A Parent Behavioral Intervention Targeting Sleep Among Preschool Aged Children at Elevated Risk for ADHD: A Pilot Effectiveness Trial in Pediatric Primary Care

针对多动症高风险学龄前儿童睡眠的家长行为干预：儿科初级保健的试点有效性试验

• 批准号: 10580397
• 负责人: Heather Marie Joseph
• 金额: $ 23.85万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-16 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10580397
• 关键词: 5 year old; Academic skills; Academy; Acute; Address; Affect; American; Attention deficit hyperactivity disorder; Behavior; Behavior Control; Behavior Therapy; Behavioral; Caregivers; Child; Child Behavior; Child Rearing; Childhood; Clinic; Clinical Trials; Coping Skills; Development; Disease; Early Intervention; Economic Burden; Education; Executive Dysfunction; Failure; Family; Feedback; Focus Groups; Hyperactivity; Impaired health; Impairment; Impulsivity; Individual; Intervention; Intervention Trial; Link; Mental Health; NIH Program Announcements; Needles; Neurodevelopmental Disorder; Nursery Schools; Outcome; Parents; Pediatrics; Population; Preschool Child; Prevalence; Primary Care; Protocols documentation; Provider; Randomized; Randomized, Controlled Trials; Recommendation; Resistance; Risk; Risk Factors; School-Age Population; Sleep; Sleep Deprivation; Sleep Disorders; Sleep disturbances; Social Development; Symptoms; Techniques; Training; Translating; Visit; Waiting Lists; Work; behavioral health; comparison intervention; coping; design; effectiveness trial; evidence base; executive function; experimental study; feasibility testing; high risk; improved; improved outcome; improvement on sleep; inattention; innovation; intervention delivery; intervention program; intervention refinement; medical specialties; pediatrician; pilot trial; primary care provider; primary care setting; reduce symptoms; response; satisfaction; skills; sleep difficulty; social

Project Summary/Abstract Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that presents as early as preschool. Inattention and hyperactivity in childhood interfere with the development of social and preacademic skills leading to lifelong impairment. Current treatments for children with ADHD have failed to make substantial changes in the trajectory of symptoms and impairment for individuals with ADHD. Sleep is a modifiable factor that is linked to ADHD symptom persistence and exacerbation. The most common sleep problems amongst preschool children (3-5 years old) are behavioral, including bedtime resistance and nighttime awakenings, and amenable to parent behavioral interventions (PBIs). The American Academy of Pediatrics recommends PBIs as the first line treatment for children with ADHD to address disruptive behaviors due to ADHD. However, sleep has not been included within PBIs to address ADHD symptoms in young children. In addition, interventions for childhood ADHD are typically challenging for families to access, as they are often delivered in specialty mental health clinics. Thus, in this innovative project we will adapt the COPEing with ADHD PBI program, that has been shown to address ADHD-associated disruptive behaviors, to target sleep disrupting behaviors for preschool aged children at elevated risk for ADHD, which will be delivered by behavioral health (BH) therapists embedded in pediatric primary care. In response to the R34 Program Announcement MH-21-230, Pilot Effectiveness Trials of Interventions for Preschoolers with ADHD, we will hold focus groups (Aim 1) with pediatricians (n=10), behavioral health therapists embedded in pediatric primary care (n=10), and caregivers of 3-5 year old children (n=10) to inform the integration and delivery of a brief, sleep-focused PBI (SF-PBI) in pediatric primary care. We will then conduct a pilot effectiveness trial (Aims 2 and 3) with a randomized, waitlist-control design for 50 families of children 3-5 year old children with early ADHD symptoms and sleep problems. This trial will (a) test the feasibility, acceptability, and appropriateness of the of the SF-PBI delivered in pediatric primary care; (b) examine change in target engagement (sleep) and ADHD symptoms; and (c) assess the relation between sleep and ADHD symptoms changes. Outcomes from this pilot effectiveness trial will inform a large-scale clinical trial to target sleep amongst preschool-aged children at elevated risk for ADHD via accessible, primary care-based intervention that harnesses parenting strategies. This work could ultimately improve outcomes for children at risk for ADHD by intervening early on sleep to reduce the prevalence, symptoms, and associated impairments of ADHD amongst children and families.

项目摘要/摘要 注意缺陷/多动症（ADHD）是一种普遍的神经发育障碍，呈现为 早在学前班。童年时期的注意力不集中和多动症干扰社会和 导致终身障碍的学术技巧。目前对患有多动症儿童的治疗未能 对患有多动症患者的症状和障碍的轨迹进行了重大改变。睡眠是 与多动症症状持久性和恶化有关的可修改因素。最常见的睡眠 学龄前儿童（3-5岁）的问题是行为的，包括就寝时间和 夜间觉醒，并适合父母行为干预措施（PBI）。美国学院 儿科建议PBI作为ADHD儿童的第一行治疗，以解决破坏性行为 由于多动症。但是，尚未在PBI中包括睡眠以解决年轻的ADHD症状 孩子们。此外，童年多动症的干预措施通常对家庭挑战，因为 通常在专业的心理健康诊所提供。因此，在这个创新的项目中，我们将适应应对 通过ADHD PBI计划，已证明可以解决与ADHD相关的破坏行为 为了增加多动症风险较高的学龄前儿童的睡眠破坏行为，这将由 行为健康（BH）治疗师嵌入了小儿初级保健中。响应R34程序 宣布MH-21-230，对学龄前儿童进行多动症的干预措施的试验有效性试验，我们将举行 焦点小组（AIM 1）与儿科医生（n = 10），行为健康治疗师嵌入儿科初级 护理（n = 10），以及3-5岁儿童的护理人员（n = 10），以告知摘要的整合和交付 小儿初级保健中以睡眠为中心的PBI（SF-PBI）。然后，我们将进行飞行员有效性试验（Aims 2 3）具有3-5岁儿童的50个儿童家庭的随机，候补，候补。 多动症症状和睡眠问题。该试验将（a）测试可行性，可接受性和适当性 在小儿初级保健中提供的SF-PBI； （b）检查目标参与的变化（睡眠）和 多动症症状； （c）评估睡眠和多动症症状之间的关系变化。结果 这项试验有效性试验将为大规模临床试验提供旨在针对学龄前儿童睡眠的大规模临床试验 通过可访问的初级保健干预措施来利用育儿的儿童ADHD风险较高 策略。这项工作最终可以通过早期介入来改善有多动症风险的儿童的结果 睡眠以减少儿童中多动症的患病率，症状和相关障碍 家庭。