A Pilot Study of a Remote ADHD Monitoring Program

The RAMP study is designed to examine the use of an attention-Deficit/Hyperactivity Disorder (ADHD) Monitoring Program during the early stages of treating ADHD in children living in rural settings. It is a multi-site pilot study conducted across two Institutional Development Award (IDeA) States Pediatric Clinical Trials Network (ISPCTN) sites in conjunction with four practices with high rural and/or underserved populations.

The Remote ADHD Monitoring Program (RAMP) will include provider ADHD Best Practice education, caregiver and teacher prompts for frequent RAMP Reports of inattention and hyperactivity symptoms and a provider dashboard with enrolled children. The RAMP Report includes the publicly available Vanderbilt Rating Scales (henceforth shortened to Vanderbilt Assessment), which is a commonly used, guideline-recommended tool for both diagnosis and management of ADHD for use by parents and teachers.

Families will be approached until 36 caregiver/child dyads are enrolled. Those enrolled will be randomized 1:1 to either the intervention group or control group. The intervention group will be enrolled in the RAMP, with prompts to provide frequent reports including ADHD symptoms. The control group will provide ADHD symptom reports through paper forms (usual care), on a provider determined schedule.

The intervention group will be enrolled in the RAMP platform and will receive text-based requests for reports with embedded links to fill out the RAMP questionnaires weekly for 4 weeks, then monthly for 2 months. The control group will receive digital education handouts about age-appropriate pediatric health topics weekly for 4 weeks, then monthly for 2 months.

For the intervention group, the child's teacher can voluntarily return the RAMP questionnaires as well, but will not have direct contact with the study team. The child's provider will also be a participant for the intervention group, and will receive requests to review the submitted RAMP reports.

The primary endpoint for this study is to evaluate the number of clinical assessments per participant that are completed by caregivers and teacher and returned to providers for ADHD management.

The secondary endpoint for this study is to evaluate the proportion of all submitted RAMP reports that are reviewed by providers.

The results of this pilot will be used to design a full-scale efficacy trial in additional rural sites to expand diversity and assess generalizability.

Inclusion criteria

The child must

• be under the care of a participating provider
• be aged 5-11 at enrollment
• have a diagnosis of ADHD
• be initiating stimulant medication for treatment for the first time or have not received stimulant medication for the last 6 months
• be attending in-person elementary school

The Primary caregiver must

• be willing and legally able to give consent
• have access to a smartphone
• be English-speaking
• reside with the child at least 3 days per week
• complete an initial symptom assessment prior to starting stimulant treatment and be willing to provide a copy to the study team

The provider must

• manage ADHD care in patients age 5-11 years
• provide informed consent
• agree to use the RAMP platform if they care for patients randomized to use it
• agree to provide information to potential participants about the study and contact the research coordinator if interested

Exclusion criteria

Child:

• has serious mental health comorbidities (Children with depression, anxiety, oppositional defiant disorder will be permitted to participate. Children with schizophrenia, bipolar disorder, conduct disorder and those who have been hospitalized for any mental health condition will be excluded from the study.)
• has severe neurodevelopment disorders (Children with well-controlled seizure disorders will be permitted to participate.)
• is currently receiving, or previously received, atypical antipsychotic medication treatment
• is or becomes pregnant