Communication to Improve Shared Decision-Making in ADHD

Fragmentation in health care and poor communication across systems adversely impact
engagement and adherence to treatment by children with ADHD and their families. Fragmentation
of services for ADHD impairs communication and collaboration between families and primary
care providers, mental health providers, and educators, and leads to suboptimal outcomes for
children. Prior studies have documented that little communication and coordination exist
among providers across different systems despite calls for better system integration.

Fragmentation in communication between providers has the potential to impair shared
decision-making. To promote shared decision-making, we have developed an electronic health
record (EHR)-linked portal to collect information from parents, teachers and clinicians on
children's ADHD symptoms and treatment-related preferences and goals. We have also developed
an ADHD Care Manager intervention manual.

Approximately 300 participants will be enrolled for this study. Participants will be randomly
assigned to use either the EHR portal alone, or the EHR portal plus a Care Manager. For those
assigned to the EHR portal plus Care Manager, the Care Manager will meet with families at the
beginning of the study to confirm their treatment preferences and goals, provide additional
education on ADHD treatment, and distribute handouts on common concerns among ADHD patients
and families. The Care Manager will contact families weekly to every 3 months by phone,
email, or in-person as needed to assess treatment use, identify new concerns, and assist
families with problem-solving. Using the portal or other means, the Care Manager will also
communicate with pediatric clinicians, mental health providers, and teachers to clarify
family treatment preferences and goals and address emerging treatment issues. Participants
will complete surveys that will assess ADHD symptoms, goal attainment, patient-reported
outcomes, patient and family engagement and treatment initiation and adherence.

Inclusion Criteria:

- Aged 5 through12 years old

- Receiving Attention-Deficit/Hyperactivity Disorder (ADHD) treatment from participating
practices

- ADHD or Attention Deficit Disorder (ADD) diagnosis code, International Classification
of Diseases (ICD) code ICD-10-CM F90.9 or F90.0, listed in the problem list or
recorded at an ambulatory visit in the past year.

- Parental/guardian permission (informed consent) and if appropriate, child assent.

Exclusion Criteria:

- Autism spectrum disorder, ICD-10-CM F84.0

- Conduct disorder, ICD-10-CM F91.1

- Psychosis, ICD-10-CM F29

- Bipolar disorder, ICD-10-CM F31.9

- Suicide attempt, ICD-10-CM T14.91, or suicide ideation, ICD-10-CM R45.85

- Children and/or their parents/caregivers are non-English speaking