Preschool Attention and Sleep Support (PASS): A Telehealth Intervention for Children at Risk for ADHD

注意力缺陷/多动障碍（ADHD）是一种慢性疾病， 缺陷以及一生中精神和身体健康状况较差的风险。虽然ADHD症状经常 在学龄前出现，大多数儿童在这一发展阶段没有得到识别或治疗， 早期干预可能对ADHD症状轨迹产生最大影响的关键窗口。 此外，即使基于证据的学前行为干预（行为父母培训[BPT]） 然而，对核心ADHD症状的治疗效果并不一致。一种解释是BPT的主要原因是 注意力集中在改善白天的障碍，而ADHD可能是最好的理解为一个24小时的障碍， 白天功能和夜间睡眠都有缺陷。事实上，学龄儿童的睡眠经常失调， ADHD儿童，与ADHD发病率增加有关（即，核心ADHD症状增加 严重程度和合并症，认知和功能较差），并通过行为睡眠药物增强 (BSM)改善ADHD的核心症状。我们最近的研究表明， 睡眠和ADHD症状在一个初级保健为基础的样本学龄前儿童，表明调节睡眠， 可能代表了早期干预寻求改变ADHD症状轨迹的关键机制， 学龄前儿童处于危险之中。认识到睡眠和多动症之间的强大联系在生命的早期，有一个 迫切需要在24小时内通过单一有效的干预措施使BPT适应目标行为， 与BSM整合，这是该年龄组睡眠调节的一线干预措施。此外， 优化交付系统，以达到学龄前儿童在现实世界的临床护理环境中的多动症风险。为 在拟议的项目中，我们将开发和评估为期8周的远程保健的可行性和可接受性。 2004年，对在初级保健中确定的学龄前儿童进行干预（学龄前注意力和睡眠支持; PASS）， ADHD的风险（即，症状加重）。PASS结合了经过验证的行为干预措施， 白天（通过BPT）和夜间（通过BSM）ADHD损伤在一个单一的，精简的治疗。通行证将 由行为医疗保健提供者提供，并将指导护理人员应用先行行为- BPT的ABC框架，以减少白天的行为问题和支持睡眠调节。我们 还将评估PASS对核心ADHD症状、功能结局和 与BPT相比，最后，我们将检验PASS是否影响假设目标 机制，通过体动记录仪和护理人员报告进行睡眠调节，并评估是否改善了睡眠调节 与核心ADHD症状的减轻有关。这项研究的结果将为 有足够把握度的RCT，以评估PASS改善ADHD症状和睡眠的有效性， 童年早期从公共卫生的角度来看，在这一关键时期改善注意力和睡眠， 发育期可能对ADHD轨迹以及更广泛的心理健康产生长期影响。

Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic condition associated with substantial functional deficits as well as risk for poorer mental and physical health over the lifespan. Although ADHD symptoms often emerge during preschool, most children are not identified or treated during this developmental stage, missing the critical window in which early intervention may have the greatest impact on ADHD symptom trajectories. Additionally, even when evidence-based preschool behavioral interventions (behavioral parent training [BPT]) are delivered, treatment effects on core ADHD symptoms are inconsistent. One explanation is BPT's primary focus on ameliorating daytime impairment, whereas ADHD may be best understood as a 24-hour disorder with deficits in both daytime function and nighttime sleep. Indeed, sleep is frequently dysregulated in school-aged children with ADHD, is associated with increased ADHD morbidity (i.e., increased core ADHD symptom severity and comorbidity, poorer cognition and functioning), and when enhanced via behavioral sleep medicine (BSM), results in improved core ADHD symptoms. Our recent work has shown similar associations between sleep and ADHD symptoms in a primary-care based sample of preschoolers, suggesting that regulating sleep may represent a critical mechanism for early interventions seeking to alter ADHD symptom trajectories among preschoolers at risk. Recognizing the powerful connection between sleep and ADHD early in life, there is a critical need to adapt BPT to target behaviors across the 24-hour period in a single, efficient intervention via integration with BSM, the first-line intervention for sleep regulation in this age group. In addition, it is essential to optimize the delivery system to reach preschoolers at-risk for ADHD in real-world clinical care settings. For the proposed project, we will develop and evaluate the feasibility and acceptability of an 8-week telehealth intervention (Preschool Attention and Sleep Support; PASS) for preschoolers identified in primary care as at risk for ADHD (i.e., with elevated symptoms). PASS combines proven behavioral interventions to tackle daytime (via BPT) and nighttime (via BSM) ADHD impairments in a single, streamlined treatment. PASS will be delivered by behavioral health care providers and will guide caregivers in applying the antecedent-behavior- consequence (ABC) framework of BPT to reduce daytime behavior concerns and support sleep regulation. We will also evaluate the short-term effectiveness of PASS on core ADHD symptoms, functional outcomes, and comorbidity compared to BPT. Finally, we will examine whether PASS impacts the hypothesized target mechanism, sleep regulation via both actigraphy and caregiver report, and assess if improved sleep regulation is associated with reduced core ADHD symptoms. Findings from this study will provide the foundation for an adequately-powered RCT to evaluate the effectiveness of PASS to improve ADHD symptoms and sleep during early childhood. From a public health perspective, improving attention and sleep during this critical developmental period may have long-lasting impacts on ADHD trajectories as well as broader mental health.