ADHD Care Coordination: What Does an Effective, Efficient Treatment Team Look Like?
Beyond medication and behavioral therapy, children with ADHD need a well-coordinated treatment team comprising parents, clinicians, teachers, and more. Here’s what a strong, effective team looks like, and how care coordination benefits more than just the patient.
Attention deficit hyperactivity disorder (ADHD) is a chronic, lifelong condition that calls for ongoing monitoring and management of symptoms — at the minimum. Especially for children, effective ADHD treatment means forging common goals and true partnerships shared by key members of the child’s treatment team — an essential body emphasized in the American Academy of Pediatrics’ latest guidelines for ADHD.1
But what does powerful care coordination look like? And who should be included in a child’s ADHD treatment team? Apart from the primary clinician, a robust care team includes parents, teachers, school staff, behavioral health practitioners, and other treatment professionals.
The Core Members of an ADHD Treatment Team
The child’s primary clinician assists in the diagnosis and care of the child, and is typically one of the following:
- Family medicine physician
- Nurse practitioner
- Physician Assistant
The primary clinician is the team leader. They will use medical knowledge, experience, and established standards of care to provide parents with the best treatment options. This means educating parents on the symptoms and criteria that lead to an ADHD diagnosis, and the ways symptoms can best be managed. Communication with families, furthermore, should reach beyond office visits.
ADHD treatment can include medication, as well as individual and/or family therapy. Stimulant medications like Adderall, Concerta, and Ritalin are first-line treatment, followed by non-stimulants like Intuniv and Kapvay. In children younger than 6, however, behavioral therapy is the first recommended treatment, though it’s often used as a complement to medication in older children.
Many primary clinicians today have adopted a family- or child-centered “medical home” approach, where parents and children are treated as full partners. This model, known as the primary care medical home (PCMH), can include care conferences that bring together clinicians, educators, behavioral health professionals, and others. PCMH certification is available for practices that follow this philosophy.
PCMH or not, clinicians should work with parents to develop a management plan with specific, targeted goals for the child. Some of the goals will come from the doctor, and some from teachers as well, but parents are the ones who know the child’s needs most intimately.
Behavioral and Mental Health Practitioners/Therapists
Psychosocial treatments for children and adolescents with ADHD are effective, especially in younger children. The team members who carry out behavioral therapy and training interventions teach parents and even school personnel how to respond to problems (like interruptions, aggressions, oppositional behavior) and help improve the child’s behavior.
Apart from introducing behavioral interventions, therapists can also help children develop coping skills to succeed in various settings and aspects of life. From teaching emotional regulation to time-management skills, these professionals are invested in a child’s real-life function and well-being. Often, the therapist or practitioner spends more time with the child than does the primary doctor, making them key in communicating updates to the team between appointments.
Parents are a child’s biggest advocates. They know their child best, and are much more accurate reporters of ADHD symptoms than are children, especially younger ones who find it difficult to articulate their difficulties). Therefore, it’s essential that parents share the details of their child’s behavior, challenges, and treatment with other members of the ADHD team.
Parents should have a clear understanding of ADHD, and how that manifests in children. Clinicians can guide and inform parents, but learning must take place outside of the doctor’s office. Parents seek out factual information about ADHD from trusted, medical sources. Keeping an open dialogue with doctors and other team members on the facts is essential.
Teachers and School Administrators
Often overlooked, educators are incredibly valuable members of a child’s ADHD treatment and care team.
Teachers are on the frontline and see children in action in the classroom and in other school activities. Many of a child’s challenges typically occur in this space, so teacher observations are essential to clinicians during the evaluation and diagnosis process, and should be heeded by parents, too.
Teachers also provide invaluable feedback to clinicians and parents about any treatment’s success or failure. For example, a child’s ADHD care may include an IEP or a 504 plan, which is carried out and observed by the teacher and school. Behavioral interventions may also be teacher-administered.
Expanding the Team?
Aside from these core members of a child’s ADHD treatment team, who else may positively contribute? Many others. If a child plays a sport, the team coach may benefit from basic information on the child’s ADHD diagnosis, and what is currently being done to manage and minimize symptoms. Care also comes in many forms, so long as the child’s interests are in mind. An ADHD coach, for example, may be a great fit for an older child or adolescent.
1 Wolraich, M. Hagan, J., et.al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics Oct. 2019, 144 (4) e20192528; DOI: 10.1542/peds.2019-2528
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Updated on October 27, 2020