Cincinnati Children's Provides Web Portal that Improves ADHD Care and Patient Outcomes to Pediatricians Nationwide

A study funded by the National Institute of Mental Health and led by Jeff Epstein, PhD, from the Division of Behavioral Medicine and Clinical Psychology, William B. Brinkman, MD, MEd, MSc, director of the Division of General and Community Pediatrics, and Tanya E. Froehlich, MD, MS, FAAP, director of research for the Division of Developmental and Behavioral Pediatrics, is supporting a nationwide rollout of the mehealth for ADHD online software. Research shows that many pediatric practices carry heavy caseloads, and staff members struggle to coordinate care for complex behavioral conditions like ADHD. At the same time, the number of diagnosed cases of ADHD continues to increase, further straining practice resources. This makes it more difficult for pediatricians to stay current with updated American Academy of Pediatrics (AAP) care guidelines for ADHD. Cincinnati Children's investigators developed the mehealth for ADHD software intervention with input from pediatrician-, parent-, and teacher- stakeholders. The software integrates QI methods with clinical utility specifically designed for community-based pediatric settings. The mehealth for ADHD software facilitates online collection of parent- and teacher-report ADHD rating scales for the assessment of ADHD as well as monitoring response to medication treatment. Two randomized controlled trials published in Pediatrics demonstrate that pediatricians’ use of the mehealth for ADHD software resulted in improved ADHD medication care and significantly better behavioral improvement in patients. The mehealth system recently expanded and improvements made by adding functions allowing parents and teachers to develop and implement behavioral treatments and to allow integration with several electronic health record systems. This grant will provide critical data on how to implement evidence-based care of ADHD provided through mehealth into clinical care provided by pediatricians and thus has the potential to transform care of children with ADHD.

Team Science for Understanding Brain Mechanisms for Preventing Migraine

Faculty members Robert Coghill, PhD, and Scott Powers, PhD, joined forces to determine why and how youth with migraines get better with both psychological and pharmacological treatment. Along with the interdisciplinary Headache Center team (Divisions of Neurology and Behavioral Medicine and Clinical Psychology), this translational line of investigation is innovative and at the cutting edge of headache medicine. Their initial study received funding from a CCRF RIP Award. The project used functional MRI and shows that eight weeks of cognitive behavioral therapy (CBT) produces changes in the connectivity of the amygdala, a brain region important in both pain and emotions. Moreover, with colleague Christopher King, PhD, they determined that the response to CBT is predictable by quantitative sensory testing before the youth receive any treatment. These initial findings provide the critical preliminary data for two recently awarded NIH R01 grants sent recently for submission for publication. More importantly, this project shows the power of team science for understanding pediatric pain and its treatment. Scott Power's group's expertise in large clinical trials, migraines, and CBT, combines in a beautifully complementary fashion with Robert Coghill's group's expertise in quantitative sensory testing and functional brain imaging of pain. In their ongoing study of migraines, they will compare brain mechanisms across standard drug treatment, placebo pill, CBT, and two sub-components of CBT. Together, the expectation of these studies is to provide patients, providers, and payers with the evidence that non-pharmacologic treatments for migraine prevention do indeed change patients' brains for the better.

Adolescent Bariatric Surgery Understanding Psychosocial Health and Emerging Risks Across 10 Years

Bariatric surgery is currently the most effective solution to treat severe obesity in adolescence and reduce associated comorbid health burden. Yet we are also learning, via work led by Meg Zeller, PhD, and her research team, that bariatric surgery during the adolescent/young adult transition brings new clinical health challenges of high public health relevance to bariatric care. In collaboration with the multisite Teen Longitudinal Assessment of Bariatric Surgery Consortium (Teen-LABS), Dr. Zeller’s consecutive R01 studies have brought novel science and additional rigor to Teen-LABS. In particular, these studies have prospectively tracked mental health, alcohol/tobacco/illicit drug use, risky sexual behavior, and suicidal risks to six years post-surgery for these adolescent patients and have included a non-surgical adolescent comparator group with severe obesity followed over the same course of time. Initial published data demonstrate early signals of concern for surgical sub-groups focused on persistent mental health needs, problematic alcohol use, and for females, a greater uptake of HIV/sexual-risk behaviors relative to comparators. This series received support from R01s funded primarily by the National Institute of Diabetes and Digestive and Kidney Diseases as well as the National Institute on Drug Abuse. A second competitive renewal recently awarded extends observation of these surgical and non-surgical cohorts. Launched in the spring of 2019, this will be the first prospectively designed and controlled study to examine psychosocial benefits and risks to health and well-being of adolescent bariatric surgery to 10 years. Data from this series will inform prevention and intervention timeframes for testing targeted interventions and developing clinical care guidelines for a pathway to long-term, successful weight management, health, and well-being for the adolescent bariatric patient.

Avani Modi, PhD

Avani Modi, PhD, a professor in Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s and director of the Center for Adherence and Self-Management received an award for three NIH grants this past fiscal year, including two R01s and R21. All three of her grants focus on the development and testing of mHealth interventions to improve adherence in youth with chronic conditions (epilepsy and type 1 diabetes). Approximately 50% of youth with chronic conditions demonstrate suboptimal adherence to their treatment regimens, which leads to increased morbidity and mortality, poor quality of life, and higher healthcare expenditures. Dr. Modi, and her colleagues at several institutions across the US (Nationwide Children’s Hospital, University of Florida, Medical University of South Carolina, and Children’s Hospital of Orange County), are working together to improve treatment adherence with the use of mobile health interventions that accessible at home by patients and their families. The goal is to provide access to these types of interventions for underserved patients due to lack of resources in their communities. By improving adherence, Dr. Modi and her team will improve the health and quality of life of youth with chronic conditions and their families.

Marina Lopez-Sola, PhD

Marina Lopez Sola, PhD, an assistant professor in the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s and director of the Pain and Emotion Neuroscience Laboratory received an NIH R01 grant focused on identifying sensitive and specific neural pathophysiology in juvenile fibromyalgia, a debilitating chronic pain condition that affects 2-6% of school-aged youth. This grant will apply machine learning techniques to fMRI data during tailored sensory, cognitive, and affective symptom provocation tasks to identify a neural marker that can detect juvenile fibromyalgia pathophysiology with high accuracy in new patients. The marker base will be on identifying sensory brain processing abnormalities and cognitive-emotional brain abnormalities. The grant will test whether different forms of multidisciplinary treatment significantly attenuate the expression of the pathophysiological brain marker. The overarching goal of Dr. Lopez-Sola’s research is to provide the scientific community with new information about the brain underpinnings of a condition that is now widely understudied and to validate the brain imaging markers of chronic widespread musculoskeletal pain. By improving the knowledge about the pathophysiology of disease in the individual patient and the effects of treatment, Dr. Lopez-Sola and her team will impact understanding of the disease, and consideration of behavioral treatments in the broad medical context.