Potential Significance:
There are presently very limited clinical resources for children with ADHD, a prevalent
disorder associated with significant functional impairments across different domains. Given
the large number of affected children and their families, and the lack of readily available
resources, very long wait-lists exist delaying access to healthcare. This is especially
important given that ADHD occurs during a critical period of child development. Despite that
effective treatments for ADHD do exist, it is quite challenging to deliver timely
interventions to children with ADHD. This study aims to assess the efficacy of an innovative
collaborative care approach that significantly improves access to evidence based health
services and builds capacity in the community. Given that public healthcare services in Dubai
are open to all emirates in the UAE and that some specialized services are lacking in other
emirates, such a program that utilizes a virtual platform will facilitate healthcare access
to this group of children in remote areas. After providing evidence for its feasibility and
efficacy, this approach is likely to then be implemented across Dubai's Health Authority and
to become a model that can be implemented nationally and regionally.
This study will significantly enhance the capacity of primary care physicians in Dubai, UAE
to provide clinical care for children with common mental health conditions, namely ADHD.
Enhancing the capacity of the Primary care sector to assess and treat this disorder in
collaboration with the center of excellence at Al Jalila Children's is expected to improve
access to clinical care while assuring optimal care is provided.
Moreover, it will improve the expertise of the center of excellence in child mental health at
Al Jalila children's through clinical and research collaboration with Boston Children's
Hospital. This study might open the doors for future collaborations with international
institute such Boston Children's which will result in improved pediatric care at Al Jalila
Children's. After providing evidence for its feasibility and efficacy, this approach is
likely to then be implemented across Dubai's Health Authority and to become a model that can
be implemented nationally and regionally.
Methods:
An individually randomized controlled trial with 2 equal groups will be conducted. Children
aged 6-12 years who are referred to their primary care provider for an ADHD assessment and
meet inclusion criteria will be randomized to intervention and control arms.
The intervention will consist of treatment of children with ADHD by physicians trained by
study staff on the assessment and treatment of ADHD. This training will be delivered over two
stages:
In stage (1), prior to any clinical interaction with patients, physicians will attend an
on-site clinical training that includes didactic teaching on ADHD including reviewing
clinical guidelines and hands-on assessment and treatment of children with ADHD presenting to
the tertiary care hospital (minimum of 35 hours). Drs. Albanna and Hamoda will deliver this
training. Participants will be expected to successfully complete two PDM exam stations
(Phenomenology, Diagnosis and Management). These PDM stations will be developed by AA and HH
and will not include real patients. This educational intervention will be delivered prior to
any interaction between pediatricians and patients, and only those pediatricians that
successfully complete the course will participate in the collaborative-care arm of the study.
In stage (2) of the training program, an ongoing module will be developed by Drs. Albanna and
Hamoda using a virtual-classroom setup. This will include monthly live online presentations
presented by Drs. Albanna and Hamoda as well as invited guest speakers for select topic, that
Drs. Albanna and Hamoda will moderate. This intends to discuss advanced topics and challenges
that may be facing the clinicians involved in the study. The research coordinator will assure
that the technical setup is prepared for the seminars. There will be a total of 8
presentations, and the duration will be 1 and half hours for each presentation. The topics
will focus on various advanced aspects of managing ADHD in primary healthcare.
Pre-presentation reading material will be emailed to the attendees along with details
regarding the time and topic of the presentation. They will be asked to log-on 15 minutes
prior and the last 30 minutes will be dedicated to discussions and questions relevant to the
topic. Every presentation will be followed by 10 MCQs prepared by the presenter. Participants
will also have weekly supervision meetings via video-conferencing. Randomization will occur
when children with suspected ADHD present to PHCs participating in this study. Children will
be randomly referred to one of these two study arms:
Arm (1): Children in this arm will received a collaborative mental health model of care by
physicians who underwent the training above. Children and their families will be assessed and
managed by these physicians, at the same primary care center they present at, using
international guidelines. In line with the collaborative care model, physicians in this arm
will have weekly supervision meetings via video-conferencing with specialists from the study
team. Case management will be provided via trained allied professional or nurse. Case
management will entail assuring that patients present on time for scheduled assessment and
follow-ups and that questionnaires are completed and handed on time.
Arm (2): The children randomized to control arm will receive treatment as usual. This
primarily consists of referral to specialized mental health services at Al Jalila Children's.
They will receive assessment and management by specialists in this tertiary care center.