Research Horizons


Free Tool Helps Providers Implement New ADHD Guidelines

A web-based technology that helps pediatricians, parents and educators improve the quality of care for Attention-Deficit/Hyperactivity Disorder (ADHD), is being offered for free to pediatric primary care practices nationwide by Cincinnati Children’s Hospital Medical Center. This technology has the potential to help providers implement the American Academy of Pediatrics’ (AAP) recently released and updated ADHD clinical practice guideline.

The rollout of this quality improvement technology, which is now recruiting pediatricians across the U.S., is funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health.  NIMH awarded Cincinnati Children’s a four-year $2.8 million grant to support the initiative, which focuses on accelerating improved patient outcomes at community-based and other practices where delivery of evidence-based ADHD care can be challenging, according to Jeffery Epstein, PhD, a pediatric psychologist and director of the Center for ADHD at Cincinnati Children’s.

Research shows that many pediatric practices carry heavy caseloads, and staff members struggle to coordinate care for complex behavioral conditions like ADHD.  At the same time, the number of diagnosed cases of ADHD continues to increase, further straining practice resources. This makes it more difficult for pediatricians to stay current with updated American Academy of Pediatrics (AAP) care guideline for ADHD published on Sept 30 <link>.

Epstein is part of the team of pediatricians, behavioral specialists and computer technology experts that developed the technology platform called “mehealth for ADHD.”  A 2016 study published in the journal Pediatrics reported when tested at 50 community based pediatrics practices involving 199 physicians and 577 children with ADHD, the mehealth for ADHD technology resulted in improved ADHD medication care and significantly better behavioral improvement in patients.  Since that study was published, the mehealth system has been expanded and improved by adding functions allowing parents and teachers to develop and implement behavioral treatments.

“We already know it works to help pediatricians fine-tune their ADHD treatment regimens to achieve better symptom control for their patients within a shorter timeframe,” Epstein said. “Our focus now is to make this evidence-based intervention available nationwide where it can do the most good—improving the outcomes of millions of children throughout the country.”

Helping Epstein lead the ADHD rollout are: William B. Brinkman, MD, MEd, MSc, director of General and Community Pediatrics at Cincinnati Children’s, and Tanya E. Froehlich, MD, MS, FAAP,  director of research for Developmental and Behavioral Pediatrics at Cincinnati Children’s .

Addressing a Common Condition

ADHD is one of the most common childhood disorders and can continue through adolescence and into adulthood, according to NIMH. Symptoms include difficulty staying focused, paying attention, difficulty controlling behavior, and hyperactivity.

The easy-to-access online “mehealth” technology portal uses standard Vanderbilt behavioral rating scales for children with ADHD. It allows parents, teachers and others involved in a child’s care to offer behavioral assessments online according to schedules that are customized by the child’s pediatrician.

The information helps support a physician’s selection of behavioral medications, appropriate dosing and testing of other interventions. The information is then analyzed by computer algorithms in the portal technology to gauge the relative effectiveness of the care regimen by looking at how treatment affects outcomes.

Making Care Effective and Sustainable

During the grant and technology rollout’s first year, Epstein and his colleagues will be working with participating practices and an advisory committee of parents, educators and caregivers to find ways to enhance the portal’s financial sustainability, as well as its effectiveness. Through the current NIH grant, the team is able to offer the mehealth technology to pediatricians free of charge until 2021.  The ultimate goal, Epstein said, is to offer the ADHD care portal at no cost to pediatricians or families in perpetuity.

The American Academy of Pediatrics included mehealth in a six-state quality improvement project that saw marked improvements in the return rate of Vanderbilt scales and a 12% reduction in total symptom scores for patients with ADHD in the project. Note: the AAP does not endorse specific tools, but rather encourages pediatricians to use a tool that meets the needs of their practice.

Cincinnati Children’s Hospital Medical Center encourages pediatricians to sign up to use the mehealth for ADHD web portal at