Attention Deficit Hyperactivity Disorder (ADHD)
Focus on ADHD
John V. Lavigne, PhD, ABPP
Susan LeBailly, PhD
Patricia Vasquez, Research Coordinator
The prevalence of childhood psychiatric disorder presenting in primary care pediatric settings is substantial (15%-20%), approximating that seen in general community epidemiologic studies. Because few of these children are treated in the tertiary mental health system, improving the mental health treatment of children seen in primary care is essential. Provision of mental health services through the primary care service sector is particularly appropriate for psychiatric conditions that are best treated with medications manageable by the primary care practitioner; this is particularly true given the serious shortage of child psychiatrists projected through the year 2020. Attention deficit hyperactivity disorder (ADHD) is one such condition.
The efficacy of stimulant treatment for ADHD is well documented. Regrettably, advances in treatment research too often are not reflected in improved clinical practice. This appears to be true for the pharmacologic treatment of ADHD, with available studies indicating that community treatment of ADHD is suboptimal. The proposed study will examine the process of translating research into practice (TRIP), determining whether the use of stimulant medication by community pediatricians, in middle class and inner city practices, can be improved to approximate that recommended in treatment guidelines, thus improving the care of their patients. The proposed study will be one of the first to attempt to alter practice procedures to conform to existing guidelines for stimulant management for ADHD, and the first to apply specific algorithms to ADHD management in child psychiatry. Other studies translating research into practice have suggested that minimal interventions (e.g., distributing practice parameters) are ineffective, while protocols requiring too many changes in practice procedures with increased time demands are not sustainable by practitioners. We propose an intervention of moderate intensity to help pediatricians use stimulant medications more effectively, while providing support needed to allow the practices to maintain improved management after training ends.
The specific aims of this study are to determine:
If specialized training for pediatricians (enhanced guidelines, training, education, computerized monitoring) in the use of stimulant medications for ADHD improves the classroom and at-home behavior of children with ADHD who are seen in primary care, and whether effects persist after support from an “ADHD specialist” is removed;
If specialized training and assistance in monitoring stimulant medications improves pediatricians’ prescription and monitoring practices and conformity to practice standards for managing ADHD.
The costs associated with training and changes in practice management procedures for managing ADHD as they relate to improvements in symptoms.
The project is a five-year study funded by the National Institute of Mental Health. Twenty-six pediatric practices, all members of the Pediatric Practice Research Group (PPRG), are participating in the study. They were paired, based on practice location and number of pediatricians and then randomized into special care and treatment as usual groups. Project staff are housed with the PPRG and can be reached at 1-800-747-8631.
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