Improving Attention Deficit Hyperactivity Disorder Treatment Adherence and Outcome in Primary Care Settings

The most effective treatment for improving the core symptoms of inattention, impulsivity and
hyperactivity in children with attention deficit hyperactivity disorder (ADHD) involves the
use of stimulant medications. Most children with ADHD are treated by pediatricians, but the
treatment provided is often less than optimal. This study is designed to see if training for
pediatricians in following guidelines for management of first-line medicines for ADHD leads
to improvement in child behavior, and whether the physicians can adhere to the guidelines.

Over 100 studies have shown that stimulant medications are effective for improving the core
symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Approximately 70% of children
who receive ADHD medications are treated by their primary care pediatrician, but studies
show that management is not always optimal. The present study is designed to see if child
behavior can be improved by training pediatricians in the use of guidelines for treating
ADHD, and whether the physicians can adhere to the guidelines. Twenty-four pediatric
practices were randomized to a treatment as usual or specialized care (receiving training in
guidelines and computer assisted monitoring of patient progress and medication titration).
Children are assessed with parent and teacher reports at baseline, 4-, 9-, and 12-months
post initiation of treatment, and classroom observations of behavior are assessed at
baseline, 6-, and 12-months. Approximately 400 children are to be enrolled.

Inclusion Criteria:

- Presence of ADHD

- Not currently on medication

Exclusion Criteria:

- No serious neurological disorders of sever mental health problems (suicidal behavior,
autism)