Improving Treatment for Children With ADHD
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When evidenced-based guidelines are followed, 74 percent of children treated by pediatricians show a 25 percent reduction in ADHD symptoms by parent report – and 82 percent show a reduction by teacher report. |
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Attention Deficit Hyperactivity Disorder (ADHD) affects an estimated 5 to 7 percent of the population and is the most common behavioral disorder among elementary school-age children. Despite its prevalence, care is often fragmented among pediatricians, mental health specialists and schools – frequently leading to delays in the treatment of children with this condition.
Aware of the extent of the community need, Cincinnati Children's teamed with community physicians to form the ADHD Collaborative, a group charged with identifying and implementing a plan to improve the care and change the outcome for children with ADHD.
According to Lori Stark, PhD, director of Behavioral Medicine and Clinical Psychology, any clinic "with walls" that Cincinnati Children's could create would quickly be at full capacity. Members of the collaborative, therefore, needed to look for alternatives to ensure kids had the best possible treatment at the point of care. Their first step was to look to the guidelines established by the American Academy of Pediatrics (AAP) and the Cincinnati Children's evidence-based guidelines for the diagnosis and treatment of the disorder. According to the guidelines, with the proper support and education, primary care physicians can be empowered to conduct a diagnostic evaluation of ADHD and can discuss and begin treatment with children and their families within the primary care setting. The collaborative partnered with primary care physicians to assist in providing the frontline care and to ensure that this care is evidence-based.
Putting Evidence-Based Guidelines Into Practice
Primary care office personnel participating in the ADHD Collaborative meet with team members from Cincinnati Children's to develop office systems and streamline processes to ensure that guidelines are followed. Participants learn quality improvement skills that can be applied to the monitoring and treatment of patients. And care providers and key office staff meet with Cincinnati Children's team members for didactic training. Over the course of several months, data is tracked and feedback provided to help fine-tune the processes the office has adopted.
The ADHD Collaborative is in its fourth year. To date 179 community physicians are participating at 51 pediatric practices. The results of the collaborative exceeded expectations with regard to implementation of the guidelines in pediatrician's practices. After working with the ADHD Collaborative, pediatricians are using rating scales from parents and teachers as part of their initial diagnostic work-up and to assess progress in treatment over time. Seventy-four percent of the children treated by the pediatricians following the guidelines show a 25 percent reduction in ADHD symptoms by parent report and 82 percent show a reduction by teacher report.
Among their many research projects, Jeff Epstein, PhD, director of the ADHD Collaborative and associate professor of pediatrics in the Division of Behavioral Medicine and Clinical Psychology, and colleagues are currently working to pilot a web-based program for ADHD diagnosis and management with participating collaborative practices. The program's aim is to provide physician education about ADHD assessment and treatment; web-based rating scales for parents and teachers; web-based access to rating scales results for physicians; and remote consultation with ADHD specialists. The scored results from ratings scales, along with suggestions for treatment and further services for comorbid disorders, can be accessed through the web by the physician's office, where they can be reviewed with the family. When fully implemented, the web-based system also will provide participating physicians with a means to monitor how effectively they are delivering care in compliance with evidence-based guidelines.
