Skip to main content

Partnership in the Treatment of Childhood Mental Health Problems: A Pediatric Perspective

Abstract

Pediatricians understand their role as promoting both the physical and mental health of children from birth until adulthood. Within the context of this long-term relationship, parents approach clinicians to address a full range of behavioral concerns ranging from variations of normal development to major mental illness. In this commentary that builds upon the earlier manuscripts in this collection, we explore the pediatrician’s role in mental health care through the example of attention-deficit hyperactivity disorder (ADHD). ADHD is an ideal prototype for the exploration of partnership in mental health care because ADHD is the most common neurobehavioral disorder in childhood, it is commonly treated in primary care settings, multiple evidence-based treatments exist, personal values strongly influence the acceptability of treatment, treatment adherence is often poor, and effective treatment relies on the collaboration of pediatricians with families, schools, and the mental health system. Through the use of the Chronic Care Model for Child Health that emphasizes the importance of optimizing and coordinating systems of care for effective partnership, the following manuscript reviews the challenges and opportunities for pediatricians partnering with families and schools to address mental health problems. Strategies highlighted in the preceding papers are discussed within the context of this model.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  • Achenbach, T. M., Bird, H. R., Canino, G., Phares, V., Gould, M. S., & Rubio-Stipec, M. (1990). Epidemiological comparisons of Puerto Rican and U.S. mainland children: Parent, teacher, and self-reports. Journal of the American Academy of Child and Adolescent Psychiatry, 29(1), 84–93.

    Article  PubMed  Google Scholar 

  • Alderfer, M. A., & Hodges, J. (2010). Supporting siblings of children with cancer: A need for family-school partnerships. School Mental Health. doi:10.1007/s12310-010-9027-4.

  • American Academy of Pediatrics. (2000). Clinical practice guideline: Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics, 105(5), 1158–1170.

    Article  Google Scholar 

  • American Academy of Pediatrics. (2001). Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics, 108(4), 1033–1044.

    Article  Google Scholar 

  • Antonelli, R. C., & Antonelli, D. M. (2004). Providing a medical home: The cost of care coordination services in a community-based, general pediatric practice. Pediatrics, 113(5), 1522–1528.

    PubMed  Google Scholar 

  • Barry, M. J. (2002). Health decision aids to facilitate shared decision making in office practice. Annals of Internal Medicine, 136(2), 127–135.

    PubMed  Google Scholar 

  • Bates, D. W., Kuperman, G. J., Wang, S., Gandhi, T., Kittler, A., Volk, L., et al. (2003). Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality. Journal of the American Medical Informatics Association, 10(6), 523–530.

    Article  PubMed  Google Scholar 

  • Biondich, P. G., Downs, S. M., Anand, V., & Carroll, A. E. (2005). Automating the recognition and prioritization of needed preventive services: Early results from the CHICA system. AMIA Annual Symposium of Proceedings, 51–55.

  • Brinkman, W. B., Sherman, S. N., Zmitrovich, A. R., Visscher, M. O., Crosby, L. E., Phelan, K. J., et al. (2009). Parental angst making and revisiting decisions about treatment of Attention-Deficit/Hyperactivity Disorder. Pediatrics, 124(2), 580–589.

    Article  PubMed  Google Scholar 

  • Bussing, R., Gary, F. A., Mills, T. L., & Wilson Garvan, C. (2003). Parental explanatory models of ADHD: Gender and cultural variations. Social Psychiatry and Psychiatric Epidemiology, 38(10), 563–575.

    Article  PubMed  Google Scholar 

  • Bussing, R., Schoenberg, N. E., & Perwien, A. R. (1998). Knowledge and information about ADHD: Evidence of cultural differences among African-American and white parents. Social Science and Medicine, 46(7), 919–928.

    Article  PubMed  Google Scholar 

  • Cegala, D. J., Marinelli, T., & Post, D. (2000). The effects of patient communication skills training on compliance. Archives of Family Medicine, 9(1), 57–64.

    Article  PubMed  Google Scholar 

  • Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science and Medicine, 44(5), 681–692.

    Article  PubMed  Google Scholar 

  • Charles, C., Gafni, A., & Whelan, T. (1999). Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model. Social Science and Medicine, 49(5), 651–661.

    Article  PubMed  Google Scholar 

  • Committee on Children With Disabilities. (1999). Care coordination: Integrating health and related systems of care for children with special health care needs. Pediatrics, 104(4), 978–981.

