Discontinuation of medication is a significant but preventable problem for children with attention deficit hyperactivity disorder (ADHD). This leads to the re-emergence of ADHD symptoms previously controlled by medication and increases the likelihood of negative outcomes. Interventions are available to improve ADHD care delivered in primary care settings, but no current intervention effectively targets ADHD medication continuity. The overall objective of this application is to develop and test new technologies to deliver a multi- component intervention to enable families to actively partner with practice teams to optimize medication effectiveness and maintain child medication continuity. Heterogeneous barriers to medication continuity have been identified. Indeed, different families have different needs at different times. The intervention will include evidence- and theory-based components to address three pervasive barriers: 1) Parents are poorly prepared for and involved in the process of optimizing medication, 2) Parents are poorly engaged in setting, tracking, and achieving explicit treatment goals, and 3) Parents are poorly supported in ADHD management activities by their social networks. These targets constitute a core foundation of family-management behaviors that are common to many chronic conditions. A user centered design process will be employed to design and optimize the prototype intervention to be highly usable, acceptable, and valuable in meeting parent and physician needs and promoting productive parent-physician interactions. The optimized intervention will be tested in a pilot cluster randomized controlled trial to evaluate the general effectiveness of the intervention (e.g. enhanced myADHDportal.com), compared to control (e.g. treatment as usual standard portal), on mediation continuity as measured by prescription records and other more proximal outcomes during the first six months of treatment. The new multi-component intervention will be embedded in a web-based intervention entitled myADHDportal.com which is currently used by over 300 clinicians and 13,000 families nationwide. MyADHDportal.com enables health care providers to systematically improve ADHD care in primary care practices. It facilitates provider monitoring of child response to treatment through collection, scoring, and graphing of parent and teacher reports of ADHD symptoms, impairment, and side effects over time. It also promotes productive communication between providers, parents, and teachers through a secure messaging function. Despite this intervention's efficacy at improving provider ADHD care behaviors (Epstein et al. 2011), child medication discontinuity continues to be a problem (i.e., chart audits revealed coverage of only 41% of days with medicine). Thus, there is an opportunity to expand this successful platform with new features specifically designed to engage and equip parents with the knowledge, skills, and tools needed to be successful maintaining continuity of medication treatment.
We expect to produce an optimized intervention that provides comprehensive family-management support to enable parents to take an active role in structured activities to maximize medication effectiveness and maintain child medication continuity. This innovative intervention could revolutionize the way families and clinicians work together to care for chronic conditions such as ADHD. An efficacious intervention platform could be adapted for use among parents of children with other chronic conditions and thereby has a tremendous potential public health impact.