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Collaborative care for children with ADHD symptoms: a randomized comparative effectiveness trial.

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Enhanced collaborative care improved outcomes for children with attention-deficit/hyperactivity disorder (ADHD). Interventions addressing engagement and behavior challenges showed significant symptom improvement in children with ADHD presentations.

Keywords:
ADHDbehavioral healthcomparative effectivenessurban health

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Area of Science:

  • Pediatric Mental Health
  • Clinical Psychology
  • Child Psychiatry

Background:

  • Attention-deficit/hyperactivity disorder (ADHD) affects numerous children, with varying responses to care models.
  • Existing ADHD care models often struggle to demonstrate individual-level symptom improvement.
  • Identifying and addressing factors contributing to treatment persistence is crucial for effective ADHD management.

Purpose of the Study:

  • To evaluate if enhanced collaborative care, including interventions for common reasons for symptom persistence, improves outcomes for children with inattention and hyperactivity/impulsivity.
  • To compare the effectiveness of standard collaborative care versus enhanced collaborative care in managing ADHD symptoms.
  • To assess the impact of additional parent-focused techniques on child ADHD symptom trajectories.

Main Methods:

  • A randomized comparative effectiveness trial involving 156 children aged 6-12 years evaluated for ADHD.
  • Participants received either standard care management with decision support or enhanced care management.
  • Enhanced care included training for care managers in motivational interviewing and parent management techniques to address engagement and behavioral challenges.

Main Results:

  • No significant differences in symptom trajectories were observed for the entire sample between the two care arms.
  • Among children with ADHD-consistent presentations, the enhanced care arm showed statistically significant improvements in hyperactivity/impulsivity, oppositionality, and social skills.
  • Specifically, enhanced care led to superior change scores in hyperactivity/impulsivity (-0.36), oppositionality (-0.40), and social skills (9.57) in this subgroup.

Conclusions:

  • Enhanced collaborative care, by addressing barriers to engagement and challenging child behaviors, shows potential to improve treatment effectiveness for children with ADHD.
  • Targeted interventions can augment standard care, leading to better outcomes for specific symptom domains in children with confirmed ADHD presentations.
  • Future research should focus on optimizing these enhanced interventions for broader application in pediatric ADHD care.