Home-Based Parent Training in ADHD Preschoolers

描述（由申请人提供）：通过一项有前途的英国家庭干预[新森林育儿一揽子计划（NFPP）]的特异性和非特异性疗效测试，解决幼儿多动症非药物治疗的需求。理由：多动症起源于儿童早期，预示着多种功能障碍。虽然精神兴奋剂对患有多动症的学龄前儿童有效，但家庭抵制使用它们。因此，为学龄前儿童建立有效的社会心理干预措施是公共卫生的优先事项。NFPP是唯一对学龄前儿童ADHD和ODD症状有记录的即时和持续疗效的干预措施。该研究评估了NFPP相对于标准父母干预[帮助不服从儿童（HNCC）]和等候名单（WL）控制的优越性。HNCC已被证明可以改善学龄前儿童的对立行为。它对ADHD症状的影响还未经测试。假设：在3岁ADHD患儿中，NFPP在减轻ADHD症状和儿童对奖励的延迟耐受方面优于HNCC和WL；NFPP在减轻ODD症状方面优于WL；NFPP在ADHD症状方面优于HNCC的优势将保持到干预后的学年。我们将探讨照顾者ADHD对治疗结果的调节作用，以及父母教养方式的改变是否介导NFPP和HNCC的治疗效果。设计：225名在家中和学校患有ADHD的学龄前儿童（3.0 - 3-11岁）将被随机分为1)NFPP, 2) HNCC或3)WL，为期8周。多动症的测量方法包括由主要看护人、老师、临床医生和直接观察儿童进行评分。看护人将被评估ADHD诊断和一般精神病理学。多信息、多方法，包括观察父母与孩子的互动，将在治疗结束时评估父母的行为和孩子的功能，并进入治疗后的学年秋季。分析：ITT ANCOVA将测试即时和后续治疗的差异。统计交互作用将探讨假设的调节因子（即看护型ADHD）与治疗差异之间的关系。结构方程模型将探讨看护行为变化的中介作用。

DESCRIPTION (provided by applicant): To address the need for non-pharmacological treatment in young children with ADHD through a test of specific and non-specific efficacy of a promising UK home-based intervention [New Forest Parenting Package (NFPP)]. Rationale: ADHD originates in early childhood and predicts multiple functional impairments. Although psychostimulants are effective in preschoolers with ADHD, families resist their use. Therefore, establishing effective psychosocial interventions for preschoolers represents a public health priority. NFPP is the only intervention with documented immediate and sustained efficacy for ADHD and ODD symptoms in preschoolers. The study evaluates NFPP's superiority to a standard parenting intervention [Helping Non-Compliant Children (HNCC)] and a wait-list (WL) control. HNCC has been shown to improve oppositional behaviors in preschoolers. Its effect on ADHD symptoms is untested. Hypotheses: In 3 year olds with ADHD, NFPP is superior to HNCC and WL in reducing ADHD symptoms, and children's delay tolerance for rewards; NFPP is superior to WL in reducing ODD symptoms; NFPP's superiority over HNCC on ADHD symptoms will be maintained into the school year following the intervention. We will explore the moderating effect of caretaker's ADHD on treatment outcome, and whether changes in parenting mediate treatment efficacy in NFPP and HNCC. Design: 225 preschoolers (3.0 - 3-11) with ADHD at home and school will be randomized to 1) NFPP, 2) HNCC, or 3) WL for 8 weeks. ADHD measures include ratings by primary caretaker, teacher, clinician and direct child observations. Caretakers will be assessed for ADHD diagnosis and general psychopathology. Multi-informant, multi-methods, including observations of parent- child interactions, will assess parental behavior and children's function at the end of treatment, and into the fall of the school year following treatment. Analyses: ITT ANCOVA's will test immediate and follow-up treatment differences. Statistical interactions will explore relationships between postulated moderators (i.e., caretaker ADHD) and treatment differences. Structural equation modeling will explore the mediating role of changes in caretaker behaviors.