9.4 CHALLENGES AND CONSIDERATIONS FOR SCREENING FOR PARENT ADHD IN PEDIATRIC PRIMARY CARE

Abstract

ADHD is common in both parents and children, yet African American families are less likely to be diagnosed or treated, or to participate in clinical trials. Parent ADHD can significantly impact child development and treatment response. Most children receive primary care annually, presenting an opportunity to screen for ADHD in children and parents. Although pediatric providers are familiar with screening and managing ADHD in children, there is little guidance on how to effectively approach parents about their own ADHD. The current qualitative study describes challenges encountered and lessons learned when implementing a parent ADHD screening protocol in primary care serving a large population of African American youth and families. The study occurred within the context of a hybrid effectiveness-implementation trial treating parents and children with ADHD with parental stimulant medication and behavioral parent training. To guide study implementation, a stakeholder advisory group was formed including pediatricians, behavioral health providers, clinic staff, and parents with ADHD or with a child with ADHD. Meetings were held before and during the study to seek feedback from stakeholders regarding factors that may influence recruitment and implementation of the treatment trial. Two meetings were held with 9 stakeholders during June and November 2020. Meetings were recorded, transcribed, coded, and analyzed for themes. Stakeholder members were predominantly female (89%) and White (44%). Thematic analyses identified 6 themes: 1) centering Black people’s experiences with mental health care; 2) the value of integrating parent mental health with child mental health care; 3) sensitivity required when talking about parent mental health; 4) attention to medication hesitation; 5) effective vs ineffective strategies to identify parent mental health; and 6) structural barriers for screening parent ADHD in pediatric primary care. Findings provide suggestions (eg, describing symptoms vs using clinical labels, having conversations initiated by trusted providers) for pediatricians on how to engage parents effectively and sensitively in discussions about their own ADHD in the context of working with underserved multiplex families in primary care.