Center for Promotion of Child Development through Primary Care

Optimizing the Collaborative Care of Mississippi Children with Attention Deficit Hyperactivity Disorder

Executive Summary

It is now clear that proper diagnosis and management of ADHD results in reduction of many adverse outcomes both in school and in the community. However, most children with ADHD are managed by primary care doctors who, as a group, have not been well equipped to provide optimal care. In addition to problems with physician education and time they, and even mental health consultants, may not seek or lack ready access to teacher report data required for making the diagnosis and optimizing treatment. Teachers suffer along with their students when communication and coordinated management is poor.

We propose to address the problems with ADHD diagnosis and management to optimize care in three school districts in Mississippi through a unique combination of two web-based systems: ADHDCheckup and The Child Health and Development Interactive System (CHADIS). ADHDCheckup is a web based communication and educational tool linking teachers, parents, children and physicians to share information about student functioning. CHADIS is a web-based assessment and decision support tool that facilitates diagnosis of any mental health problems as well as competencies in the child and also provides instant physician education and linkage to resources. Systematic standard teacher screening will be used to identify students who may have ADHD and to refer them to their own pediatricians. In this first cohort pediatricians with practices in the three school districts will be randomly assigned to one of two groups: ADHDCheckup/CHADIS intervention or Usual Care. Those in the ADHDCheckup/CHADIS group will be provided CHADIS information and decision support, webcast case discussions bimonthly, and access to teacher information via ADHDCheckup. The CHADIS protocols recommend that children meet specific criteria for a proper diagnosis. If medication is warranted and chosen by the family it is advised that the child show effectiveness of the medicine through positive results on a "single patient placebo trial" which are also used to optimize dosage. Non-medication interventions are also recommended by CHADIS and include parent education, use of competency building activities, tutoring and mental health referral when indicated -- all identified by the CHADIS resource engine. The Usual Care group may request teacher information but otherwise treat children as they are accustomed to do. We hypothesize that children in the ADHDCheckup/CHADIS intervention group will have fewer behavioral symptoms, fewer school problems including reports of disruptive classroom behavior, suspensions and expulsions, class absences, behavioral interventions at school (guidance counselor visits, co-teaching, in class aides, emotional disability class placement), and better grades than children in the Usual Care group. We expect that future follow-up studies will show less substance abuse, depression, conduct disorder, and fewer accidents and injuries in both ADHDCheckup/CHADIS intervention groups.