title: Telepsychiatrists' Medication Treatment Strategies in the Children's Attention-Deficit/Hyperactivity Disorder Telemental Health Treatment Study.
abstract: The purpose of this study was to examine the prescribing strategies that telepsychiatrists used to provide pharmacologic treatment in the Children's Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS).
  
  
  
  CATTS was a randomized controlled trial that demonstrated the superiority of a telehealth service delivery model for the treatment of ADHD with combined pharmacotherapy and behavior training (n=111), compared with management in primary care augmented with a telepsychiatry consultation (n=112). A diagnosis of ADHD was established with the Computerized Diagnostic Interview Schedule for Children (CDISC), and comorbidity for oppositional defiant disorder (ODD) and anxiety disorders (AD) was established using the CDISC and the Child Behavior Checklist. Telepsychiatrists used the Texas Children's Medication Algorithm Project (TCMAP) for ADHD to guide pharmacotherapy and the treat-to-target model to encourage their assertive medication management to a predetermined goal of 50% reduction in ADHD-related symptoms. We assessed whether telepsychiatrists' decision making about making medication changes was associated with baseline ADHD symptom severity, comorbidity, and attainment of the treat-to-target goal.
  
  
  
  Telepsychiatrists showed high fidelity (91%) to their chosen algorithms in medication management. At the end of the trial, the CATTS intervention showed 46.0% attainment of the treat-to-target goal compared with 13.6% for the augmented primary care condition, and significantly greater attainment of the goal by comorbidity status for the ADHD with one and ADHD with two comorbidities groups. Telepsychiatrists' were more likely to decide to make medication adjustments for youth with higher baseline ADHD severity and the presence of disorders comorbid with ADHD. Multiple mixed methods regression analyses controlling for baseline ADHD severity and comorbidity status indicated that the telepsychiatrists also based their decision making session to session on attainment of the treat-to-target goal.
  
  
  
  Telepsychiatry is an effective service delivery model for providing pharmacotherapy for ADHD, and the CATTS telepsychiatrists showed high fidelity to evidence-based protocols.
authors.affiliation: 1 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Rockhill
authors.affiliation: 2 Department of Education, University of Washington , Seattle, Washington.
authors.forename: Yuet Juhn
authors.initials: YJ
authors.lastname: Tse
authors.affiliation: 3 Child Health, Behavior and Development Center, Seattle Children's Research Institute , Seattle, Washington.
authors.forename: Megan D
authors.initials: MD
authors.lastname: Fesinmeyer
authors.affiliation: 3 Child Health, Behavior and Development Center, Seattle Children's Research Institute , Seattle, Washington.
authors.forename: Jessica
authors.initials: J
authors.lastname: Garcia
authors.affiliation: 1 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.|3 Child Health, Behavior and Development Center, Seattle Children's Research Institute , Seattle, Washington.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Myers
mesh_terms: D000465:Algorithms; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome
keywords: evidence-based telepsychiatry; telemental health; telepsychiatrists’ adherence; telepsychiatry; telepsychiatry for ADHD; telepsychiatry outcomes