1/2 Treating Mothers with ADHD and their Young Children Via Telehealth: A Hybrid Type I Effectiveness-Implementation Trial

1/2 通过远程医疗治疗患有多动症的母亲及其幼儿：I 型有效性实施混合试验

基本信息

批准号：
10224020
负责人：
MARK A STEIN
金额：
$ 69.52万
依托单位：
SEATTLE CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-08-07 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10224020
关键词：
Adoption Adult Attention Attention deficit hyperactivity disorder Awareness Behavior Therapy Behavioral Caring Child Child Behavior Child Rearing Childhood Clinical Combined Modality Therapy Data Development Dissemination and Implementation Early Intervention Enrollment Environmental Risk Factor Familial disease Family Genetic Risk Health Personnel Healthcare Hybrids Impairment Impulsivity Intervention Left Link Literature Mediating Mental Health Modeling Mothers Outcome Parents Participant Patients Pharmaceutical Preparations Prevalence Primary Health Care Prior Therapy Procedures Provider Randomized Readiness Recommendation Research Research Methodology Risk School-Age Population Severities Site Structure Symptoms Testing Time Training Treatment outcome Washington base care delivery care providers comparative effectiveness effectiveness implementation study effectiveness implementation trial emotion dysregulation emotion regulation health care delivery implementation barriers implementation study improved inattention innovation maternal outcome medical specialties offspring personalized intervention practice setting prescription stimulants primary care setting primary outcome racial and ethnic racial diversity recruit screening participation skills socioeconomics symptomatology telehealth treatment guidelines treatment response treatment strategy uptake

项目摘要

ABSTRACT/PROJECT SUMMARY Maternal ADHD, present in 25-50% of families of children with ADHD and frequently untreated, interferes with effective parenting and predicts poor child developmental and behavioral treatment outcomes. Based on the literature and our own pilot data, we will randomly assign mothers with ADHD and their young at-risk children to one of two conditions: (1) stimulant medication for mothers with ADHD followed by a child treatment strategy (CTS) beginning with behavioral parent training (BPT) with the added recommendation of child stimulant treatment if the child remains impaired or (2) a CTS without treatment for maternal ADHD on parent, child, and family outcomes. We will examine target mechanisms including improvements in maternal ADHD-related impairment and symptomatology (attention, impulsivity, emotional regulation), parenting skills, and BPT engagement, as well as treatment moderators (baseline maternal ADHD severity, maternal impairment, and parenting skills). Moreover, in an effort to develop a model of treatment that has potential for widespread dissemination while also reducing barriers to receiving care, we will screen mothers for ADHD in primary care, where child ADHD is most often identified and treated, and co-located mental health providers will deliver treatments via telehealth. Development of an implementation plan and associated toolkit using a stakeholder participatory strategy will enhance the ability to move efficiently to adoption of this approach. In addition, we will study the care delivery context, assessing procedures for and rates of screening and participation as well as staffing, workflow, provider- and patient-level acceptability, readiness, and feasibility of implementation approaches. This hybrid effectiveness-implementation project will be achieved via a collaborative R01 across 2 research sites in the US (N = 240 families), with 4-5 primary care partners at each site.

摘要/项目摘要 25-50% 的儿童患有 ADHD 的家庭中存在母亲 ADHD，并且经常未经治疗，这会干扰有效的养育方式并预测不良儿童的发育和行为治疗结果。基于根据文献和我们自己的试点数据，我们将随机分配患有多动症的母亲及其高危儿童符合以下两种情况之一：(1) 对患有多动症的母亲使用兴奋剂药物，然后采取儿童治疗策略 (CTS) 从行为父母培训 (BPT) 开始，并添加儿童兴奋剂的建议如果孩子仍然存在障碍，则接受治疗，或 (2) 父母、孩子和母亲未接受母亲多动症治疗的 CTS 家庭结果。我们将研究目标机制，包括改善与母亲多动症相关的症状障碍和症状（注意力、冲动、情绪调节）、养育技巧和 BPT 参与度以及治疗调节因素（母亲 ADHD 严重程度基线、母亲损伤和育儿技巧）。此外，为了开发一种具有广泛应用潜力的治疗模式传播的同时也减少接受护理的障碍，我们将在初级保健中筛查母亲是否患有多动症，儿童多动症最常被识别和治疗的地方，同地办公的心理健康服务提供者将提供服务通过远程医疗进行治疗。使用利益相关者制定实施计划和相关工具包参与性战略将增强有效采用这一方法的能力。此外，我们将研究护理提供环境，评估筛查和参与的程序和比率作为人员配备、工作流程、提供者和患者层面的可接受性、准备情况和实施的可行性接近。该混合有效性实施项目将通过跨 2 个领域的协作 R01 来实现美国的研究地点（N = 240 个家庭），每个地点有 4-5 个初级保健合作伙伴。