    Article  Google Scholar 

  • Committee on Psychosocial Aspects of Child, Family Health, Task Force on Mental Health. (2009). The future of pediatrics: Mental health competencies for pediatric primary care. Pediatrics, 124(1), 410–421.

    Article  Google Scholar 

  • Committee on School Health. (2004). School-based mental health services. Pediatrics, 113(6), 1839–1845.

    Article  Google Scholar 

  • Crijnen, A. A. M., Achenbach, T. M., & Verhulst, F. C. (1999). Problems reported by parents of children in multiple cultures: The child behavior checklist syndrome constructs. American Journal of Psychiatry, 156(4), 569–574.

    PubMed  Google Scholar 

  • dosReis, S., Butz, A., Lipkin, P., Anixt, J., Weiner, C., & Chernoff, R. (2006). Attitudes about stimulant medication for Attention-Deficit/Hyperactivity Disorder among African American families in an inner city community. The Journal of Behavioral Health Services and Research, 33(4), 423–430.

    Article  Google Scholar 

  • dosReis, S., Zito, J. M., Safer, D. J., Soeken, K. L., Mitchell, J. W., Jr., & Ellwood, L. C. (2003). Parental perceptions and satisfaction with stimulant medication for attention-deficit hyperactivity disorder. Journal of Developmental and Behavioral Pediatrics, 24(3), 155–162.

    PubMed  Google Scholar 

  • Eiraldi, R., Mazzuca, L., Clarke, A., & Power, T. (2006). Service utilization among ethnic minority children with ADHD: A model of help-seeking behavior. Administration and Policy in Mental Health and Mental Health Services Research, 33(5), 607–622.

    Article  PubMed  Google Scholar 

  • Epstein, R. M., Franks, P., Fiscella, K., Shields, C. G., Meldrum, S. C., Kravitz, R. L., et al. (2005). Measuring patient-centered communication in patient-physician consultations: Theoretical and practical issues. Social Science and Medicine, 61(7), 1516–1528.

    Article  PubMed  Google Scholar 

  • Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Altaye, M., Brinkman, W. B., House, K., et al. (2010). Attention-Deficit/Hyperactivity Disorder outcomes for children treated in community-based pediatric settings. Archives of Pediatrics and Adolescent Medicine, 164(2), 160–165.

    Article  PubMed  Google Scholar 

  • Fiks, A. G., Grundmeier, R. W., Biggs, L. M., Localio, A. R., & Alessandrini, E. A. (2007). Impact of clinical alerts within an electronic health record on routine childhood immunization in an urban pediatric population. Pediatrics, 120(4), 707–714.

    Article  PubMed  Google Scholar 

  • Garg, A. X., Adhikari, N. K. J., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., et al. (2005). Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: A systematic review. JAMA, 293(10), 1223–1238.

    Article  PubMed  Google Scholar 

  • Gerstle, R. S. (2004). E-mail communication between pediatricians and their patients. Pediatrics, 114(1), 317–321.

    Article  PubMed  Google Scholar 

  • Guevara, J. P., Feudtner, C., Romer, D., Power, T., Eiraldi, R., Nihtianova, S., et al. (2005). Fragmented care for inner-city minority children with attention-deficit/hyperactivity disorder. Pediatrics, 116(4), e512–e517.

    Article  PubMed  Google Scholar 

  • Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics.

    Google Scholar 

  • Hsu, J., Huang, J., Fung, V., Robertson, N., Jimison, H., & Frankel, R. (2005). Health information technology and physician-patient interactions: Impact of computers on communication during outpatient primary care visits. Journal of the American Medical Informatics Association, 12(4), 474–480.

    Article  PubMed  Google Scholar 

  • Jensen, P. S., Arnold, L. E., Swanson, J. M., Vitiello, B., Abikoff, H. B., Greenhill, L., et al. (2007). 3-Year follow-up of the NIMH MTA Study. Journal of the American Academy of Child & Adolescent Psychiatry, 46(8), 989–1002.

    Article  Google Scholar 

  • Jensen, P. S., Hinshaw, S. P., Swanson, J. M., Greenhill, L. L., Conners, C. K., Arnold, L. E., et al. (2001). Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and applications for primary care providers. Journal of Developmental and Behavioral Pediatrics, 22(1), 60–73.

    PubMed  Google Scholar 

  • Kemper, A. R., Uren, R. L., & Clark, S. J. (2006). Adoption of electronic health records in primary care pediatric practices. Pediatrics, 118(1), e20–e24.

