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

摘要/项目摘要 母亲的ADHD，存在于25%-50%的ADHD儿童家庭中，并且经常得不到治疗，干扰了 有效的育儿方式，并预测不良的儿童发育和行为治疗结果。基于 文献和我们自己的试点数据，我们将随机分配患有ADHD的母亲和她们年幼的高危儿童 对以下两种情况之一：(1)对患有ADHD的母亲进行兴奋剂治疗，然后采取儿童治疗策略 (CTS)从父母行为训练(BPT)开始，并增加儿童兴奋剂的推荐 如果孩子仍然受损，接受治疗或(2)CTS，而不治疗母亲的ADHD， 家庭结果。我们将审查目标机制，包括改善与产妇ADHD相关的机制 损害和症状学(注意力、冲动、情绪调节)、育儿技巧和BPT 参与度以及治疗主持人(基线产妇ADHD严重程度、产妇损害和 育儿技能)。此外，为了努力开发一种有可能广泛传播的治疗模式 在减少接受护理的障碍的同时，我们将在初级保健中对母亲进行ADHD筛查， 儿童ADHD最常被识别和治疗的地方，以及位于同一地点的精神健康提供者将提供 通过远程医疗进行治疗。使用利益相关者开发实施计划和相关工具包 参与式战略将增强有效地采用这一方法的能力。此外，我们 将研究提供护理的背景，评估筛查和参与率的程序和比率 作为人员配备、工作流程、提供者和患者级别的可接受性、就绪性和实施可行性 接近了。这一混合效力-实施项目将通过跨2个区域的协作R01实现 在美国的研究地点(N=240个家庭)，每个地点有4-5个初级保健伙伴。

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.