RFA-R14-004: PLAY-MH

DRDC Solicitation #:  RFA-R14-004

Project Title: Project to Learn About Youth – Mental Health (PLAY-MH)

Maximum Budget: Year 1 $250,000; Year 2 $250,000 (includes direct & indirect costs)
NOTE: All budget amounts are subject to the availability of funding.
Project period:  up to 2 years
Anticipated Number of Awards:  up to 2
Project start date:  September 30, 2014

Eligible Applicants: 

This funding opportunity is open to Higher Education Institutions, Non-profits other than institutions of higher education, For Profit organizations, or Government offices  (State, local, tribal,) with the exception that applications will NOT be accepted from entities in the funded states of South Carolina and Colorado. 

Description:

Healthy People 2020 Focus Area(s) aligned with this project:   Mental Health and Mental Disorders (MHMD-6): increase the proportion of children with mental health problems that receive treatment

Center/Division goal(s) and priorities aligned with this research project:  
NCBDDD: Priority 5: Identifying and reducing disparity in key health indicators, including obesity, among children, youth and adults with disabilities.
DHDD: Improve developmental outcomes of children.

Purpose:  The purpose of this program is to conduct a set of population-based research projects of pediatric neurobehavioral disorders that describe prevalence, treated prevalence, and co-occurrence of internalizing, externalizing, and tic disorders of childhood.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a disruptive behavioral disorder, characterized by abnormal level of inattentiveness and/or hyperactivity and impulsivity that impairs functioning. ADHD often persists into adolescence and can affect behavior and functioning even in adults although little is known about its developmental trajectory and correlates from non-clinical samples of youth identified and treated for ADHD in usual community care. Children with ADHD are at increased risk for poor academic achievement, delinquent and antisocial behavior, early substance use and/or abuse, peer and family problems, as well as a litany of psychiatric comorbidity. Effective pharmacological and psychosocial treatments exist, but their long-term effects have not been adequately studied particularly to document the health risks and benefits associated with treatment modality and compliance in usual community care. National survey data indicate that ADHD affects approximately 11% or 6.4 million American children 4-17 years of age and the percentage of children with a parent-reported ADHD diagnosis by a health care provider increased by 42% between 2003-04 and 2011-12.   Among children with a current ADHD diagnosis, 69% were taking medication for the disorder.

Tourette syndrome (TS) is a hereditary neurological disorder characterized by repetitive involuntary movements and vocal sounds called tics. The epidemiology of TS is difficult to study due to the lower prevalence of the disorder (3-6 per 1000 children 6-17 years of age).  Lower estimates that rely on previously diagnosed cases may reflect a substantial number of cases that are undiagnosed; this may be particularly relevant for minority or underserved populations, where prevalence estimates are lower.  The first national, epidemiological description of TS extended from data collected on the 2007 National Survey of Children’s Health. One primary finding was the high frequency with which other mental disorders co-occurred with TS; the disorder with the highest co-occurrence among children with TS was ADHD. Previous research by NCBDDD indicates that the significantly higher parenting aggravation that is associated with TS is largely accounted for by the presence of co-occurring mental disorders, including ADHD.  Similarly, health care needs and educational outcomes among children with TS are also impacted by co-occurring conditions.  Better understanding the prevalence of TS, the diagnostic and treatment pathways for TS, and co-occurring conditions among children with TS, including ADHD, could lead to greater understanding of the factors associated with improved parenting, family, and child outcomes of children with TS.

In FY 2002 – FY 2005 two cooperative agreements were awarded to conduct community-based epidemiological research on ADHD in childhood.  The primary research design included population-based screening of entire elementary school districts, followed by direct diagnostic interviewing of a sample of the screened youth and their parents. The cooperative agreements were followed by a set of longitudinal studies (through federal research contracts) of the research participants (FY 2006-2011).  These studies informed community-based prevalence (1), rates of comorbidity, and rates of health risk behaviors among elementary-age children with and without ADHD, as determined by a rigorous case definition developed by a collaborative, multidisciplinary research team.  A pilot study was incorporated at one site to extend the methodology to identifying children with tic disorders, including TS.  This strategy has been adapted to include both internalizing and externalizing disorders. Population-based estimates of internalizing disorders, such as anxiety and depression, externalizing disorders, such as ADHD, oppositional defiant disorder, and conduct disorder, and tic disorders are needed in order to better understand the impact of these disorders on children, families and society. This program is authorized under Sections 301, 311 and 317(C) of the Public Health Service Act, (42 U.S.C. Sections 241, 243, and 247b–4) as amended.