    Article  PubMed  Google Scholar 

  • Kleiner, K. D., Akers, R., Burke, B. L., & Werner, E. J. (2002). Parent and physician attitudes regarding electronic communication in pediatric practices. Pediatrics, 109(5), 740–744.

    Article  PubMed  Google Scholar 

  • Lahdensuo, A., Haahtela, T., Herrala, J., Kava, T., Kiviranta, K., Kuusisto, P., et al. (1996). Randomised comparison of guided self management and traditional treatment of asthma over one year. BMJ, 312(7033), 748–752.

    PubMed  Google Scholar 

  • Lesesne, C. A., Visser, S. N., & White, C. P. (2003). Attention-Deficit/Hyperactivity Disorder in school-aged children: Association with maternal mental health and use of health care resources. Pediatrics, 111(5), 1232–1237.

    PubMed  Google Scholar 

  • Leslie, L. K., Plemmons, D., Monn, A. R., & Palinkas, L. A. (2007). Investigating ADHD treatment trajectories: Listening to families’ stories about medication use. Journal of Developmental and Behavioral Pediatrics, 28(3), 179–188.

    Article  PubMed  Google Scholar 

  • Leslie, L. K., Weckerly, J., Plemmons, D., Landsverk, J., & Eastman, S. (2004). Implementing the American Academy of Pediatrics Attention-Deficit/Hyperactivity Disorder diagnostic guidelines in primary care settings. Pediatrics, 114(1), 129–140.

    Article  PubMed  Google Scholar 

  • Leslie, L. K., & Wolraich, M. L. (2007). ADHD service use patterns in youth. Ambulatory Pediatrics, 7(1, Supplement 1), 107–120.

    Google Scholar 

  • Loe, I. M., & Feldman, H. M. (2007). Academic and educational outcomes of children with ADHD. Ambulatory Pediatrics, 7(1, Supplement 1), 82–90.

    Google Scholar 

  • McWilliams, D. B., Jacobson, R. M., Van Houten, H. K., Naessens, J. M., & Ytterberg, K. L. (2008). A program of anticipatory guidance for the prevention of emergency department visits for ear pain. Archives of Pediatrics and Adolescent Medicine, 162(2), 151–156.

    Article  PubMed  Google Scholar 

  • Molina, B. S., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., et al. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 484–500.

    Article  PubMed  Google Scholar 

  • MTA Cooperative Group. (1999). Multimodal Treatment Study of Children with ADHD. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56(12), 1073–1086.

    Article  Google Scholar 

  • MTA Cooperative Group. (2004). National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for Attention-Deficit/Hyperactivity Disorder. Pediatrics, 113(4), 754–761.

    Article  Google Scholar 

  • National Advisory Mental Health Council Clinical Treatment and Services Research Workgroup. (1999). Bridging science and service: A report by the National Advisory Mental Health Council Clinical Treatment and Services Research Workgroup. Washington, DC: National Institute of Mental Health.

    Google Scholar 

  • Newacheck, P. W., Strickland, B., Shonkoff, J. P., Perrin, J. M., McPherson, M., McManus, M., et al. (1998). An epidemiologic profile of children with special health care needs. Pediatrics, 102(1 Pt 1), 117–123.

    Google Scholar 

  • O’Connor, A.M, & Stacey, D. (2005). Should patient decision aids (PtDAs) be introduced in the health care system? Copenhagen: WHO Regional Office for Europe.

  • O’Connor, A. M., Stacey, D., Barry, M. J., Col, N. F., Eden, K. B., Entwistle, V., et al. (2007). Do patient decision aids meet effectiveness criteria of the International Patient Decision Aid Standards Collaboration? A systematic review and meta-analysis. Medical Decision Making, 27(5), 554–574.

    Article  PubMed  Google Scholar 

  • O’Connor, A. M., Stacey, D., Entwistle, V., Llewellyn-Thomas, H., Rovner, D., Holmes-Rovner, M., et al. (2003). Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev, 2, CD001431.

  • Olaniyan, O., dosReis, S., Garriett, V., Mychailyszyn, M. P., Anixt, J., Rowe, P. C., et al. (2007). Community perspectives of childhood behavioral problems and ADHD among African American parents. Ambulatory Pediatrics, 7(3), 226–231.

    Article  PubMed  Google Scholar 

  • Osheroff, J. A., Pifer, E. A., Teich, J. M., Sittig, D. F., & Jenders, R. A. (2005). Improving outcomes with clinical decision support: An implementer’s guide. Chicago: Healthcare Information and Management Systems Society.

