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Attention-deficit/hyperactivity disorder (ADHD) is a treatable pediatric condition, but children with racial-ethnic minority backgrounds often do not receive timely or consistent treatment. Understanding how systemic racism impacts care and learning from families of color about their experiences can provide critical insights for improving clinical practice and engaging patients equitably in ADHD care. We interweave a mother's experience navigating ADHD care for her son with commentary from an interprofessional team about what clinicians can do for families to reduce the impact of systemic racism on care. [Pediatr Ann. 2025;54(1):e12–e17.] [ABSTRACT FROM AUTHOR]

The article highlights a study that the children from socioeconomically disadvantaged backgrounds with neurodevelopmental disabilities such as attention-deficit/hyperactivity disorder (ADHD) may experience even more dramatic hardship during the Covid-19 pandemic. It discusses that most parents reported increased caregiver burden, worse child ADHD symptoms, increased screen time, difficulty with remote school, and more unmet basic needs during the pandemic.

Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) disproportionately affects socioeconomically disadvantaged children, but for unclear reasons. We examined the association between social determinants of health (SDH) and ADHD symptoms in a national sample of preschool-age children. Methods: We conducted exploratory factor analysis (EFA) and exploratory structural equation modeling (ESEM) with a sample of 7,565 preschool-age children from the 2016 National Survey of Children's Health, to examine the association between ADHD symptoms and SDH. Results: EFA indicated a one-factor structure for ADHD symptoms, and three factors for SDH (socioeconomic status, access to basic needs, and caregiver well-being). Independently, all three SDH were significantly associated with higher ADHD symptoms. However, in the ESEM model, only worse caregiver well-being (β =.39, p <.01) was significantly associated with ADHD symptoms, and fully mediated the relationship between SDH and ADHD symptoms. Conclusion: Addressing caregiver well-being in preschoolers with ADHD symptoms could be an early intervention strategy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in children. Although ADHD is treatable, barriers remain to engagement in treatment, especially among socioeconomically disadvantaged and racial and ethnic minority families. Our goal was to examine the process by which families engage in ADHD treatment and to identify targets for an intervention to improve engagement in care. METHODS: We conducted in-depth semistructured qualitative interviews with 41 parents of diverse youth aged 3 to 17 years old in treatment of ADHD at an urban safety net hospital. Parents were asked about their journey through diagnosis and treatment, community attitudes about ADHD, and other factors influencing treatment access and decision-making. Transcripts were analyzed by using thematic analysis. RESULTS: Of children with ADHD, 69.2% were male, 57.7% were Black or African American, and 38.5% were of Hispanic, Latino, or Spanish origin. Parents were 92.7% female, were 75.6% English speaking, and had a median income of $20 000. Parents described 6 stages to the process of engaging in care for their child's ADHD, which unfolded like a developmental process: (1) normalization and hesitation, (2) fear and stigmatization, (3) action and advocacy, (4) communication and navigation, (5) care and validation, and (6) preparation and transition. Barriers often occurred at points of stage mismatch between parents and providers and/or systems. Difficulty resolving an earlier stage interfered with the progression through subsequent stages. CONCLUSIONS: The 6 stages framework could be used to develop new strategies to measure engagement and to design family-centered interventions to facilitate engagement in ADHD treatment. [ABSTRACT FROM AUTHOR]

Over 50% of young adults (defined as individuals aged 18-25 years) with substance use disorders (SUDs) have at least 1 co-occurring psychiatric disorder, and the presence of cooccurring disorders worsens SUD outcomes. Treatment of both co-occurring psychiatric disorders and SUDs in young adults is imperative for optimal treatment, yet many barriers exist to achieving this goal. We present a series of evidence-informed principles of care for young adults with co-occurring psychiatric disorders derived by a workgroup of experts convened by Boston Medical Center's Grayken Center for Addiction. The 3 principles are as follows: (1) young adults should receive integrated mental health and addiction care across treatment settings; (2) care should be responsive to the needs of young adults exposed to trauma and other adverse childhood experiences; and (3) treatment programs should regularly assess and respond to the evolving mental health needs, motivations, and treatment goals of young adults with co-occurring disorders. Our guidance for each principle is followed by a review of the evidence supporting that principle, as well as practice considerations for implementation. More research among young adults is critical to identify effective treatments and service systems for those with co-occurring disorders. [ABSTRACT FROM AUTHOR]

Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. The literature was systematically searched for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. Studies reporting on the following implementation outcomes were included: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. This search identified 34 unique studies, including randomized controlled trials, observational studies, and survey/mixed method approaches. Components facilitating implementation of on-site integrated behavioural healthcare included interprofessional communication and collaboration at all stages of implementation; clear protocols to facilitate intervention delivery; and co-employment of integrated care providers by specialty clinics. Some studies found differences in service use by demographic factors, and others reported funding challenges affecting sustainability, warranting further study. [ABSTRACT FROM AUTHOR]

