Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Massachusetts General Hospital, Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD

Name of Innovative Program: 
Using Text Messaging to Support Parents Manage Their Children’s Attention Deficit Hyperactivity Disorder
Sponsoring Organization
Massachusetts General Hospital, Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD
Name of Innovative Program Lead: 
Mai Uchida, M.D. & Ronna Fried, Ed.D.
E-mail Address of Innovative Program Lead: 
muchida@partners.org
Project Description: 
ADHD is the most common neurobehavioral disorder in children that often negatively affects children’s school performance, interpersonal relationships, mood and self esteem. In addition, many parents have difficulties in managing their children’s conditions. It is well researched that psychostimulant medication is the most effective treatment for ADHD, although adherence to the medication is extremely poor (the non-compliance rate is up to 70%) due to forgetfulness, the complicated nature of stimulant prescriptions, and stigma towards ADHD and medications. Our study will evaluate the utility of personalized text messaging technology to help parents manage their children’s Attention-deficit/hyperactivity disorder (ADHD). Sixty 6-12 year old children with ADHD and their parents will be randomized to two arms. The experimental group will receive personalized text messages that include medication reminders, educational information about ADHD, parental guidance and motivational messages. The non-experimental group will receive treatment as usual. We will monitor their level of ADHD symptoms, academic progress, psychosocial functioning, as well as medication compliance. If this intervention is found useful, the implementation of this would have the capacity to improve the quality of life in many children and their parents considering the high prevalence of ADHD and how widely used text messaging is.
Creativity and Innovation: 
Text messaging intervention has proven effective in the management of chronic medical conditions such as diabetes and HIV, but has yet to be used for ADHD. The personalized text messages are all original and were created based on frequently asked questions from parents of children with ADHD, making this intervention a highly innovative patient centered approach. This intervention could be integrated into standard clinical practice without significantly adding to the cost of treatment or physician time. It is documented that improved management of ADHD and adherence lead to fewer comorbid disorders and decreased risk for substance use. Therefore, adding this intervention to standard practice may also lead to sustained reductions in public health spending for this population. Since text messaging is widely used, this intervention can be widely disseminated to any area with cellular services, leading to better treatment outcomes for children with ADHD irrespective of their geographical location.
Leadership: 
The Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD of the Massachusetts General Hospital (MGH) is a specialized program providing both clinical care and research for the evaluation and treatment of children and adults with psychiatric difficulties. We have conducted two large, longitudinal NIH grants studying ADHD in boys (R01 HD036317) and girls (R01 MH050657) over the lifespan. These are amongst the largest and most comprehensive longitudinal studies of ADHD ever conducted. Our director, Joseph Biederman, M.D., is ranked as the second highest producer of high-impact papers in psychiatry overall throughout the world, and as the highest in terms of total citations to his papers published on ADHD, as determined by the Institute for Scientific Information. We have desseminated our findings through presentations at national and international annuals meetings such as the American Psychiatric Association and World Psychiatric Association, and also in specialized seminars for the public audience.
Sustainability: 
We obtained a grant from American Academy of Child and Adolescent Psychiatry to create the text messages and set up the technology. Our group has successfully completed over 150 clinical trials for ADHD. The successful recruitment and completion of these studies indicates our department’s capacity to ascertain the subjects for the present proposal and complete the study. Our collaborator, the Center for Connected Health at MGH has been a pioneer in the application of text messaging in a variety of medical programs, including a text-messaging program that successfully increased the rate of healthier pregnancies for teens in community health centers. With their collaboration, we believe we will not only be able to successfully complete our proposal, but to continue to improve the quality of our intervention as well as develop similar approaches for other psychiatric disorders.
Replicability: 
Since text messaging technology is highly available, cost effective and easy-to-use, this intervention can be widely replicated in a wide range of geographical locations including areas that have limited access to child psychiatrists. This text messaging intervention has an uncomplicated design, hence it can be extended to adult ADHD as well as other psychiatric disorders by developing the appropriate disease specific content of the text messages. If proven efficacious, we are committed to disseminate this text message intervention through presentations at professional meetings, publications in scientific journals, cross-institutional collaborations, as well as community outreach, so that it can be used internationally and across psychiatric disorders.
Results/Outcomes: 
Participating children will be evaluated by a child psychiatrist at no cost to the family weekly for the first several visits, and then less frequently, similar to the regular treatment schedule. In addition to this, validated and well-known rating scales such as the Child Behavior Check List and the Behavior Rating Inventory of Executive Function will be administered to them, their parents or their teachers. To assess adherence, we will log the calls to the clinician, their showing up for appointments, medication pick-ups and pill counts. We will also use an electronic monitoring system called the RxVitality GlowCaps system. The GlowCaps pill bottle has a radio embedded cap that transmits a signal that notifies us when the participants open their pill bottles. This will allow us to keep track of the accurate timing of their medication intake (which must be approximate to their opening of their pill bottles).
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