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

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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.