral tools into the software using an iterative stakeholder-centered design approach whereby feedback will be obtained from all stakeholders (i.e., parents, teacher, and pediatricians) before, during, and after development of these behavioral tools. Next, we will assess the acceptability of this software through qualitative methods such as usability studies and focus groups with users. Finally, we will conduct a cluster randomized controlled trial in community pediatric settings to test whether integration of the behavioral tools into the software (1) increases rates of behavioral treatment; (2) facilitates better integrity of behavioral interventions when implemented; (3) improves functional impairment in children with ADHD; and (4) generates higher satisfaction with ADHD care.
By continuing to expand the functionality of the software, we are increasing patients’ access to evidence-based care. This is especially critical for rural and underserved communities who have no or limited access to evidence-based mental health services. Moreover, by putting these behavioral tools in the hands of parents, teachers, and pediatricians, we are making it more likely that children will receive a high quality of care that includes both medication management and behavioral strategies, thereby improving the overall treatment outcomes of children with ADHD.
