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

项目总结/摘要 注意力缺陷/多动障碍（ADHD）是一种常见的神经发育障碍， 早在学前班。儿童期的注意力不集中和多动会干扰社交和 导致终身残疾的学前技能。目前对ADHD儿童的治疗未能 使ADHD患者的症状和损伤轨迹发生实质性变化。睡眠是一 与ADHD症状持续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）的问题是行为问题，包括睡前阻力， 夜间觉醒，并服从父母行为干预（PBIs）。的美国学院 儿科建议将PBI作为ADHD儿童解决破坏性行为的一线治疗方法 因为ADHD。然而，睡眠并没有包括在PBIs中，以解决年轻人的ADHD症状。 孩子此外，儿童多动症的干预措施通常对家庭来说具有挑战性，因为他们 通常在专业的心理健康诊所进行。因此，在这个创新的项目中，我们将适应COPEing 与ADHD PBI计划，已被证明可以解决ADHD相关的破坏性行为， 睡眠干扰行为的学龄前儿童在多动症的风险增加，这将是交付 行为健康（BH）治疗师嵌入儿科初级保健。关于R34计划 公告MH-21-230，学龄前ADHD儿童干预措施的初步有效性试验，我们将举行 焦点小组（目标1）与儿科医生（n=10），行为健康治疗师嵌入儿科初级 护理人员（n=10）和3-5岁儿童的护理人员（n=10），以告知简报的整合和交付， 以睡眠为中心的PBI（SF-PBI）在儿科初级保健中的应用。然后，我们将进行一项试验性的成效试验（目标2 采用随机、等待对照设计，对50个3-5岁早期儿童的家庭进行了研究。 ADHD症状和睡眠问题本试验将（a）测试以下方法的可行性、可接受性和适当性： （B）检查目标参与（睡眠）的变化，以及 ADHD症状;和（c）评估睡眠和ADHD症状变化之间的关系。的成果 这项试验性有效性试验将为一项针对学龄前儿童睡眠的大规模临床试验提供信息， 通过可获得的、基于初级保健的干预措施，利用养育子女， 战略布局这项工作最终可以通过早期干预来改善有ADHD风险的儿童的结果 睡眠，以减少儿童ADHD的患病率，症状和相关损害， 家庭

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.