Research Goals and Objectives: Implement epidemiologic screening and diagnostic procedures targeting children and adolescents with mental disorders (ages 5 to 17).

The purpose of project is to implement an existing strategy to describe the prevalence and treated prevalence of internalizing, externalizing, and tic disorders of elementary-aged children through adolescents in a defined community; to identify rates of co-occurrence of the disorders within the defined community; and to describe current and previous receipt of mental health treatment in children with previously diagnosed mental disorders.  An additional goal of this award is to assess diversion and misuse of psychoactive medications prescribed for the purpose of treating a mental disorder. The grantees will work in collaboration with CDC and other funded awardees to implement the study methodology and inform analytic decisions.

Special Instructions for applicants:

The successful applicant will describe the following components in their research plan:

  1. The demographic profile of the targeted catchment area.  A sampling strategy should also be described in which at least 5,000 children (5-17 years) are screened for mental disorders by their teachers, from which a random sample of screened youth are invited to participate in a telephone-based or in-person diagnostic evaluation.
  2. A screening strategy utilizing the BASC-2 BESS (Behavioral and Emotional Screening System for Children – Second Edition), and SDQ (Strengths and Difficulties Questionnaire) to establish risk for mental disorders. The methodology should be piloted within the proposed school district(s) and then implemented across the entire catchment area.
  3. A diagnostic assessment strategy in which the DISC (Diagnostic Interview Schedule for Children) and the YGTSS (Yale Global Tic Severity Scale) or comparable tools, determined in collaboration between CDC and the grantees, are used to establish presence of mental disorders among children with known screening status. (Note to Applicants:  This project is currently being conducted at 2 sites and this RFA seeks to expand the project to 2 additional sites.  The CDC may wish to amend the diagnostic assessment strategy for all sites, in collaboration with the grantees, and will be cognizant of each site’s budget and any additional work required when proposing revisions.) The assessment strategy should also include the collection of data related to child and family demographics and existing mental disorder treatment.
  4. An incentive strategy to maximize participation in the study.
  5. A site-specific assessment plan proposing data collection pursuant to the applicant’s specific areas of expertise, interest, and availability of funds, to include at least one of the following focus areas: health risk behaviors, barriers to treatment, adherence to and diversion of medication for mental disorder treatment.
  6. A plan for compliance with Institutional Review Board regulations and acquisition of a Certificate of Confidentiality from CDC.
  7. A data management and dissemination plan that reflects the process by which the project data will be cleaned, delivered, and prepared for publication as reports, presentations, and peer-reviewed journal articles.

Describe the potential public health impact of this opportunity:

Rates of mental disorders, including ADHD, as well as use of psychoactive medications and health service use for mental disorders has been increasing for well over a decade (2-5).  Aside from ADHD, less has been documented about the epidemiology of other specific externalizing, internalizing and tic disorders.

Little is known about the factors that relate to the complex geographic patterns in the prevalence of these disorders across the United States. Understanding the current epidemiology of mental disorders of childhood is important in order to develop Public Health strategies to prevent the later impact of serious mental illness among adults, estimated at $193 billion in lost earnings alone.(6)

References:

1. Wolraich, M.L., R.E. McKeown, S.N. Visser, D. Bard, S. P. Cuffe, B. Neas, L.J. Geryk, et al. “The Prevalence of ADHD: Its Diagnosis and Treatment in Four School Districts across Two States.” Journal of Attention Disorders (Published online September 5, 2012).

2. Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., . . . Blumberg, S. J. (2014). Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011. Journal of the American Academy of Child and Adolescent Psychiatry; 53(1): 34-46.e32.

3. Pfuntner A, Wier LM, Stocks C. Most frequent conditions in U.S. hospitals, 2010 Rockville, MD: Agency for Healthcare Research and Quality 2013 January.

4. Comer JS, Olfson M, Mojtabai R. National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996-2007. Journal of the American Academy of Child and Adolescent Psychiatry. 2010;49(10):1001-1010.

5. Olfson M, Crystal S, Huang C, Gerhard T. Trends in antipsychotic drug use by very young, privately insured children. Journal of the American Academy of Child and Adolescent Psychiatry. 2010;49(1):13-23.

6. Kessler RC, Heeringa S, Lakoma MD, Petukhova M, Rupp AE, Schoenbaum M, et al. Individual and Societal Effects of Mental Disorders on Earnings in the United States: Results From the National Comorbidity Survey Replication. American Journal Psychiatry 2008;165(6):703-711.