Piloting a Sequential, Multiple Assignment, Randomized Trial for Mothers with Attention-Deficit/Hyperactivity Disorder and Their At-Risk Young Children.
Piloting a Sequential, Multiple Assignment, Randomized Trial for Mothers with Attention-Deficit/Hyperactivity Disorder and Their At-Risk Young Children.
复制标题
针对患有注意力缺陷/多动症的母亲及其高危幼儿进行序贯、多重分配、随机试验。
DOI：
10.1089/cap.2018.0136
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发表时间：
2019
影响因子：
1.9
通讯作者：
Stein,MarkA
中科院分区：
文献类型：
--
作者：
Schoenfelder,ErinN;Chronis-Tuscano,Andrea;Strickland,Jennifer;Almirall,Daniel;Stein,MarkA
目的：父母注意力缺陷/多动障碍(ADHD)与不良父母教养方式有关，降低了儿童ADHD治疗的有效性。我们进行了一项序贯、多任务、随机试验(SMART Pilot)，以评估ADHD母亲的序贯药物和行为治疗的可行性和可接受性，以针对多个ADHD家庭中的母亲ADHD、父母教养方式和儿童ADHD症状/损害。方法：纳入35名ADHD母亲及其5-8岁ADHD症状。母亲们被随机分为8周的单独滴定的兴奋剂药物(MSM)或行为父母培训(BPT)，然后重新随机到8周的继续一线治疗(根据需要进行修改)或联合治疗，从而产生4种治疗序列(MSM-MSM、MSM-BPT、BPT-MSM和BPT-BPT)。结果：多重ADHD家庭的招募主要来自儿童提供者。母亲坚持用药，接受治疗的次数很多。母亲和临床医生发现这两种治疗方法都是可以接受的，而且都是首选的联合治疗，特别是在BPT之前接受药物治疗。接受单一疗法治疗的家庭(MSM-MSM，BPT-BPT)负担更大。结论：对于母子双方都有ADHD症状的家庭来说，母亲服用兴奋剂和BPT是可以接受和可行的干预措施。对孩子的ADHD症状感到担忧的母亲愿意自己接受治疗，作为改善孩子健康和功能的初步战略。全功率智能设计在评估干预措施的顺序和帮助临床医生开发在现实世界实践环境中治疗多胎家庭的算法方面显示出前景。
Objective:Parental attention-deficit/hyperactivity disorder (ADHD) is associated with suboptimal parenting and reduces the effectiveness of child ADHD treatments. We conducted a Pilot Sequential, Multiple Assignment, Randomized Trial (SMART Pilot) to evaluate the feasibility and acceptability of sequencing medication and behavioral treatments for mothers with ADHD to target outcomes, including maternal ADHD, parenting, and child ADHD symptoms/impairment in multiplex ADHD families.Methods:Thirty-five mothers with ADHD and their 5- to 8-year-old child with ADHD symptoms were enrolled. Mothers were randomized to 8 weeks of individually titrated stimulant medication (MSM) or behavioral parent training (BPT), followed by rerandomization to 8 weeks of continued first-line treatment (with as-needed modifications) or combined treatment, leading to four treatment sequences (MSM-MSM, MSM-BPT, BPT-MSM, and BPT-BPT).Results:Recruitment of multiplex ADHD families came primarily from child providers. Mothers were adherent to medication and had high therapy session attendance. Mothers and clinicians found both treatments to be acceptable and preferred combination treatment, especially receiving medication before BPT. Monotherapy treatment visits were viewed as more burdensome (MSM-MSM, BPT-BPT).Conclusions:Maternal stimulant medication and BPT are acceptable and feasible interventions for families in which both the mother and child have ADHD symptoms. Mothers with concerns about their children's ADHD symptoms are receptive to receiving treatment themselves as an initial strategy for improving their children's health and functioning. Fully powered SMART designs show promise in evaluating the sequencing of interventions and helping clinicians develop algorithms for treating multiplex families in real-world practice settings.