Improving Attention Deficit Hyperactivity Disorder Behavioral Care Quality in Community-Based Pediatric Settings

Approximately nine percent of children have a diagnosis of attention deficit hyperactivity disorder (ADHD). Optimal treatment combines pharmacological and behavioral treatment. The former primarily improves symptoms, such as improved attention and reduced hyperactivity; the latter improves impairments, such as academic underachievement, impaired social relationships, and disrupted family functioning. Combining these two treatment modalities has been shown to be the most effective treatment and is universally recommended. However, because pediatricians and not mental health professionals treat the vast majority of children, rates of behavioral treatment are low.

This research developed and tested the integration of behavioral tools into mehealth.com, an evidence-based, online tool for assessing and treating individuals with ADHD, in order to improve access to behavioral treatment strategies, and ultimately improve outcomes for children with ADHD.

The specific aims of the research were as follows:

• Design, build, and integrate behavioral tools into the mehealth.com software using an iterative stakeholder-centered design approach whereby feedback will be obtained from all stakeholders before, during, and after development of these tools.
• Assess the acceptability of the integrated behavioral tools through qualitative methods; conduct a cluster-randomized controlled trial in community pediatric settings to test whether integration of the behavioral tools into the mehealth.com software increases access to and rates of behavioral treatment, facilitates better integrity of behavioral interventions when implemented, improves functional impairment in children with ADHD, and generates higher satisfaction with ADHD care.

The research team first developed the behavioral tools using a stakeholder-centered design approach through a series of interviews and design sessions with pediatricians, parents, and teachers. The behavioral tools were then integrated into the mehealth.com software and were then assessed for acceptability through usability testing and focus groups. The research team then conducted a randomized controlled trial with 169 elementary school children with ADHD to examine the behavioral tools’ impact on patient outcomes.

Study results revealed that the use of the behavioral tools within the mehealth.com software did not lead to intervention-related improvements among the children with ADHD participating in the study. However, there was significant evidence that suggested the intervention led to improvement in academic impairment. Challenges in implementation and adherence to behavioral intervention within the study possibly led to the lack of findings within this research. Despite the lack of improvement, the research team has confidence that the developed behavioral reward software is a viable intervention for improving behavioral outcomes of children with ADHD.