This Mentored Patient-Oriented Research Career Development Award (K23) program is designed to develop expertise for becoming an independent investigator in the study of medication continuity in children with Attention-Deficit/Hyperactivity Disorder (ADHD) cared for in primary care settings. This is a critical area because despite the proven efficacy of stimulant medications to reduce ADHD symptoms, many children discontinue treatment, thereby preventing them from realizing the full therapeutic benefits of treatment and this contributes to unnecessary suffering for children and their families. The ultimate goal is to develop the expertise needed to develop evidence-based, personalized interventions to improve medication continuity among children and adolescents with ADHD. The Candidate's strong background of research and clinical training in pediatrics, education, and research provides an excellent foundation for this work. The proposed training goals include enhancing skills in the following areas: 1) biostatistical modeling with longitudinal data;2) adherence measurement;3) design and implementation of interventions for ADHD;4) development of psychological, adherence, and family/self management interventions;5) grant writing and presentation of scientific data. Achieving these training goals is essential to the Candidate's success in transitioning to independence as an investigator who pursues methodologically sound, technically feasible, and innovative approaches to intervention research in this population. The objective of the research plan is to better understand the factors that promote medication continuity in children with ADHD. A prospective, longitudinal cohort of 100 children 6-10 years old started on medicine for ADHD by their primary care doctor. The cohort will be recruited from 21 physicians in 7 practices. We will collect four waves of data over 18 months to address the following specific aims:
Aim 1 : Describe medication continuity in a community-based clinical cohort of children treated for ADHD.
Aim 2 : Identify reasons parents stop and re-start their child's medication treatment.
Aim 3 : Determine relationship between factors that influence family decision making and medication continuity. The Candidate plans to achieve his goal by translating knowledge gained from this study to 1) segment the population at risk for poor medication continuity and, 2) develop personalized interventions that target modifiable factors important to promote medication continuity.

Public Health Relevance

The proposed work is significant because ADHD results in impairment of academic, social, and family functioning. In addition, children with ADHD are at higher risk for injury, and as they reach adolescence are at higher risk for motor vehicle accidents, substance abuse, and risky sexual behavior. Poor medication continuity, therefore, contributes to unnecessary child, adolescent, and family suffering.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Mental Health Services in Non-Specialty Settings (SRNS)
Program Officer
Hill, Lauren D
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Cincinnati Children's Hospital Medical Center
United States
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Brinkman, William B; Simon, John O; Epstein, Jeffery N (2018) Reasons Why Children and Adolescents With Attention-Deficit/Hyperactivity Disorder Stop and Restart Taking Medicine. Acad Pediatr 18:273-280
Al Ghriwati, Nour; Langberg, Joshua M; Gardner, William et al. (2017) Impact of Mental Health Comorbidities on the Community-Based Pediatric Treatment and Outcomes of Children with Attention Deficit Hyperactivity Disorder. J Dev Behav Pediatr 38:20-28
Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca et al. (2017) Specific Components of Pediatricians' Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement. J Am Acad Child Adolesc Psychiatry 56:483-490.e1
Brinkman, William B; Baum, Rebecca; Kelleher, Kelly J et al. (2016) Relationship Between Attention-Deficit/Hyperactivity Disorder Care and Medication Continuity. J Am Acad Child Adolesc Psychiatry 55:289-94
Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca et al. (2016) Impact of a Web-Portal Intervention on Community ADHD Care and Outcomes. Pediatrics 138:
Gordon, Megan K; Baum, Rebecca A; Gardner, William et al. (2016) Comparison of Performance on ADHD Quality of Care Indicators: Practitioner Self-Report Versus Chart Review. J Atten Disord :
Wyatt, Kirk D; List, Betsy; Brinkman, William B et al. (2015) Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis. Acad Pediatr 15:573-83
Lipstein, Ellen A; Brinkman, William B; Fiks, Alexander G et al. (2015) An emerging field of research: challenges in pediatric decision making. Med Decis Making 35:403-8
Brinkman, William B; Epstein, Jeffery N; Auinger, Peggy et al. (2015) Association of attention-deficit/hyperactivity disorder and conduct disorder with early tobacco and alcohol use. Drug Alcohol Depend 147:183-9
Brady, Patrick W; Brinkman, William B; Simmons, Jeffrey M et al. (2014) Oral antibiotics at discharge for children with acute osteomyelitis: a rapid cycle improvement project. BMJ Qual Saf 23:499-507

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