We tested the accuracy of 2 parent-report tools, the Pediatric Symptom Checklist (PSC-35) and Child Behavior Checklist (CBCL), to identify attention-deficit/hyperactivity disorder (ADHD) and distinguish complex (highly comorbid) cases in an urban, largely Latino pediatric practice. Spanish- and English-speaking parents of children aged 6 to 10 years completed a PSC-35 and CBCL at well visits. Those with CBCL Attention Problems Subscale (CBCL-APS) T scores ≥60 plus controls completed the diagnostic MINI-KID (Miniature International Neuropsychiatric Interview) for Children. Receiver operating characteristic (ROC) curves quantified accuracy of both scales to distinguish ADHD from non-ADHD, and complex from simple ADHD. Two hundred and nine children were screened, and 41 completed diagnostic interviews. Both the CBCL-APS and PSC Attention Scale (PSC-AS) accurately identified ADHD; the CBCL-APS performed best (AUROCCBCL_APS = 0.837; AUROCPSC_AS = 0.728). The PSC Total and Internalizing Scores and the number of CBCL subscale elevations accurately distinguished complex from simple ADHD; the PSC Internalizing Score performed best (AUROCPSC_TOTAL = 0.700; AUROCPSC_INT = 0.817; AUROCCBCL_SUBS = 0.762). [ABSTRACT FROM AUTHOR]

This study examined whether being scheduled in a screening clinic versus scheduled directly with a long-term provider to conduct a mental health intake (MHI) is associated with engagement in child psychiatry services in New England, USA.We used electronic medical record data from one safety-net hospital serving a predominantly low-income and minoritised population. The study sample included 815 youths aged 0 to 25 years, referred or scheduled for a MHI between 1 January 2016 and 31 December 2016. We used chi-square and t-tests to examine the association between referral pathways and engagement, logistic regression to understand the relationship between youth’s socio-demographic characteristics and referral pathways, and logistic and Poisson regressions to assess potential moderating effects of socio-demographic characteristics on engagement.The mean age of the study population was 12 years; 46% were female, and the majority had public health insurance (84%) and lived in high social vulnerability areas (65%). Less than half of the youth attended the first scheduled MHI visit. Those scheduled with the screening clinic were less likely than those scheduled with the provider to ever attend a MHI appointment. Spanish-speakers were more likely to be directly scheduled with a provider (Odds Ratio, OR 0.48; 95% CI: 0.32, 0.73), while those with public health insurance were more likely to be scheduled with the screening clinic (OR 0.56; 95% CI: 0.43, 0.96). Spanish-speaking status and areas social vulnerability scores moderated the relationship between the referral pathway and engagement in psychiatric appointments.The study highlights the need for psychiatric services to evaluate how MHI referral procedures may mitigate barriers to care and facilitate engagement for youth at high risk of not attending psychiatric service appointments. [ABSTRACT FROM AUTHOR]

Pediatric mental and behavioral health disorders are a growing public health concern with immediate and long-term impacts for children, families, and society. Pediatricians are uniquely positioned, but often inadequately trained, to identify and address childhood mental and behavioral health needs. Two major learning domains were identified for a 2-week rotation in senior year: 1) screening, diagnosis, and treatment of depression, anxiety, and ADHD in outpatient pediatric settings; and 2) evaluation, de-escalation, and triage of children in acute mental health crises. Residents participate in repeated sessions in integrated behavioral health clinics, conduct screenings with social workers, perform intakes supervised by a child psychiatrist, and evaluate patients with acute mental health concerns in the emergency department with child psychiatrists, in the community with Boston Emergency Services Team, and in inpatient settings with the hospital's Behavioral Response Team. Self-directed learning activities provide individualized experiences tailored to residents' interests. By random selection, half of senior residents will participate in the rotation during its first year. All senior residents were invited to complete a baseline survey at the beginning of the year evaluating their satisfaction with their behavioral health training thus far. Fourteen of 29 (48%) eligible seniors completed the baseline assessment, showing that residents were least satisfied with their training in titrating/initiating medications to treat depression and anxiety, and most satisfied with their training in agitation management (Figure). Thus far, 11 senior residents have participated in the rotation. Many senior residents have received limited training in behavioral and mental health competencies. We developed a novel 2-week rotation that leverages hands-on experiences with child psychiatrists, social workers, and crisis response teams, as well as individualized self-directed learning, which we will follow-up with surveys to assess efficacy as our next steps. [ABSTRACT FROM AUTHOR]

Introduction: Screening to promote social-emotional well-being in toddlers has positive effects on long-term health and functioning. Communication about social-emotional well-being can be challenging for primary care clinicians for various reasons including lack of time, training and expertise, resource constraints, and cognitive burden. Therefore, we explored clinicians' perspectives on identifying and communicating with caregivers about social-emotional risk in toddlers. Method: In 2021, semistructured interviews were conducted with pediatric clinicians (N = 20) practicing in Federally Qualified Health Centers in a single metropolitan area. Most participants identified as female (n = 15; 75%), white non-Hispanic/Latino (n = 14; 70%), and were Doctors of Medicine or Osteopathic Medicine (n = 14; 70%). Thematic analysis was conducted on audio-recorded interview transcripts. Results: Clinicians used various approaches to identify social-emotional concerns which were sometimes difficult to distinguish from other developmental concerns. The clinician–caregiver relationship guided identification and communication practices and cut-across themes. Themes include: starting with caregivers' concerns, communicating concerns with data and sensitivity, navigating labels, culture, and stigma, and limiting communication based on family capacity and interest. Discussion: Prioritizing the clinician–caregiver relationship is consistent with best practice and family-centered care. Yet, the dearth of standardized decision support may undermine clinician confidence and impede timely conversations about social-emotional concerns. An evidence-based approach with developmentally based culturally informed quantitative tools and standardized decision supports could help ensure equitable management and decision making about young children's social and emotional well-being and development. Public Significance Statement: The public significance of our study is the identification of clinician communication practices that may support or impede early and equitable identification of social-emotional risk. [ABSTRACT FROM AUTHOR]