    Google Scholar 

  • Pliszka, S. R., Crismon, M. L., Hughes, C. W., Corners, C. K., Emslie, G. J., Jensen, P. S., et al. (2006). The Texas Children’s Medication Algorithm Project: Revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 45(6), 642–657.

    Article  PubMed  Google Scholar 

  • Polaha, J., Cooper, S. L., Meadows, T., & Kratochvil, C. J. (2005). The assessment of attention-deficit/hyperactivity disorder in rural primary care: The portability of the American Academy of Pediatrics guidelines to the “real world”. Pediatrics, 115(2), e120–e126.

    Article  PubMed  Google Scholar 

  • Porter, S. C., Forbes, P., Feldman, H. A., & Goldmann, D. A. (2006). Impact of patient-centered decision support on quality of asthma care in the emergency department. Pediatrics, 117(1), e33–e42.

    Article  PubMed  Google Scholar 

  • Power, T. J., Hughes, C. L., Helwig, J. R., Nissley-Tsiopinis, J., Mautone, J. A., & Lavin, H. J. (2010). Getting to first base: Promoting engagement in family-school intervention for children with ADHD in urban, primary care practice. School Mental Health. doi:10.1007/s12310-010-9029-2.

  • Rosen, P., & Kwoh, C. K. (2007). Patient-physician e-mail: An opportunity to transform pediatric health care delivery. Pediatrics, 120(4), 701–706.

    Article  PubMed  Google Scholar 

  • Rushton, J. L., Fant, K. E., & Clark, S. J. (2004). Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder. Pediatrics, 114(1), e23–e28.

    Article  PubMed  Google Scholar 

  • Shapiro, E. S., DuPaul, G. J., Barnabas, E., Benson, J. L., & Slay, P. M. (2010). Facilitating school, family, and community partnerships: Enhancing student mental health: An overview of the special issue. School Mental Health. doi:10.1007/s12310-010-9033-6.

  • Stormshak, E. A., Fosco, G. M., & Dishion, T. J. (2010). Implementing interventions with families in schools to increase youth school engagement: The family check-up model. School Mental Health. doi:10.1007/s12310-009-9025-6.

  • Turchi, R. M., Berhane, Z., Bethell, C., Pomponio, A., Antonelli, R., & Minkovitz, C. S. (2009). Care coordination for CSHCN: Associations with family-provider relations and family/child outcomes. Pediatrics, 124(Supplement_4), S428–S434.

    Google Scholar 

  • US Department of Health and Human Services. (1999). Diagnosis of Attention-Deficit/Hyperactivity Disorder: Technical review 3. (Agency for Health Care Policy and Research Publication No. 99–0050). Rockville, Md: US Department of Health and Human Services.

    Google Scholar 

  • Wagner, E. H. (2000). The role of patient care teams in chronic disease management. BMJ, 320(7234), 569–572.

    Article  PubMed  Google Scholar 

  • Weems, C. F., Scott, B. G., Taylor, L. K., Cannon, M. F., Romano, D. M., Perry, A. M., et al. (2010). Test anxiety prevention and intervention programs in schools: Program development and rationale. School Mental Health. doi:10.1007/s12310-010-9032-7.

  • Weiland, S. K., Pless, I. B., & Roghmann, K. J. (1992). Chronic illness and mental health problems in pediatric practice: Results from a survey of primary care providers. Pediatrics, 89(3), 445–449.

    PubMed  Google Scholar 

  • Westin, A. F. (2008). Connecting for health: Americans overwhelmingly believe electronic personal health records could improve their health. New York: Markle Foundation.

    Google Scholar 

Download references

Acknowledgments

We thank Cayce Hughes, MPH for his help in assembling this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alexander G. Fiks.

Additional information

This paper was written with the support from Award Number K23HD059919 from the Eunice Kennedy Shriver National Institute of Children Health & Human Development (Dr. Fiks) and Award Number RC1 HL100546 from the National Heart Lung & Blood Institute (Dr. Leslie). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fiks, A.G., Leslie, L.K. Partnership in the Treatment of Childhood Mental Health Problems: A Pediatric Perspective. School Mental Health 2, 93–101 (2010). https://doi.org/10.1007/s12310-010-9037-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12310-010-9037-2

Keywords

  • Pediatrics
  • Partnership
  • Mental health