title: Collaborative care for children with ADHD symptoms: a randomized comparative effectiveness trial.
abstract: OBJECTIVE
  Although many attention-deficit/hyperactivity disorder (ADHD) care models have been studied, few have demonstrated individual-level symptom improvement. We sought to test whether complementing basic collaborative care with interventions that address common reasons for symptom persistence improves outcomes for children with inattention and hyperactivity/impulsivity.
  
  
  METHODS
  We conducted a randomized comparative effectiveness trial of 2 care management systems for 6- to 12-year-old children being evaluated for ADHD (n = 156). All participants received care management with decision support. Care managers in the enhanced care arm also were trained in motivational and parent management techniques to help parents engage in their child's treatment, address their own mental health needs, and manage challenging child behaviors. We used multivariable models to assess inattention, hyperactivity/impulsivity, oppositionality, and social skills over 1 year.
  
  
  RESULTS
  Both treatment arms generated guideline concordant diagnostic processes in 94% of cases; 40% of children had presentations consistent with ADHD. For the entire sample, there were no differences in symptom trajectories between study arms; mean differences in change scores at 12 months were -0.14 (95% confidence interval -0.34 to 0.07) for inattention; -0.13 (-0.31 to 0.05) for hyperactivity/impulsivity; -0.09 (-0.28 to 0.11) for oppositionality; and 3.30 (-1.23 to 7.82) for social skills. Among children with ADHD-consistent presentations, enhanced arm participants experienced superior change scores for hyperactivity/impulsivity of -0.36 (-0.69 to -0.03), oppositionality -0.40 (-0.75 to -0.05), and social skills 9.57 (1.85 to 17.28).
  
  
  CONCLUSIONS
  Among children with ADHD-consistent presentations, addressing barriers to engagement with care and challenging child behaviors has potential to improve the effectiveness of collaborative care.
authors: Departments of Pediatrics, and michael.silverstein@bmc.org.
authors: Michael
authors: M
authors: Silverstein
authors: Departments of Pediatrics, and.
authors: L Kari
authors: LK
authors: Hironaka
authors: Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts; and.
authors: Heather J
authors: HJ
authors: Walter
authors: Departments of Pediatrics, and Departments of Community Health Sciences, and.
authors: Emily
authors: E
authors: Feinberg
authors: Departments of Pediatrics, and.
authors: Jenna
authors: J
authors: Sandler
authors: Departments of Pediatrics, and.
authors: Michelle
authors: M
authors: Pellicer
authors: Departments of Pediatrics, and.
authors: Ning
authors: N
authors: Chen
authors: Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
authors: Howard
authors: H
authors: Cabral
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy; D001900:Boston; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy; D057186:Comparative Effectiveness Research; D003299:Cooperative Behavior; D003661:Decision Support Techniques; D004505:Education, Nonprofessional; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D062405:Motivational Interviewing; D010346:Patient Care Management / Q000379:methods*
chemical_list: D000697:Central Nervous System Stimulants
keywords: ADHD; behavioral health; comparative effectiveness; urban health