HealthDay News — A family-centered, compassionate care approach may be more effective for pediatric patients with attention-deficit/hyperactivity disorder compared with usual care, results of a study published in Pediatrics suggest.

“Although many attention-deficit/hyperactivity disorder (ADHD) care models have been studied, few have demonstrated individual-level symptom improvement,” wrote Michael Silverstein, MD, MPH, of the Boston University School of Medicine, and colleagues.

To test whether complementing basic collaborative care with interventions that address common reasons for symptom persistence improves outcomes with children with inattention and hyperactivity/impulsivity, the investigators conducted a randomized comparative effectiveness trial.

The children who were enrolled in the study had not been diagnosed with ADHD (n=156) but were recommended for testing by their primary-care providers .The patients, aged 6 to 12 years, were randomized to receive usual care or usual care plus enhanced collaborative support. For enhanced collaborative care, the care managers received several days of training to teach parents healthy parenting skills and interact with families in an open-minded, non-judgmental, empathetic way.

Ultimately, 40% of the study participants were found to have ADHD symptoms that would qualify for a diagnosis.

After one year, the children as a whole showed improvements in hyperactivity, impulsivity, inattention, and social skills. Significantly greater improvements in all these areas occurred among the children who had symptoms that would qualify for an ADHD diagnosis and received enhanced collaborative care — but not among those who received collaborative care but did not end up having symptoms that would qualify for an ADHD diagnosis.

The enhanced collaborative approach tested by the researchers attempted to mitigate factors that may inhibit a child’s ability to receive a successful treatment. These factors included difficulty adhering to the therapy (for economic, family, or other reasons); a mother’s mental health problems; and other conditions the child has, such as oppositional defiance disorder, depression, anxiety, learning disabilities, or even post-traumatic stress disorder.

“Among children with ADHD-consistent presentations, addressing barriers to engagement with care and challenging child behaviors has potential to improve the effectiveness of collaborative care,” concluded the researchers.


  1. Silverstein M et al. Pediatrics. 2015; doi: 10.1542/peds.2014-3221