Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Anne L. Thatcher, DNP, MSW, APRN, PMHNP-BC, LMSW


Brittania Phillips, DNP, APRN, PMHNP-BC

Lisa Wiersema, LCPC


Problem: Failure to identify and treat attention-deficit hyperactivity disorder (ADHD) is associated with academic underachievement, social difficulties, negative physical and mental health effects. Evidence suggests approximately 3% of a broad-based population sample and roughly 13% of an at-risk population are undiagnosed despite significant symptomology (Downey & Zun, 2018; Madsen et al., 2018; Okumura et al., 2019). The United States (U.S.) has no structured screening system for ADHD. Consequently, children receive no referral for diagnosis or treatment to mitigate its effects.

Methods: The Institute for Healthcare Improvement (IHI) Model for Evidence-Based Practice using the Plan Do Study Act (PDSA) cycle guided this quality improvement (QI) initiative. The design was an observational, prospective cohort with a qualitative arm. A convenience sample of children aged 6- to 12-years receiving care from one Midwest counseling and therapy practice psychotherapist was utilized. Quantitative data was collected using the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) over eight weeks at psychotherapy appointments.

Results: Six eligible participants (N = 6) participated in the study. Subjects were predominantly female (83%, n = 5) compared to male (17%, n = 1). One positive screen (16.7%, n = 1) resulted. Positive characteristics included female gender, inattentive ADHD, and anxiety/depression. Screening for ADHD using the VADPRS (M = 0.17, SD = 0.408), t(5) = 0.496, p = 0.320 is not significantly different from CDC prevalence rates in Illinois (M = 0.084).

Practice Implications: Results were clinically significant. APRN guided, agency-wide implementation of VADPRS may reduce myriad consequences of unrecognized, untreated ADHD.