Discussion
ADHD
In the current pilot study, a protocol to screen multiplex ADHD families was implemented in urban pediatric primary care clinics serving predominantly racially minoritized families and families insured through Medicaid. In the first 6 months of implementing the screening protocol, approximately 1 in 5 families attending well-child visits who completed the screeners had elevated parent and child ADHD symptoms. However, overall screening completion rate was low (18.28%). Stakeholder input provided context and offered a deeper understanding of factors that may have contributed to the low ADHD screening completion rates. Themes largely converged between the types of stakeholders, but divergence was also observed between parents and providers/staff. Although the inclusion of multiple types of stakeholders provided important perspectives from an array of individuals who play a role or are impacted by the implementation of multiplex ADHD screening and treatment, we had a small number of participants within each type of stakeholder, limiting generalizability of our findings. As such, current findings represent preliminary data on an understudied topic.First, although providers in the study expressed enthusiasm for integrating parent mental health with pediatric care, parents expressed significant hesitation about this approach. Furthermore, there is tension between parents’ preference for having conversations with trusted providers about parent mental health and the structural and logistical reality of limited time for pediatric providers to have these sensitive conversations during a well-child visit. On the one hand, the relationship built between providers and parents offers providers the unique opportunity to inquire about more sensitive and potentially uncomfortable topics, such as parent’s own ADHD. This aligns with previous literature identifying Black and/or Latino communities and low-income groups preferring to receive mental health information from a credible, trusted source and someone that is known to them, such as a family doctor, and a preference for receiving mental health information in a familiar setting [Aside from logistical considerations, stakeholder input also provided insight on how to sensitively broach the topic of parent ADHD within a pediatric primary care setting given the continued inequities in mental healthcare and research with under-resourced families and challenges related to stigma. A key clinical takeaway is to attend to historical and continued oppression and negative experiences of individuals with marginalized identities and how these experiences impact their decision-making around ADHD care for themselves and their child. Significant stigma around mental health persists among communities of color and communities with socioeconomic disadvantages [This cultural sensitivity is particularly important if part of the treatment plan for ADHD includes the potential for medication which is associated with more mistrust and stigma. Parents in the study expressed concerns about medication for ADHD for themselves or their children based on past experiences. This finding is consistent with Glasofer et al. [