Background 
Attention-Deficit/Hyperactivity Disorder, ADHD
DISORDER, MAY
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common disorder that affects both children and adults. Given the high heritability of ADHD [Disparities in diagnosis and treatment related to socioeconomic status (SES) exist for individuals with ADHD. Primary care providers working in under-resourced urban settings with higher poverty rates report more challenges in conducting appropriate diagnostic assessments for ADHD compared to those in suburban settings [Implementation of ADHD interventions in community and primary care settings face several barriers that may be distinct from private, suburban clinics, including limited primary care provider education on ADHD, lack of resources and time involved in diagnosing and treating a complex disorder such as ADHD, and the need to coordinate with others (e.g., parents, schools, other health professionals) to manage the disorder [Pediatric primary care represents an opportunity for the early identification of multiplex ADHD, given that the American Academy of Pediatrics (AAP) recommends routine evaluation and treatment of ADHD in children beginning at age 4 [No study, to date, has examined screening for parent and child ADHD in pediatric primary care. Although screening for parent mental health in pediatric primary care has benefits, there are challenges to implementing screening protocols in this setting. For example, parents may not feel comfortable discussing their own mental health symptoms with their child’s provider due to lack of trust or worries about being judged [At present, there is little guidance on how to effectively approach parents about their own ADHD in a pediatric care setting, and broaching this topic with under-resourced families may require even greater sensitivity due to systemic inequities, mistrust, and stigma. The current pilot study describes initial efforts of implementing a protocol to screen for parent and child ADHD in urban pediatric primary care clinics and stakeholder perspectives on challenges and strategies to effectively engage with families living in under-resourced communities around topics of parent mental health, ADHD screening, and treatment of ADHD in multiplex families. The study period spanned from August to November 2020, during the COVID-19 pandemic and the Black Lives Matter movement following the police murder of George Floyd in May 2020.