Improving ADHD Behavioral Care Quality in Community-Based Pediatric Settings

项目摘要/摘要 尽管治疗儿童注意缺陷多动障碍(ADHD)的最有效方法是 结合药物和行为策略，绝大多数患有ADHD的儿童都得到了 仅限药物治疗。虽然有效，但药物主要针对ADHD症状，通常几乎没有作用 对与ADHD相关的功能障碍领域的影响，如学业成绩低下、社交障碍 关系，并扰乱了家庭功能。行为治疗率低的原因之一是 初级保健儿科医生，而不是精神健康专业人员，负责治疗绝大多数 患有多动症的儿童。我们已经开发、测试并开始分发基于Web的软件 (www.myadhdportal.com)，这已经在改善ADHD质量的随机临床试验中得到证明 由儿科医生提供的药物治疗。然而，当前的软件功能完全限于 药物管理。拟议研究的目标是开发和测试行为整合 将工具纳入基于证据的myadhdportal.com软件，以改善获得行为治疗的机会 战略，并最终改善ADHD儿童的结局。自动算法和决策 我们将为创建和监控行为工具开发的规则将确保行为治疗，如 每日成绩单和代币经济以与证据基础一致的方式交付。 最初，我们将使用一个 以利益相关者为中心的迭代设计方法，由此将从所有利益相关者获得反馈(即， 家长、教师和儿科医生)在开发这些行为工具之前、期间和之后。接下来，我们 我将通过可用性研究和焦点等定性方法来评估该软件的可接受性 具有用户的组。最后，我们将在社区儿科环境中进行一项整群随机对照试验 要测试将行为工具集成到myADHDportal.com软件中(1)是否会增加 行为治疗；(2)在实施时促进行为干预的更好完整性；(3)改善 ADHD儿童的功能障碍；以及(4)对ADHD护理产生更高的满意度。通过 为了继续扩展myADHDportal.com软件的功能，我们正在增加患者的访问权限 以证据为基础的护理。这对于农村和服务不足的社区来说尤其关键，这些社区没有或 获得循证精神卫生服务的机会有限。此外，通过将这些行为工具放入 在父母、老师和儿科医生的帮助下，我们正在使孩子们更有可能获得 包括药物管理和行为策略的护理质量，从而改善 ADHD儿童的总体治疗结果。

Project Summary/Abstract Though the most effective treatment for children with Attention Deficit Hyperactivity Disorder (ADHD) consists of combined medication and behavioral strategies, the vast majority of children with ADHD are treated with medication only. While effective, medication primarily targets ADHD symptoms and typically has little to no impact on ADHD-related areas of functional impairment such as academic underachievement, impaired social relationships, and disrupted family functioning. One reason for the low rates of behavioral treatment is that primary care pediatricians, not mental health professionals, are responsible for treating the vast majority of children with ADHD. We have developed, tested, and are beginning to disseminate web-based software (www.myadhdportal.com) that has been shown in randomized clinical trials to improve the quality of ADHD medication care delivered by pediatricians. However, the current software functionality is limited entirely to medication management. The goal of the proposed study is to develop and test the integration of behavioral tools into the evidence-based myadhdportal.com software in order to improve access to behavioral treatment strategies, and ultimately improve outcomes for children with ADHD. The automated algorithms and decision rules we will develop for creating and monitoring the behavioral tools will ensure that behavioral treatments like daily report cards and token economies are delivered in a manner that is consistent with the evidence-base. Initially, we will design, build, and integrate behavioral tools into the myADHDportal.com software using an iterative stakeholder-centered design approach whereby feedback will be obtained from all stakeholders (i.e., parents, teacher, and pediatricians) before, during, and after development of these behavioral tools. Next, we will assess the acceptability of this software through qualitative methods such as usability studies and focus groups with users. Finally, we will conduct a cluster randomized controlled trial in community pediatric settings to test whether integration of the behavioral tools into the myADHDportal.com software (1) increases rates of behavioral treatment; (2) facilitates better integrity of behavioral interventions when implemented; (3) improves functional impairment in children with ADHD; and (4) generates higher satisfaction with ADHD care. By continuing to expand the functionality of the myADHDportal.com software, we are increasing patients' access to evidence-based care. This is especially critical for rural and underserved communities who have no or limited access to evidence-based mental health services. Moreover, by putting these behavioral tools in the hands of parents, teachers, and pediatricians, we are making it more likely that children will receive a high quality of care that includes both medication management and behavioral strategies, thereby improving the overall treatment outcomes of children with ADHD.