Improving the outcomes of adolescents with ADHD via a pre-visit question prompt list/video intervention: a randomized controlled feasibility trial

摘要 注意力缺陷/多动（ADHD）障碍是最普遍的心理健康状况之一， 青年和大多数人在初级保健中得到照顾。先前的研究表明，患有ADHD的青少年 没有ADHD的年轻人。医学研究所强调家庭的重要性 访问期间的互动。需要采取易于实施的简单干预措施， 更多的注意力缺陷多动症儿童就诊时。我们是最早使用问题提示的研究团队之一 与青春的名单我们发现一个青少年哮喘问题提示列表/视频干预显著增加 青年提问和提供教育。我们还发现，接受干预的年轻人， 在12个月时，询问他们的提供者的问题更有可能改善哮喘控制。 我们建议让青少年和父母都收到一份ADHD问题提示列表，并观看一个简短的 关于参与ADHD访问的重要性的视频。为青年和青年提供快速名单的理由是， 与哮喘患者就诊时父母倾向于提问而年轻人不提问相反， 以前的ADHD工作，很少有青少年或家长提出问题。然而，年轻人报告说， 关于ADHD和父母的问题平均为8.9个问题。以社会认知理论为指导， 建议对干预措施进行随机对照可行性试验。我们将招收140名英语- 年龄在11 - 17岁的患有ADHD医疗记录诊断的年轻人， 范德比尔特上的注意力不集中亚型、多动/冲动亚型或注意力不集中/多动综合亚型 三个儿科诊所的评估量表。我们将随机分配家庭， 提示列表和视频（N = 35）、仅问题提示列表（N = 35）、仅视频（N = 35）或常规护理 （N = 35）。这将使我们能够了解是否需要视频和问题提示列表部分， 更大的审判。我们的试验的目的是：（1）检查ADHD问题提示是否列出和/或预- 访问视频显着影响的干预机制的建议。我们将调查是否 每个干预组的青少年和家长：（a）问更多的问题，得到更多的提供者 在基线和3个月访视期间接受关于ADHD的教育，并且（B）在3和6个月时具有更高的自我效能 月比青少年和父母在通常的照顾组。(2)为了调查ADHD的有效性 问题提示列表和/或访视前视频，检查青少年在每次干预中是否 在6个月时，两组儿童的ADHD症状、学校和社会表现以及生活质量都有所改善。 与普通护理组相比。(3)评估青少年、家长和提供者对 使用ADHD问题提示列表和/或预访视的可接受性、可行性、耐受性和安全性 视频.这项试点试验的结果将用于：（a）确定具有最大潜力的干预组 影响和（B）确定最佳机制和结果变量，以在更大的试验中进行评估。

Abstract Attention-deficit/hyperactivity (ADHD) disorder is one of the most prevalent mental health conditions among youth and the majority are cared for in primary care. Prior work indicates that youth with ADHD have poorer functioning than youth without ADHD. The Institute of Medicine emphasizes the importance of family engagement during visits. Simple interventions that are easy to implement are needed to engage youth and parents more during ADHD pediatric visits. We were one of the first research teams to use question prompt lists with youth. We found that a youth asthma question prompt list/video intervention significantly increased youth question-asking and provider education. We also found that youth who received the intervention and asked their providers questions were significantly more likely to have improved asthma control at 12 months. We propose to test having both youth and parents receive an ADHD question prompt list and watch a short video on the importance of being involved in ADHD visits. The rationale for having prompt lists for both youth and parents is that in contrast to asthma visits where parents tended to ask questions and youth did not, in our prior ADHD work, very few youth or parents asked questions. Yet, youth reported having an average of 8 questions about ADHD and parents an average of 8.9 questions. Using Social Cognitive Theory as a guide, we propose to conduct a pilot randomized controlled feasibility trial of the intervention. We will enroll 140 English- speaking youth ages 11-17 with an ADHD medical record diagnosis who screen as having predominantly inattentive subtype, hyperactive/impulsive subtype, or combined inattention/hyperactivity on the Vanderbilt assessment scale from three pediatric clinics. We will randomize the families to receive both the question prompt lists and video (N=35), just the question prompt lists (N=35), just the video (N=35), or usual care (N=35). This will allow us to understand whether both the video and question prompt list parts are needed in the larger trial. The aims of our trial will be: (1) To examine whether the ADHD question prompt lists and/or pre- visit video significantly impact the proposed mechanisms of the intervention. We will investigate whether adolescents and parents in each of the intervention groups: (a) ask more questions and receive more provider education about ADHD during their baseline and 3 month visits and (b) have higher self-efficacy at 3 and 6 months than adolescents and parents in the usual care group. (2) To investigate the effectiveness of the ADHD question prompt lists and/or the pre-visit video by examining whether adolescents in each of the intervention groups have improved ADHD symptoms, school and social performance, and quality-of-life at 6 months compared to those in the usual care group. (3) Assess adolescent, parent, and provider feedback on the acceptability, feasibility, tolerability, and safety of using the ADHD question prompt lists and/or the pre-visit video. The results from this pilot trial will be used to: (a) identify the intervention arm with the greatest potential impact and (b) determine the best mechanisms and outcome variables to assess in a larger trial.