Effectiveness of a Telehealth Service Delivery Model for Treating Attention-Deficit/Hyperactivity Disorder: A Community-Based Randomized Controlled Trial

Abstract

Objective To test the effectiveness of a telehealth service delivery model for the treatment of children with attention-deficit/hyperactivity disorder (ADHD) that provided pharmacological treatment and caregiver behavior training. Method The Children’s ADHD Telemental Health Treatment Study (CATTS) was a randomized controlled trial with 223 children referred by 88 primary care providers (PCPs) in 7 communities. Children randomized to the experimental telehealth service model received 6 sessions over 22 weeks of combined pharmacotherapy, delivered by child psychiatrists through videoconferencing, and caregiver behavior training, provided in person by community therapists who were supervised remotely. Children randomized to the control service delivery model received treatment with their PCPs augmented with a telepsychiatry consultation. Outcomes were diagnostic criteria for ADHD and oppositional defiant disorder (ODD) and role performance on the Vanderbilt ADHD Rating Scale (VADRS) completed by caregivers (VADRS-Caregivers) and teachers (VADRS-Teachers) and impairment on the Columbia Impairment Scale-Parent Version (CIS-P). Measures were completed at 5 assessments over 25 weeks. Results Children in both service models improved. Children assigned to the telehealth service model improved significantly more than children in the augmented primary care arm for VADRS-Caregiver criteria for inattention (χ2[4]=19.47, p<.001), hyperactivity (χ2[4]=11.91, p=0.02), combined ADHD (χ2[4]=14.90, p=0.005), ODD (χ2[4]=10.05, p=0.04), and VADRS-Caregiver role performance (χ2 [4]=12.40, p=0.01) and CIS-P impairment (χ2[4]=20.52, p<.001). For the VADRS-Teacher diagnostic criteria, children in the telehealth service model had significantly more improvement in hyperactivity (χ2[4]=11.28, p=0.02) and combined ADHD (χ2[4]=9.72, p=0.045). Conclusion The CATTS trial demonstrated the effectiveness of a telehealth service model to treat ADHD in communities with limited access to specialty mental health services. Clinical trial registration information Children’s Attention Deficit Disorder With Hyperactivity (ADHD) Telemental Health Treatment Study; http://clinicaltrials.gov; NCT00830700.

Teletherapy Delivery of Caregiver Behavior Training for Children with Attention-Deficit Hyperactivity Disorder

“…Children and caregivers described in the current study consisted of 37 of the 223 participants in the Children's ADHD Telemental Health Treatment Study (CATTS). The methodology [22][23][24] and outcomes 25 for the CATTS trial have been described elsewhere and are briefly summarized.…”

“…24,25 Participants included boys and girls, 5.5-12 years old, living with their legal guardians, attending school, and referred to the trial by their primary care providers in seven underserved communities in the Pacific Northwest. Children's primary caregivers were also participants.…”

Attention-deficit/hyperactivity disorder (ADHD): from randomised controlled trials to evidence-based clinical services

“…In fact, very few randomised pragmatic trials have been carried out to gain insight into the most effective ways to deliver care to individuals with ADHD. Among these, it is worthy to cite here a community-based trial showing the effectiveness of a telehealth service model to manage ADHD in communities with limited access to specialised mental health care provision (Myers et al 2015) and a cluster randomised trial showing that collaborative consultative services, based on the promotion of collaboration between community-based practitioners and mental health professionals, are effective to improve clinical outcomes related to ADHD (Epstein et al 2007).…”

New Frontiers in Healthcare and Technology: Internet-and Web-Based Mental Options Emerge to Complement In-Person and Telepsychiatric Care Options

“…Moderate intensity models include an integrated program of MH screening, therapy on site, and telepsychiatric consultation (phone, email or video), with continuing medical education (CME) and training on screening questionnaires [103,104] or asynchronous telepsychiatry (ATP) to primary care in English and Spanish-speaking patients in primary care [18,98,99]. High intensity models are typically the ones previously mentioned involving collaborative care [105][106][107].…”

“…Moderate intensity models include an integrated program of MH screening, therapy on site, and telepsychiatric consultation (phone, email or video), with continuing medical education (CME) and training on screening questionnaires [103,104] or asynchronous telepsychiatry (ATP) to primary care in English and Spanish-speaking patients in primary care [18,98,99]. High intensity models are typically the ones previously mentioned involving collaborative care [105][106][107].Improved access at a distance to rarely available standard treatments: Rapid eye movements are part of the Eye Movement Desensitization and Reprocessing approach typically used for treatment of a patients suffering from an acute stress disorder. However, experts who provide uncommon treatments may be difficult to find in one's community, which is why a videoconference mediated treatment has been tested with promising results [108].…”