Developing a Pediatrics-based Social Needs Intervention to Reduce Disparities in ADHD Outcomes for Low-income Children

制定基于儿科的社会需求干预措施，以减少低收入儿童多动症结果的差异

• 批准号: 10795536
• 负责人: Andrea Spencer
• 金额: $ 10.85万
• 依托单位: LURIE CHILDREN'S HOSPITAL OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-21 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10795536
• 关键词: Developing; Pediatrics; based; Social; Needs

PROJECT SUMMARY. Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common chronic conditions in childhood, with significantly higher rates and worse outcomes among socioeconomically disadvantaged children. Social adversities including unmet basic needs such as food insecurity, housing instability, and lack of quality child care emerge as potent risk factors for ADHD symptoms as early as the preschool years. The development of early intervention strategies for young children with both ADHD and socioeconomic disadvantage is critical for mitigating future impairment. New research demonstrates that a low intensity, family-centered screening and referral program (WE CARE) at well infant visits is feasible and can increase receipt of resources for unmet social needs (e.g. food, transportation, and parent education). Adapting this strategy to target preschoolers with emerging ADHD, who are typically first identified in primary care, could significantly impact clinical symptoms and disease trajectory during a critical developmental period. Therefore, the objective of this project is develop an early intervention strategy, adapted from the WE CARE program, targeting unmet social needs for low-income families of preschool-age children with emerging ADHD. The WE CARE intervention will be adapted on 3 key domains (for a new target population, content, and primary outcomes) through the pursuit of 3 interrelated studies. These are: 1) Examine the association between specific unmet social needs and ADHD symptoms in 7,565 nationally representative children age 3-5 from the National Survey for Children's Health (NSCH) and explore potential mediators of this association (including parental stress, activation, and unmet need for care) via structural equation modeling (SEM); 2) Identify parent-reported mechanisms by which unmet social needs exacerbate ADHD symptoms in preschool age children and how an intervention addressing these needs could improve clinical outcomes by conducting semi-structured interviews with 25 parents of preschoolers with ADHD symptoms; and 3) Conduct an adaptive, randomized pilot trial of a novel treatment model addressing unmet social needs with parents of 60 low-income children age 3-5 with ADHD symptoms. This research plan reflects Objective 3.2 of the NIMH Strategic Plan, to develop ways to tailor existing and new interventions to optimize outcomes, and addresses an urgent need to reduce socioeconomic disparities in pediatric mental health outcomes by targeting modifiable risk factors in vulnerable young children. These research aims will also serve as vehicles for pragmatic learning of the following training goals: 1) Learn advanced statistical modeling and measurement methods for social determinants research; 2) Gain expertise in intervention development to reduce mental health disparities; and 3) Obtain training in modern clinical trial design for the study of psychosocial and health services interventions. This mentored K23 award will facilitate Dr. Spencer's long-term goal of becoming an independent investigator developing novel interventions to reduce socioeconomic inequities in pediatric psychiatric outcomes.

项目摘要。注意力缺陷多动障碍（ADHD）是一种最常见的慢性 儿童的社会经济状况， 弱势儿童。社会困境，包括粮食不安全、住房等基本需求得不到满足 不稳定，缺乏高质量的儿童保育，早在儿童时期就成为ADHD症状的潜在危险因素。 学龄前儿童多动症早期干预策略的发展， 社会经济不利因素对减轻未来损害至关重要。新的研究表明，低 在健康婴儿访视时，以家庭为中心的高强度筛查和转诊计划（WE CARE）是可行的， 为未得到满足的社会需求（如食品、交通和家长教育）提供更多资源。 调整这一策略，以针对学龄前儿童与新兴的多动症，谁通常是第一次确定在小学 在关键的发育期，护理可能会显著影响临床症状和疾病轨迹。 因此，本项目的目标是制定一项早期干预战略， 该计划针对患有新兴ADHD的学龄前儿童的低收入家庭未满足的社会需求。 WE CARE干预措施将在3个关键领域进行调整（针对新的目标人群、内容和 通过3项相互关联的研究，实现主要成果。（1）考察协会 在7,565名3-5岁的全国代表性儿童中，特定未满足的社会需求与ADHD症状之间的关系 从全国儿童健康调查（NSCH），并探讨这种关联的潜在介质 （包括父母压力，激活和未满足的护理需求）通过结构方程模型（SEM）; 2） 确定父母报告的机制，通过这些机制，未满足的社会需求加剧了学龄前儿童的ADHD症状 年龄的儿童，以及如何解决这些需求的干预措施可以改善临床结果， 与25名有ADHD症状的学龄前儿童的父母进行半结构化访谈; 3）进行适应性， 一项针对60名低收入家庭父母的新型治疗模式的随机试点试验， 3-5岁有ADHD症状的儿童。该研究计划反映了NIMH战略计划的目标3.2， 制定方法，调整现有的和新的干预措施，以优化成果，并解决迫切需要， 通过针对可改变的风险因素，减少儿童心理健康结果的社会经济差异， 脆弱的儿童。这些研究目标也将成为语用学习的工具。 以下培训目标：1）学习先进的社会统计建模和测量方法 决定因素研究; 2）获得干预发展方面的专业知识，以减少心理健康差距;以及 3)获得现代临床试验设计的培训，以研究心理社会和卫生服务干预措施。 这个指导K23奖将促进博士斯宾塞的长期目标，成为一名独立的调查员 开发新的干预措施，以减少儿科精神病结局中的社会经济不平等。