2/2 Treating Mothers with ADHD and their Young Children Via Telehealth: A Hybrid Type I Effectiveness-Implementation Trial

摘要/项目总结 母亲多动症，目前在25 - 50%的家庭儿童多动症和经常未经治疗，干扰 有效的养育和预测不良儿童发展和行为治疗的结果。基于 文献和我们自己的试点数据，我们将随机分配患有ADHD的母亲和他们的年轻高危儿童， 两种情况之一：（1）对患有ADHD的母亲使用兴奋剂药物，然后使用儿童治疗策略 (CTS)从行为父母培训（BPT）开始，并增加了儿童兴奋剂的建议 治疗，如果孩子仍然受损或（2）CTS没有治疗母亲ADHD的父母，孩子， 家庭成果。我们将研究目标机制，包括改善母亲多动症相关的 损伤和神经病学（注意力、冲动、情绪调节）、育儿技巧和BPT 参与，以及治疗调节（基线母亲ADHD严重程度，母亲损伤， 育儿技巧）。此外，为了开发一种有可能广泛应用的治疗模式， 传播的同时也减少了接受护理的障碍，我们将在初级保健中对母亲进行ADHD筛查， 儿童多动症最常被发现和治疗的地方， 通过远程医疗进行治疗。利用利益攸关方制定实施计划和相关工具包 参与性战略将提高有效采取这一办法的能力。另外我们 将研究护理提供的背景，评估筛查和参与的程序和比率， 如人员配备、工作流程、提供者和患者层面的可接受性、就绪性和实施的可行性 接近。该混合有效性-实施项目将通过跨2 美国的研究中心（N = 240个家庭），每个研究中心有4 - 5个初级保健合作伙伴。

ABSTRACT/PROJECT SUMMARY Maternal ADHD, present in 25-50% of families of children with ADHD and frequently untreated, interferes with effective parenting and predicts poor child developmental and behavioral treatment outcomes. Based on the literature and our own pilot data, we will randomly assign mothers with ADHD and their young at-risk children to one of two conditions: (1) stimulant medication for mothers with ADHD followed by a child treatment strategy (CTS) beginning with behavioral parent training (BPT) with the added recommendation of child stimulant treatment if the child remains impaired or (2) a CTS without treatment for maternal ADHD on parent, child, and family outcomes. We will examine target mechanisms including improvements in maternal ADHD-related impairment and symptomatology (attention, impulsivity, emotional regulation), parenting skills, and BPT engagement, as well as treatment moderators (baseline maternal ADHD severity, maternal impairment, and parenting skills). Moreover, in an effort to develop a model of treatment that has potential for widespread dissemination while also reducing barriers to receiving care, we will screen mothers for ADHD in primary care, where child ADHD is most often identified and treated, and co-located mental health providers will deliver treatments via telehealth. Development of an implementation plan and associated toolkit using a stakeholder participatory strategy will enhance the ability to move efficiently to adoption of this approach. In addition, we will study the care delivery context, assessing procedures for and rates of screening and participation as well as staffing, workflow, provider- and patient-level acceptability, readiness, and feasibility of implementation approaches. This hybrid effectiveness-implementation project will be achieved via a collaborative R01 across 2 research sites in the US (N = 240 families), with 4-5 primary care partners at each site.