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

用于提高家长依从性和多动症治疗结果可持续性的数字健康解决方案

基本信息

批准号：
10056759
负责人：
Linda Pfiffner
金额：
$ 72.68万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10056759
关键词：
Address Adherence Affect Aftercare Attention deficit hyperactivity disorder Attitude Behavior Therapy Behavioral Child Child Behavior Child Rearing Clinical Competence Data Development Enhancement Technology Family Focus Groups Goals Health Health Personnel Impairment Income Internet Interview Knowledge Libraries Life Link Maintenance Measures Mediating Mental Health Methods Motivation Notification Outcome Parents Persons Pilot Projects Population Process Psychological reinforcement Rewards Role School-Age Population Schools Social support Symptoms Testing Training Training Programs Treatment outcome Youth base design digital evidence base executive function functional disability handheld mobile device health application improved in vivo innovation novel parental monitoring skills social sustained attention tool treatment strategy uptake usability

项目摘要

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.

抽象的行为父母培训 (BPT) 已被广泛应用于治疗注意力缺陷多动障碍和相关的损害，但儿童的短期治疗收益通常缺乏普遍性和由于 BPT 依赖于父母，因此缺乏父母的依从性会导致这些有限的影响。在日常生活中对儿童使用治疗建议的养育技巧可能会遇到一些障碍。阻碍家长的依从性，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维持特定的障碍（例如适应能力）应对新挑战的技能；EF/由于缺乏持续的社会支持而产生的动机障碍）。可通过创新的 dHealth 工具直接解决。本研究的目的是开发和测试一种新颖的方法。可扩展的数字健康解决方案，旨在解决障碍并提高家长在日常生活中的技能利用率开发的 BPT 行动机制，旨在提高治疗的可持续性将全面开发 dHealth 工具，以增强学校中基于团体的 BPT。目标 1 是开发技术增强版本。行为家长培训，用于提高家长依从性并收集有关可用性、可行性的初步数据主要利益相关者（父母、儿童和精英）的定性和定量投入。通过焦点小组、定性访谈和扩展的形成性使用测试，将获得该工具。针对技能运用的具体特点：1）技能能力：障碍技能库/视频、知识问题、定制内容和交互式故障排除向导，2) EF 流程：体内通知技能使用/辅导，将父母/孩子对互动/个性化计划的看法与日常生活相结合儿童参与、精简内容、3) 动机/态度：动机/“改变谈话”信息、目标- 设置、自动监控家长/孩子的进度、游戏化和数字奖励，4) 维护- 具体：个性化故障排除，以协助解决新问题和社会障碍以提供支持目标 2 是实施技术增强版本的试点随机对照试验。 BPT (N=30) 与仅 BPT (N=30) 进行比较，以收集立即和持续的初步疗效数据（治疗后最多 12 个月）父母技能利用（主要目标）和养育障碍（中级）目标）为更大规模的试验提供信息目标 3 是检查家长技能利用率（目标机制）是否有效。我们将探讨该应用程序的参与度以及这种参与度是否与改善儿童的成绩有关。 (a) 应用程序使用和技能利用之间的关联；(b) 技能利用和儿童成果，以及 c) 应用程序使用减少家长预测技能利用和儿童结果的障碍。优化关联的技能利用（立即和持续）的潜在中介机制 dHealth 工具与改善儿童和育儿结果之间的关系。