Related Experiment Video
Updated: Apr 15, 2026
The Adventures of Fundi Intervention Based on the Cognitive and Emotional Processing in Attention Deficit Hyperactive Disorder Patients
Published on: June 12, 2020
Collaborative care for children with ADHD symptoms: a randomized comparative effectiveness trial
Michael Silverstein1, L Kari Hironaka2, Heather J Walter3
1Departments of Pediatrics, and michael.silverstein@bmc.org.
Insights
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.
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.
Objectives:
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.
More Related Videos
13:09Using Brain Activation nir-HEG/Q-EEG and Execution Measures CPTs in a ADHD Assessment Protocol
Published on: April 1, 2018
10:02Event Related Potentials ERPs and other EEG Based Methods for Extracting Biomarkers of Brain Dysfunction: Examples from Pediatric Attention Deficit/Hyperactivity Disorder ADHD
Published on: March 12, 2020
Related Concept Videos
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....
01:26Modeling in Therapy
Participant Modeling
Participant modeling involves therapists demonstrating calm and effective behaviors in...
01:28Drug Therapy
Antianxiety Medications
01:19Autism Spectrum Disorder
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.
01:30Adrenergic Agonists: Therapeutic Uses
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
01:30Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...