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Mehealth for ADHD™ Background

Established consensus guidelines for ADHD care exist but can be challenging to implement in typical community-based pediatric practices. With a mission to improve the quality of ADHD care in the tri-state region, Cincinnati Children’s Hospital Medical Center (CCHMC) developed a program called the ADHD Collaborative to promote guideline adoption among local community pediatricians. The program focused on providing provider education and modifying the office system using quality improvement (QI) methods to facilitate guideline adherence. The ADHD Collaborative was very successful at improving ADHD care, [1] and sustaining these practice behaviors over time at minimal cost to the project and to the office practice. [2] Unfortunately, the methods used in the ADHD Collaborative (i.e., didactic trainings, office-based training visits, providing QI tools, monitoring through chart review) were not amenable to spreading the intervention nationally.

To bring the powerful methods used in the Cincinnati ADHD Collaborative to pediatricians around the county, a team of clinical investigators at CCHMC developed the mehealth for ADHD on-line tool with input from pediatrician-, parent-, and teacher- stakeholders. mehealth for ADHD integrates quality improvement methods with clinical utility that is specifically designed for use in community-based pediatric settings. mehealth for ADHD has been tested in two separate randomized controlled trials (RCT). Both RCTs showed dramatic improvements in the ADHD care quality at practices using mehealth for ADHD compared to control practices providing typical care. [3,4] Moreover, our most recent clinical trial demonstrated that children treated with ADHD medications at practices using mehealth for ADHD had significantly greater ADHD symptom reductions than children treated at control practices. [4]

In partnership with the American Academy of Pediatrics Chapter Quality Network, the mehealth for ADHD tool was initially spread using 6 state AAP chapters. Now, the CCHMC team has NIH funding to study how technology-based practice improvement tools such as mehealth for ADHD can be used to improve clinical care nationally. The goal is to recruit ~5,000 community-based pediatricians to adopt the mehealth for ADHD tool and to research how practice-, pediatrician-, and patient-level sociodemographic factors relate to reach, adoption, implementation, and maintenance of use.
  1. Epstein, J.N., Langberg, J.M., Lichtenstein, P.K., Mainwaring, B.A., Luzader, C.P., & Stark, L.J. (2008) A community-wide intervention to improve the ADHD assessment and treatment practices of community physicians. Pediatrics, 122(1):19-27. doi: 10.1542/peds.2007-2704. PMID: 18595982.
  2. Epstein, J.N., Langberg, J.M., Lichtenstein, P.K., Kolb, R., & Stark, L.J. (2010). Sustained improvement in pediatrician’s ADHD practice behaviors in the context of a community-based quality improvement initiative. Children’s Health Care, 39, 296-311.
  3. Epstein, J.N., Langberg, J.M., Lichtenstein, P.K., Kolb, R., Altaye, M. & Simon, J.O. (2011). Use of a web portal to improve community-based pediatric ADHD care: A cluster randomized trial. Pediatrics, 128(5), e1201-e1208. doi: 10.1542/peds.2011-0872. Epub 2011 Oct 17. PMID: 22007005; PMCID: PMC3208964.
  4. Epstein, J.N., Kelleher, K.J., Baum, R., Brinkman, W.B., Peugh, J., Gardner, W., Lichtenstein, P., & Langberg, J.M., (2016). Impact of a web-portal intervention on community ADHD care and outcomes. Pediatrics, e20154240. DOI: 10.1542/peds.2015-4240; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960725/

Mehealth for ADHD Team:


Jeff Epstein, Ph.D. is an Endowed Chair and Professor of Pediatrics in the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center / University of Cincinnati. A licensed psychologist whose research and clinical work focuses on the diagnosis and treatment of ADHD, Dr. Epstein is Founder and Director of the Cincinnati Children’s Center for ADHD. The Center for ADHD is one of the largest centers in the country devoted entirely to improving the care of children and adolescents with ADHD, offering individual patient diagnostic and treatment services, ground-breaking therapy groups to address behavioral and academic issues, and a state-of-the-art ADHD summer treatment program. The Center for ADHD is also one of the leading ADHD research centers in the nation, with the team currently working on more than 12 federally funded research studies as well as multiple studies with alternative funding sources, primarily focusing on developing new and innovative ways to understand, evaluate and treat ADHD. Dr. Epstein’s research on ADHD has been continuously funded by the NIH for over two decades. He has published over 130 research articles related to ADHD, many of which focus on promoting evidence-based ADHD care in community settings.


William B. Brinkman, MD, MEd, MSc, is the Carl Weihl Professor of Pediatrics and Director of the Division of General & Community Pediatrics. Dr. Brinkman leads a diverse, talented, multidisciplinary team who share a passion and commitment to transform the delivery of primary care and improve population health through exceptional clinical programs, high-impact clinical and translational research, innovative educational programs, and effective academic and community partnerships


Caitlyn Clark, BA, is research coordinator at Cincinnati Children’s Center for ADHD for an NIH-funded R01 aimed at the nationwide dissemination of mehealth for ADHD to improve the quality of ADHD care among community-based pediatricians. Caitlyn is also program coordinator for Cincinnati Children’s Summer Treatment Program (STP), an evidence-based summer program for children with ADHD, founded in 1980 by William E. Pelham, Jr., Ph.D.


Tanya Froehlich, MD, MS, is a developmental-behavioral pediatrician and an ADHD clinical specialist and researcher. She is a member of the Board of Directors for the Society for Developmental and Behavioral Pediatrics and for the American Professional Society of ADHD and Related Disorders who strives to improve ADHD care in numerous ways. Dr. Froehlich currently serves on national ADHD clinical practice guideline development committees for both the American Academy of Pediatrics and the Society for Developmental and Behavioral Pediatrics. She co-chaired the committee which developed the American Board of Pediatrics ADHD-related Part 2 Maintenance of Certification module. In addition, Dr. Froehlich has provided consultation to the Centers for Disease Control and the U.S. Office of the Inspector General regarding ADHD care, research needs, and clinical considerations. Furthermore, she has provided continuing medical education seminars and workshops on ADHD care at regional, national, and international conferences.

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