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

项目总结。注意力缺陷/多动障碍(ADHD)是最常见的慢性 儿童状况，在社会经济中发病率明显较高，结果较差 弱势儿童。社会逆境，包括未得到满足的基本需求，如粮食无保障、住房 不稳定和缺乏高质量的托儿服务是ADHD症状的潜在危险因素 学龄前几年。为患有ADHD和ADHD的幼儿制定早期干预策略 社会经济劣势对减轻未来的损害至关重要。新的研究表明，低谷 加强以家庭为中心的筛查和转介计划(我们关心)是可行的，也可以 为未得到满足的社会需求(如食物、交通和家长教育)提供更多的资源。 将这一策略调整为针对患有新出现的ADHD的学龄前儿童，他们通常在小学时首先被发现 在关键的发育期，这种护理可能会对临床症状和疾病轨迹产生重大影响。 因此，本项目的目标是开发一种早期干预策略，适用于WE CARE 该方案针对新出现的多动症学龄前儿童的低收入家庭的未得到满足的社会需求。 我们关心的干预措施将在3个关键领域进行调整(针对新的目标人群、内容和 主要结果)通过追求3个相互关联的研究。这些是：1)检查关联 7565名3-5岁全国代表性儿童中未满足的特定社会需求与ADHD症状之间的关系 来自全国儿童健康调查(NSCH)，并探索这种联系的潜在中介 (包括父母的压力、激活和未满足的护理需求)； 确定父母报告的未得到满足的社会需求加剧学龄前儿童ADHD症状的机制 年龄儿童以及针对这些需求的干预如何通过开展 对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、 一种新的治疗模式的随机试点试验，以解决60名低收入家庭父母未得到满足的社会需求 3-5岁有ADHD症状的儿童。本研究计划反映NIMH战略计划的目标3.2，以 制定方法，调整现有和新的干预措施，以优化成果，并满足以下迫切需要 通过针对可改变的危险因素减少儿童心理健康结果中的社会经济差异 易受伤害的幼儿。这些研究目标也将作为务实学习的工具 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)接受现代临床试验设计方面的培训，以研究心理社会和卫生服务干预。 这项有指导意义的K23奖项将有助于斯宾塞博士成为一名独立调查员的长期目标 开发新的干预措施，以减少儿科精神病学结果中的社会经济不平等。

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.