H03 – Multiplex ADHD Families in Pediatric Primary Care: Considerations for Screening African American Parents and Children

Summary

Multiplex ADHD families, where both a parent and a child have ADHD, are a common occurrence. Up to 50% of children with ADHD have one parent who also has ADHD. Parent ADHD is associated with worse developmental and treatment outcomes for their children, emphasizing the importance of screening for and treating parent ADHD in the context of treating children with ADHD. Given that child ADHD is often identified and treated in primary care, screening for both parent and child ADHD in primary care may be an effective method of identifying multiplex families. However, it is not standard practice to screen for parent ADHD in pediatric primary care. There is little guidance on how to effectively approach parents about their own ADHD and this topic may be especially challenging among Black families due to historic and continued inequities in care, mistrust of psychology and medicine, and stigma around mental illness and medication. To overcome these obstacles in traditionally underserved populations, innovative and culturally relevant approaches are needed. In this presentation, researchers and providers involved in an ongoing effectiveness-implementation trial for multiplex ADHD families will discuss a novel treatment model implemented in pediatric primary care, clinical and implementation challenges, and lessons learned for treating multiplex ADHD. Our NIH-funded trial is a collaboration between the University of Maryland, Children’s National Hospital, and Seattle Children’s Hospital. We seek to identify multiplex ADHD families in primary care settings and link them to behavioral health care via telehealth. Families are randomized to receive one of two treatment strategies: 1) parent stimulant medication followed by behavioral parent training, and 2) behavioral parent training alone. We will present descriptive data from the Children’s National Hospital site related to recruitment, screening completion, and study enrollment. Youth served by the primary care clinics at Children’s National are predominantly Black or African-American (80%) and 85% are insured by Medicaid. We will also present qualitative findings from stakeholder meetings related to challenges of administering parent ADHD screens in clinics (M = 35% return rate), low screening completion (M = 58% across recruitment strategies), high number of no-shows to appointments (41%), as well as strategies to overcome these challenges. We will discuss strategies to sensitively address the complexities around screening for parent ADHD when working with underserved families and inform how to best treat multiplex ADHD families in primary care.