Evaluating a Web-based Adult ADHD Toolkit for Primary Care Clinicians

Natalia Y. Loskutova, MD, PhD; Cory B. Lutgen, BS; Elisabeth F. Callen, PhD, GStat; Melissa K. Filippi, PhD, MPH; Elise A. Robertson, MA


J Am Board Fam Med. 2021;34(4):741-752. 

In This Article

Abstract and Introduction


Introduction: Approximately 5% of the US adult population has Attention Deficient Hyperactivity Disorder (ADHD) that can negatively impact quality of life. Health care professionals report a need to increase their knowledge of and confidence in treating adult ADHD. The American Academy of Family Physicians National Research Network (AAFP NRN) collaborated with a panel of experts to create a web-based AAFP Adult ADHD Toolkit composed of resources to aid in the diagnosis, management, and treatment of adults with ADHD.

Objectives: Assess the impact of using an AAFP Adult ADHD Toolkit in a practice setting.

Methods: Ninety-seven primary and behavioral health care professionals from AAFP NRN practices (n=6) used the Toolkit for 17 weeks. Data on Toolkit use, usefulness, implementation, impact, and changes in knowledge and confidence were collected via pre-post and weekly surveys. Mixed methods, regression analyses, t-tests, and mixed ANOVA were used to assess change over time.

Results: Use of the Toolkit improved health care providers' knowledge by midpoint relative to baseline in areas related to treatment effects, side effects, and outcomes (3.6 vs 3.0; P = .004); existing ADHD resources (3.3 vs 2.9; P = .03); and management of ADHD in patients with comorbid conditions (3.2 vs 2.7; P = .01). By the end of the study, Toolkit use was associated with increased confidence in mental health and life history interview techniques (3.5 vs 3.0; P = .03); treatment options for ADHD with comorbid mental health disorders (3.2 vs 2.3; P ≤ .001); and treatment options for ADHD with coexisting substance use disorders (3.0 vs 2.3; P = .003). By the end of the study, most participants (n=47, 87%) reported the Toolkit addressed most of their needs related to diagnosis, treatment, and management of adult ADHD.

Conclusion: Availability and adoption of the Toolkit into the routine care of adults with ADHD measurably increased health care professionals' knowledge especially in those providers who regularly see adult patients with ADHD.


Attention deficit hyperactivity disorder (ADHD) is a prevalent condition in both children and adults, affecting about 5% of the adult population. Primary Care Practitioners (PCPs) are usually the first clinicians to be in contact with adults affected by ADHD. PCPs receive little training for diagnosing and treating adult ADHD and know little about the comparative effectiveness and cost-effectiveness of the diagnostic and treatment options for this disorder. Previous studies reported a low level of competence in diagnosing ADHD in adults, poor familiarity with existing diagnostic criteria, low awareness of existing provider and patient resources, and deficiencies in evidence-based medication treatment decisions for adults with ADHD among PCPs.[1–4] Many family physicians reported they prescribe stimulants based on their own success, comfort level, and clinical judgment rather than evidence-based guidelines.[5] This is not surprising, as there are no evidence-based primary care-focused treatment algorithms and practice guidelines for adult ADHD in the United States. While adult ADHD resources for physicians and patients exist, there is no comprehensive, accurate, and easily accessible "one-stop shop" resource on adult ADHD. PCPs report a need to increase their knowledge of the disorder and confidence in diagnosing and managing ADHD in adults through education, tools, and resources.

To address this need, we sought to use the consensus-based participatory approach to develop and evaluate a toolkit for facilitating comprehensive care for adults with ADHD. The evaluation was designed to assess the implementation of the toolkit in routine clinical care with minimal outside intervention. The objectives of this article are to report on (a) the methods used in toolkit development, and (b) the results of implementation and evaluation on provider-level outcomes (knowledge, attitudes, and practice/behavior), use, and perceived value of the toolkit.