IMPROVING PEDIATRICIANS' USE OF AD/HD GUIDELINES

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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.