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

项目摘要/摘要 注意力缺陷/多动障碍(ADHD)是一种普遍存在的神经发育障碍，表现为 早在学前班的时候。儿童时期的注意力不集中和多动干扰了社会和儿童的发展 学前性技能会导致终生残疾。目前对ADHD儿童的治疗方法未能奏效 使ADHD患者的症状和损害轨迹发生实质性变化。睡眠是一种 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)存在行为问题，包括睡前抵抗和 夜间觉醒，并服从父母的行为干预(PBI)。美国科学院 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 由于多动症。然而，睡眠并没有包括在PBI中以解决年轻人的ADHD症状 孩子们。此外，对儿童ADHD的干预通常对家庭来说具有挑战性，因为他们 通常在专门的精神卫生诊所提供。因此，在这个创新的项目中，我们将调整COPEING 通过ADHD PBI计划，已证明可以解决与ADHD相关的破坏性行为，以 患有多动症风险较高的学龄前儿童的睡眠障碍行为将由 嵌入儿科初级保健的行为健康(BH)治疗师。对R34计划的回应 公告MH-21-230，对患有ADHD的学龄前儿童干预的试点有效性试验，我们将举行 焦点小组(目标1)，由儿科医生组成(n=10)，行为健康治疗师嵌入儿科初级 护理(n=10)和3-5岁儿童的照顾者(n=10)，以告知融合和交付一份简报， 儿童初级保健中的以睡眠为重点的PBI(SF-PBI)。然后，我们将进行试点有效性试验(目标2 3)采用随机、等待名单对照设计，对50个3-5岁早产儿家庭进行研究 多动症症状和睡眠问题。这项试验将(A)检验以下各项的可行性、可接受性和适当性 在儿科初级保健中提供SF-PBI；(B)检查目标参与(睡眠)的变化和 评估睡眠与ADHD症状变化之间的关系。结果来自 这项试点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，利用育儿手段，提高儿童患ADHD的风险 战略。这项工作可以通过早期干预最终改善ADHD高危儿童的结局 睡眠以减少儿童和儿童中ADHD的患病率、症状和相关损害 家人。

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.