Methodology for conducting the children's attention-deficit hyperactivity disorder telemental health treatment study in multiple underserved communities

Clin Trials. 2013;10(6):949-58. doi: 10.1177/1740774513494880. Epub 2013 Jul 29.


Background: Children living in nonmetropolitan communities are underserved by evidence-based mental health care and are underrepresented in clinical trials.

Purpose: In this article, we describe lessons learned in conducting the Children's Attention-Deficit Hyperactivity Disorder (ADHD) Telemental Health (TMH) Treatment Study (CATTS), a randomized controlled trial testing the effectiveness of TMH in improving outcomes of children with ADHD living in underserved communities.

Methods: Children were referred by primary care providers (PCPs). The test intervention group received six telepsychiatry sessions with each session followed by an caregiver behavior training session delivered in-person by a local therapist. A secure website was used to support decision making by the telepsychiatrists and to facilitate real-time collaboration between the telepsychiatrists and community therapists. The control group received a single telepsychiatry consultation. Questionnaires tapping ADHD symptoms and other outcomes were administered to parents and teachers online through a secure portal from personal computers.

Results: total of 88 PCPs in seven communities referred the 223 children who participated in the trial. Attrition in treatment sessions and research assessments was very low. Lessons learned TMH proved to be a viable means of providing evidence-based pharmacological services to children and training to local therapists. Recruitment was enhanced by offering the control group a telepsychiatry consultation. Site-specific strategies were needed to meet recruitment targets.

Conclusions: The CATTS trial used methods designed to optimize inclusion of children living in multiple dispersed and underserved areas. The study will serve as a model for other research projects aiming at reducing geographic disparities in access to quality mental health care.

Trial registration: NCT00830700.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / therapy*
  • Child
  • Child Health Services / methods*
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Medically Underserved Area*
  • Mental Health Services*
  • Multicenter Studies as Topic / methods
  • Psychiatry / methods*
  • Randomized Controlled Trials as Topic / methods
  • Referral and Consultation*
  • Telemedicine / methods*

Associated data