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)障碍是最常见的心理健康疾病之一 青年和大多数人在初级保健中得到照顾。先前的研究表明，患有多动症的年轻人 比没有多动症的年轻人更能发挥作用。医学研究所强调家庭的重要性 在访问期间的参与。需要易于实施的简单干预措施来吸引青年和 在ADHD儿科就诊期间，父母更多。我们是首批使用问题提示的研究团队之一 与青春同在。我们发现，青少年哮喘问题提示列表/视频干预显著增加 青少年提问和提供者教育。我们还发现，接受干预的年轻人 问他们的提供者问题，在12个月时哮喘控制得到改善的可能性明显更大。 我们建议测试一下，让青少年和家长都能收到ADHD问题提示表，并观看一小段 关于参与ADHD访问的重要性的视频。两个年轻人都有提示单的理由是 和父母探视哮喘不同的是，父母往往会问问题，而年轻人不会，在我们的 以前多动症的工作，很少有青少年或家长提问。然而，年轻人报告的平均年龄为8岁。 关于ADHD和父母的问题平均有8.9个问题。以社会认知理论为指导，我们 建议开展干预的试点随机对照可行性试验。我们将招收140名英语学生-- 年龄在11-17岁之间，有ADHD病历诊断的年轻人，他们被筛查为主要患有 范德比尔特的注意力不集中亚型、多动/冲动亚型或注意力不集中/多动合并亚型 来自三个儿科诊所的评估表。我们将随机抽取这些家庭来回答这两个问题 提示列表和视频(N=35)、仅问题提示列表(N=35)、仅视频(N=35)或日常护理 35例。这将使我们能够了解是否需要视频和问题提示列表部分 更大规模的试验。我们试验的目的将是：(1)检查ADHD问题提示列表和/或前驱 访问视频对建议的干预机制有显著影响。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，接受更多的提供者 在基线和3个月的访问中进行有关ADHD的教育，并且(B)在3和6岁时有较高的自我效能 比平时护理组中的青少年和父母多几个月。(2)调查儿童多动症的成效 通过检查青少年是否在每次干预中列出问题提示列表和/或访问前视频 这些小组在6个月后改善了ADHD症状、学校和社交表现以及生活质量 与常规护理组的患者相比。(3)评估青少年、家长和提供者对 使用ADHD问题提示表和/或访问前的可接受性、可行性、耐受性和安全性 录像。这项试点试验的结果将用于：(A)确定最具潜力的干预措施 (B)确定最佳机制和结果变量，以便在更大规模的试验中进行评估。

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.