Angelika H. Claussen

Objective: Coordination between healthcare providers and schools may improve ADHD diagnosis and treatment but is often insufficient. This descriptive survey study examined factors associated with provider coordination with schools. Method: Data were from child-serving U.S. primary care providers who completed the Porter Novelli Fall 2023 DocStyles ADHD survey module ( n = 1,047); grouped into three levels of school coordination: (1) no school communication; (2) use school information without direct coordination; or (3) school intervention coordination. Level of coordination was compared by provider and practice characteristics, barriers to diagnosis and treatment, and training needs. Result: Among providers, 20.5% offered no school communication, 55.8% used school information without direct coordination, and 23.7% offered school intervention coordination. Pediatricians least often reported no school communication; nurse practitioners most often reported school intervention coordination. Multiple factors were significantly associated with level of school coordination ( p < .046–.001). Barriers to ADHD care such as provider lack of knowledge and training needs, and family resistance to evaluation, worries about stigma, and treatment access were most common among providers offering school intervention coordination. Provider lack of comfort with ADHD evaluation and inadequate training post-degree was most common for providers offering no communication; providers who used school information most often reported not needing more ADHD training. Conclusion: Findings highlight opportunities to improve school coordination by addressing barriers to ADHD care. Efforts to increase training and reduce barriers may benefit from differentiation between providers who need foundational knowledge about ADHD care and those who offer school coordination and seek advanced training and support.

Objective: The American Academy of Pediatrics (AAP) recommends behavioral therapy as first-line evidence-based treatment for young children with ADHD, and in combination with medications for children ages 6 years and older. However, a significant percentage of young children are receiving medication treatment for ADHD rather than behavioral treatment. There is limited research capturing parent experiences of barriers to implementing behavioral health services for young children with ADHD diagnoses. This paper seeks to fill this gap by exploring these perceived barriers among parents of children diagnosed with ADHD. Method: Parents of children with ADHD diagnoses ( N = 29) were invited to participate in four focus groups to discuss their experiences with accessing treatment for their child. Focus group participants were recruited from one Southeast city through an ADHD parental support group and nationally from parents attending a conference on ADHD. Results: Three themes emerged as perceived barriers that impact ADHD treatment. Parents reported barriers that can be conceptualized as (1) misconceptions and stigma; (2) availability of financial and time-related resources; and (3) treatment messaging and provider coordination. These barriers may be more pronounced for parents of young children with ADHD living in the Southeast. Conclusion: Parent responses about perceived barriers in this study suggest a need for better coordinated care of ADHD across places of service, providers, and families. These findings may inform future efforts to improve access to and utilization of evidence-based treatments for ADHD in the Southeast and nationwide.

Objective: ADHD is a commonly diagnosed neurodevelopmental disorder in the U.S., with symptoms including hyperactivity, inattention, and impulsivity. These symptoms can lead to increased engagement in unhealthy behaviors. The current study examined the associations between health risk factors and ADHD among a community-based sample of 345 students (4th–12th grade) by ADHD alone or with co-occurring disorders, ADHD medication use, and ADHD symptom count. Distinct from prior studies, our analysis also examined associations among pairs of health risk factors by ADHD diagnostic criteria. Method: Data came from the Replication Project to Learn About Youth—Mental Health, using a two-stage design, incorporating teacher, parent, and student reported data. Result: Students with ADHD experienced a higher prevalence of not using a bike helmet (prevalence ratio [PR] = 1.17, 95% confidence interval [CI] [1.01, 1.35]), being bullied, threatened, or feeling unsafe at school (PR = 1.83, 95% CI [1.02, 3.30]) carrying a weapon (PR = 7.02, 95% CI [2.58, 19.08]), and feeling sad or hopeless within the past 2 weeks (PR = 2.74, 95% CI [1.01, 7.47]) compared to those with no disorder. Students with ADHD exhibited different risk associations compared to those with no disorder, specifically for interpersonal violence risk. Medication treatment for ADHD was not associated with fewer health risks, except that students taking ADHD medication were less likely to skip breakfast (PR = 0.40, 95% CI [0.20, 0.78]) compared to those without ADHD. Higher ADHD symptom counts were associated with elevated television screen time, stimulant medication misuse, physical fight involvement, and carrying a weapon ( p < .05). Conclusion: Evaluating participation in health risk factors and developing tailored interventions may benefit youth with ADHD, regardless of treatment status.

