It takes a village to care for attention-deficit/hyperactivity disorder: Improving management collaboration between tertiary care centers and the community

Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood neuro-developmental complaint presenting to clinicians in primary care. ADHD is a chronic, serious cognitive and behavior disorder, which is characterized by heterogeneity, ambiguity, and high comorbidity, and thus cannot lend itself to a universal treatment package. Because no single intervention is optimally effective, the literature supports a multimodal approach which would ideally have available comprehensive services, including medical, mental health, education, social services, and community resources. In 2000, the American Academy of Pediatrics developed evidence based clinical practice guidelines for the diagnosis and evaluation of school-aged children with ADHD in primary care settings. However, research on the implementation of the AAP guidelines by primary care practitioners revealed that they encounter multiple barriers in the management of ADHD, including limited knowledge and experience in managing ADHD, lack of time, financial constraints, and poor communication with education professionals and mental health clinicians. This chapter reviews the aims and challenges in providing adequate care for children with ADHD and their families in primary care settings. Further, an alternative, multidisciplinary care model is proposed, which highlights the importance of specialized services provided at a tertiary care level. Ideally, this model should adopt principles of care for chronic conditions, such as family-centered system of care, shared decision-making and ongoing education to primary care providers. Such a solution would allow sharing resources and expertise between service providers and thus could ensure not only a professional, shortened process of diagnosis and treatment but also a patient-centered intervention that would take into account individuals' needs and preferences.