Personalizing Behavioral Parent Training: Improving Reach and Outcomes for Families of Children with ADHD

项目总结

PROJECT SUMMARY It is critical to improve the reach and efficacy of psychosocial treatments for childhood attention-deficit hyperactivity disorder (ADHD), the single most prevalent pediatric mental health disorder (9% prevalence; Danielson et al., 2018a). Evidence-based treatments for ADHD, such as behavioral parent training (BPT), produce moderate effect sizes on clinical outcomes including parenting skills, parent stress, child impairment, and child academic functioning when targeted (Evans et al., 2018; Merrill et al., 2017; Power et al., 2012). However, the impact of BPT in the community is attenuated by poor transportability and high therapist involvement in standard treatment. The magnitude of treatment need is far beyond the capacity of the current mental health system, with only about 30% of parents receiving BPT (Danielson et al., 2018b). Technology- delivered interventions, and specifically mHealth applications, can overcome this gap as 81% of Americans own a smartphone (Pew Research Center, 2019), and many minoritized and low-income individuals rely on smartphones for internet access. The current study aims to leverage an established data collection and intervention development smartphone application to develop and pilot a mobile BPT intervention for parents of children with ADHD and academic difficulties. The intervention will target candidate mechanisms of child behavioral and academic success including parenting skills, parent academic management, and engagement with treatment material. mBPT will include: 1) online, asynchronous treatment videos, 2) survey data collection, 3) prompts to complete between session parent practice, and 4) personalized adaptive components to enhance parenting skills. Following intervention development and refinement, 60 children with ADHD will be recruited from area pediatric practices and randomly assigned to (1) business and usual (BAU) or (2) mBPT. Within the mBPT group, adaptive components of the intervention will be evaluated in a microrandomized trial. Primary aims are to demonstrate the feasibility and acceptability of the intervention approach. Further, the hypothesized mechanisms (e.g., parent skill use, user engagement) will be measured and correspondence to hypothesized outcomes (e.g., improved child behavior and homework performance) will be evaluated. Data collected will be used to justify a larger effectiveness trial to evaluate mBPT effects on child behavior and academic impairment.