IMPROVING PEDIATRICIANS' USE OF AD/HD GUIDELINES

描述(申请人摘要)：本建议书回答了NIMH RFA MH-00-005：“制定、测试和实施创新的干预措施 这个提案的中心是开发和实施一个 介绍注意力缺陷的治疗方法的创新干预 多动障碍(ADHD)在实验室环境下被发现有效 社区环境中的儿科医生。拟议的初始阶段将划定 目前儿科对ADHD的评估和治疗实践。这个 对干预措施的评估是纵向的，将有助于确定 采用功效研究结果的障碍和促进者 社区儿科医生与儿科医生坚持的效果 关于儿童(总体功能和学术)的拟议议定书 措施)患有多动症和共病障碍的人及其家人。最后，为了 测试干预的持久性，我们将重新评估儿科医生的 干预一年后的评估和治疗实践。 ADHD是儿童中最常见的精神疾病，也是 很少有儿童心理健康障碍有有效的， 短期治疗(兴奋剂药物)。因此，它是一个理想的候选人 用于实践和传播研究(由NAMHC在桥接中定义 科学和服务部，联大监督委员会向NAMHC和NAMHC提交报告 NIMH赞助的《贝尔蒙报告》)。然而，功效研究的传播 调查结果已经超过了向儿科医生传播知情方法的速度。 这种知识差距导致了儿科的变数，而且往往是劣等的。 多动症在社区中的实践。为了将ADHD的知识从 “从实验室到日常实践，”美国儿科学会(AAP)是 起草ADHD临床实践指南。我们的干预呈现了这些 儿科医生指南以及一本实用的程序手册 ADHD的评估和治疗。 这项提案涉及100名儿科医生与800名儿童在一个 横断面设计和200名儿童的随机、2年纵向研究 学习。我们将：1)描述ADHD的评估和治疗程序 社区儿科医生，2)评估实施和影响 旨在促进采用AAP ADHD指南的干预措施；3)评估 儿科医生采用AAP指南的程度和预测因素； 4)比较儿童的服务使用情况和结果(AAP指南与 传统做法)；5)描述坚持治疗的预测因素；6) 跟踪研究人员诊断为ADHD的儿童，但不跟踪他们的 儿科医生；最后评估ADHD的直接和间接成本。

DESCRIPTION (Applicant's abstract): This proposal answers the NIMH RFA MH-00-005: "Developing, Testing and Implementing Innovative Interventions for ADHD." This proposal centers on the development and implementation of an innovative intervention for presenting treatments of Attention Deficit Hyperactivity Disorder (ADHD) found efficacious in a laboratory setting to pediatricians in a community setting. The proposed initial phase will delineate current pediatric practice in the assessment and treatment of ADHD. The evaluation of the intervention is longitudinal and will aid in identifying barriers to and facilitators of the adoption of efficacy study results by pediatricians in the community and the effects of pediatrician's adhering to the proposed protocol or not on children (overall functioning and academic measures) with ADHD and comorbid disorders, and their families. Finally, to test the durability of the intervention, we will reassess the pediatrician's assessment and treatment practices one year after the intervention. ADHD is the most commonly diagnosed mental illness in children and one of the few childhood mental health disorders for which there is an efficacious, short-term treatment (stimulant medications). Thus, it is an ideal candidate for practice and dissemination research (as defined by the NAMHC in Bridging Science and Service, The UNOCCAP Oversight Board report to NAMHC and the NIMH-sponsored "Belmont Report"). However, the spread of efficacy research findings has outpaced the dissemination of informed methods to pediatricians. This knowledge gap has contributed to variable, and often inferior, pediatric ADHD practices in the community. In an effort to move ADHD knowledge from the "the laboratory to daily practice," the American Academy of Pediatrics (AAP) is drafting ADHD Clinical Practice Guidelines. Our intervention presents these guidelines to pediatricians along with a practical procedural manual on the assessment and treatment of ADHD. This proposal involves 100 pediatricians working with 800 children in a cross-sectional design and 200 children in a randomized, 2-year longitudinal study. We will: 1) describe ADHD assessment and treatment procedures of community pediatricians, 2) evaluate the implementation and impact of an intervention designed to enhance adoption of the AAP ADHD guidelines; 3) assess the extent and predictors of adoption of the AAP guidelines by pediatricians; 4) compare the service use and outcomes of children (AAP guidelines versus traditional practice); 5) describe predictors of adherence to treatment; 6) follow children diagnosed with ADHD by the researchers, but not their pediatricians; and finally 7) assess direct and indirect ADHD costs.