A Digital Health Solution for Improving Parent Adherence and Sustainability of ADHD Treatment Outcomes

摘要 行为父母训练（BPT）是公认的治疗注意缺陷多动障碍， 相关的损害，但儿童的短期治疗收益通常缺乏普遍性， 持续发展由于BPT依赖于父母，因此缺乏父母的坚持有助于这些有限的影响 在日常生活中使用治疗建议的育儿技巧。一些障碍可以 阻碍父母的依从性，包括技能能力、执行功能（EF）过程和动机/ 态度，以及面对面治疗结束后的特定维护障碍（例如能力适应 新挑战的技能; EF/缺乏持续社会支持的动机障碍）。这些障碍可能是 通过创新的dHealth工具直接解决。本研究的目的是开发和测试一种新的 可扩展的数字医疗解决方案，旨在解决障碍并提高父母在日常生活中的技能利用率 背景，BPT的假设作用机制，目的是提高治疗的可持续性 青少年ADHD的治疗将充分开发一个dHealth工具，以加强学校中基于小组的最佳实践和预测 设置，最大化治疗的可及性。目标1是开发一个技术增强版的 行为父母培训，以提高父母的依从性，并收集有关可用性、可行性 和可接受性。关键利益相关者（父母、儿童和临床医生）的定性和定量输入 通过焦点小组，将进行定性访谈和扩展的形成性使用测试。工具 以具体特点解决技能利用的障碍：1）技能能力：技能库/视频、知识 问题、定制内容和交互式故障排除向导，2）EF过程： 技能使用/辅导，互动/个性化计划的链接家长/儿童视图， 儿童参与，精简内容，3）动机/态度：动机/"改变谈话"信息，目标- 设置，自动监控父母/孩子的进度，游戏化和数字奖励，4）维护- 具体障碍：个性化故障排除以帮助解决新问题，支持社交功能 家长在治疗结束后。目标2是实施技术增强版的试点RCT BPT（N = 30）与仅BPT（N = 30）相比，以收集即刻和持续 (up至治疗后12个月）父母技能利用（主要目标）和养育障碍（中间 目标），以告知更大规模的试验。目的3是检查父母技能利用率（目标机制）是否 应用程序的参与度，以及这种参与度是否与改善的儿童成果相关。我们将探讨 （a）应用程序使用与技能利用之间的关联;（B）技能利用与儿童结果之间的关联;以及（c）应用程序使用之间的关联 减少了父母在预测技能利用和子女结果方面的障碍。探索性分析检查 潜在的中介机制的技能利用（即时和持续），以优化关联 dHealth工具与改善儿童和养育结果之间的关系。

ABSTRACT Behavioral parent training (BPT) is well-established for treating Attention Deficit Hyperactivity Disorder and associated impairments, but short-term treatment gains for children typically lack generalizability and sustainability. Lack of parental adherence contributes to these limited effects, since BPT relies on parents using treatment-recommended parenting skills with children in daily life contexts. A number of barriers can impede parent adherence including skill competence, executive functioning (EF) processes, and motivation/ attitudes, as well as maintenance-specific barriers after in-person treatment ends (e.g. competence adapting skills to new challenges; EF/motivational barriers from lack of ongoing social support). Such barriers may be directly addressable through innovative dHealth tools. The objective of this study is to develop and test a novel and scalable digital health solution designed to address barriers and improve parent skill utilization in daily life contexts, the hypothesized mechanism of action for BPT, with the goal of improving sustainability of treatment outcomes for youth with ADHD. A dHealth tool will be fully developed to augment group-based BPT in school settings, maximizing accessibility of the treatment. Aim 1 is to develop a technology-enhanced version of behavioral parent training for improving parent adherence and collect preliminary data on usability, feasibility and acceptability. Qualitative and quantitative input from key stakeholders (parents, children and clinicians) through focus groups, qualitative interviews and extended formative usage testing will be obtained. The tool addresses barriers to skill utilization with specific features: 1) skill competence: skills library/videos, knowledge questions, tailored content, and interactive troubleshooting wizard, 2) EF processes: in vivo notifications for skill use/coaching, linked parent/child views of interactive/personalized plans integrated in daily routines with child involvement, streamlined content, 3) motivation/attitudes: motivational/ ”change talk” messaging, goal- setting, automated monitoring of parent/child progress, gamification, and digital rewards, 4) maintenance- specific barriers: individualized troubleshooting to assist with new problems and social features to support parents after in-person treatment ends. Aim 2 is to implement a pilot RCT of the technology-enhanced version of BPT (N=30) compared to BPT only (N=30) to gather preliminary efficacy data on immediate and sustained (up to 12 months after treatment) parent skill utilization (primary target), and parenting barriers (intermediate targets) to inform a larger scale trial. Aim 3 is to examine whether parent skill utilization (target mechanism) is engaged by the app and whether this engagement is associated with improved child outcomes. We will explore the association between: (a) app use and skill utilization; (b) skill utilization and child outcomes, and c) app use with reduced parent barriers for predicting skill utilization and child outcomes. Exploratory analyses examine the potential mediating mechanism of skill utilization (immediate and sustained) for optimizing the association between the dHealth tool and improved child and parenting outcomes.