Objective: Promoting health during adolescence can support long-term well-being, especially for teens diagnosed with attention-deficit/hyperactivity disorder (ADHD), who face increased risks due to the disorder's impact on development and health behaviors. ADHD is often associated with difficulties in social interactions, a higher likelihood of bullying involvement, and co-occurring mental health conditions. These factors may also be influenced by health factors such as physical activity, sleep quality, and screen time usage. Nationally representative teen self-reports provide a novel perspective on ADHD-related health outcomes compared with relying on parent reports. Method: We used nationally representative data from the National Health Interview Survey (NHIS) and NHIS-Teen from July 2021 to December 2022, to examine teen-reported health and well-being factors, stratified by parent-reported ADHD diagnoses among teens aged 12 to 17 years. Weighted prevalence estimates and adjusted prevalence ratios (aPR) adjusting for teen age, sex, and family income, all with 95% confidence intervals (CIs), were calculated. Results: Just over 10% of teens had ADHD and they reported higher prevalence of bullying victimization (aPR = 1.64, CI = 1.27–2.11), difficulties making friends (aPR = 1.83, CI = 1.15–2.90), difficulty getting out of bed (aPR = 1.29, CI = 1.02–1.64), irregular wake times (aPR = 2.17, CI = 1.45–3.25), and >4 hours daily screen time (aPR = 1.26, CI = 1.05–1.52) than teens without ADHD; teens with ADHD reported a lower prevalence of lacking peer support (aPR = 0.70, CI = 0.51–0.96). Conclusion: Teens with ADHD face distinct challenges related to social-emotional well-being and health behaviors that support overall wellness. Findings may inform opportunities for health promotion among teens with ADHD.

We reviewed the available evidence on psychosocial treatments for disruptive behaviors in children, as an update to Kaminski and Claussen (2017), focusing on children up to age 12 years. Search strategies, study inclusion, and treatment classification followed the procedures developed by Southam-Gerow and Prinstein (2014). Of the 44 included studies from 2016 to 2021, only 9 impacted previous results, either by increasing the level of evidence (for two treatment families) or documenting evidence for a new treatment family (four new treatment families). All three treatment families classified as Level 1: Well Established are parent-focused and now include Group parent behavior therapy + group child behavior therapy (previously classified as Probably Efficacious), in addition to Group parent behavior therapy and Individual parent behavior therapy with child participation (already classified as Well Established). Fifteen treatment families were classified as Level 2: Probably Efficacious, eight were classified as Level 3: Possibly Efficacious. Given the variability of programs in each treatment family, the evidence is for the overall treatment approach and may not apply to each program with those characteristics. Data were insufficient to examine outcomes in relation to participant characteristics. The information can be used to improve dissemination, implementation, and uptake of effective treatment, and inform research on improving access barriers.

Objective: Young children with attention-deficit/hyperactivity disorder (ADHD) can have challenging behaviors putting them at risk for preschool expulsion and for adverse outcomes across child development, health, and education. We examined the association of preschool expulsion with ADHD symptoms, diagnosis, treatment, and functioning among children with ADHD. Methods: Using the cross-sectional National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome on 2947 children aged 5 to 17 years ever diagnosed with ADHD, parents reported on preschool expulsion, ADHD symptoms, diagnosis, treatment, and functioning. Weighted analyses included calculations of estimated means, prevalence, and prevalence ratios. Results: Preschool expulsion was experienced by 4.4% of children ever diagnosed with ADHD (girls: 1.5%; boys: 5.7%). Children with preschool expulsion had lower mean ages at first concern about ADHD symptoms, ADHD diagnosis, and initiation of ADHD medication and had higher prevalence of severe ADHD symptoms and other mental, behavioral, or developmental disorders. A history of preschool expulsion was associated with difficulties with overall school performance, organized activities, writing, handwriting, and the parent-child relationship, but not with math, reading, or peer or sibling relationships. Children with preschool expulsion more often received school supports, behavioral classroom management, peer intervention, and social skills training. Conclusion: Among children ever diagnosed with ADHD, history of preschool expulsion was associated with more severe ADHD symptoms, other disorders, earlier diagnosis and medication initiation, and academic and social impairment. Health care providers can use preschool expulsion as an indicator of risk for children with ADHD and connect families to effective treatments.

Objective: To characterize provider types delivering outpatient care overall and through telehealth to U.S. adults with ADHD. Method: Using employer-sponsored insurance (ESI) and Medicaid claims, we identified enrollees aged 18 to 64 years who received outpatient care for ADHD in 2021. Billing provider codes were used to tabulate the percentage of enrollees receiving ADHD care from 10 provider types overall and through telehealth. Results: Family practice physicians, psychiatrists, and nurse practitioners/psychiatric nurses were the most common providers for adults with ESI, although the distribution of provider types varied across states. Lower percentages of adults with Medicaid received ADHD care from physicians. Approximately half of adults receiving outpatient ADHD care received ADHD care by telehealth. Conclusion: Results may inform the development of clinical guidelines for adult ADHD and identify audiences for guideline dissemination and education planning.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study’s conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child’s likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children’s long-term developmental health.