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

学前注意力和睡眠支持 (PASS)：针对患有 ADHD 风险的儿童的远程医疗干预

• 批准号: 10580314
• 负责人: Jessica Ruth Lunsford-Avery
• 金额: $ 24.15万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-10 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10580314
• 关键词: Address; Attention; Attention deficit hyperactivity disorder; Behavior; Behavior Therapy; Behavioral; Caregivers; Child; Child Rearing; Childhood; Chronic; Clinical; Clinical Trials; Cognition; Development; Disease; Early Intervention; Early identification; Early treatment; Effectiveness; Environment; Focus Groups; Foundations; Health Personnel; Hour; Impairment; Individual; Intervention; Life; Life Cycle Stages; Longevity; Measures; Medicine; Mental Health; Morbidity - disease rate; Nursery Schools; Outcome; Parents; Preparation; Primary Care; Public Health; Randomized, Controlled Trials; Reporting; Research Personnel; Risk; Risk Factors; Sampling; School-Age Population; Science; Severities; Shapes; Sleep; Sleep Disorders; Sleep disturbances; Societies; Stress; Symptoms; System; Time; Toddler; Training; Work; Youth; acceptability and feasibility; actigraphy; age group; behavioral health; clinical care; comorbidity; critical developmental period; early childhood; effectiveness evaluation; evidence base; expectation; follow-up; functional outcomes; high risk; improved; improvement on sleep; intervention delivery; physical conditioning; post intervention; primary care setting; prospective; skills; sleep behavior; sleep regulation; telehealth; treatment effect; treatment trial

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.

注意缺陷/多动症（ADHD）是一种与实质功能相关的慢性病 在整个生命周期内，缺陷以及身心健康较差的风险。尽管经常出现多动症症状 在学前班期间出现，大多数儿童在此发育阶段没有被发现或治疗 早期干预可能对多动症症状轨迹产生最大影响的关键窗口。 此外，即使基于证据的学龄前行为干预措施（行为父母培训[BPT]） 交付，对核心多动症症状的治疗效果不一致。一个解释是BPT的主要 专注于改善白天障碍，而ADHD最好被理解为24小时的疾病 白天功能和夜间睡眠的缺陷。确实，睡眠经常失调 患有多动症的儿童与ADHD发病率增加有关（即核心ADHD症状增加 严重性和合并症，认知和功能较差），以及通过行为睡眠医学增强 （BSM），导致核心多动症症状改善。我们最近的工作显示了相似的关联 在学龄前儿童的初级护理样本中的睡眠和多动症症状，表明调节睡眠 可能代表着试图改变ADHD症状轨迹的早期干预措施的关键机制 有风险的学龄前儿童。认识到生命早期睡眠与多动症之间的强大联系，有一个 通过单一的，有效的干预措施，将BPT适应BPT的靶向行为 与BSM集成，BSM是该年龄组睡眠调节的一线干预措施。另外，这是必不可少的 为了优化在现实世界中临床护理环境中，在危险中吸引学龄前儿童的交付系统。为了 拟议的项目，我们将开发和评估8周远程医疗的可行性和可接受性 在初级保健中确定的学龄前儿童的干预（学龄前关注和睡眠支持；通过） 多动症的风险（即症状升高）。通行证结合了验证的行为干预措施以解决 白天（通过BPT）和夜间（通过BSM）进行单一简化治疗中的ADHD障碍。通行证将是 由行为医疗保健提供者提供的，并将指导护理人员应用前身行为 后果（ABC）BPT的框架减少白天行为问题并支持睡眠调节。我们 还将评估通行证对核心多动症症状，功能结果和 与BPT相比，合并症。最后，我们将检查通过是否影响假设的目标 机制，通过Actraphy和Caregiver报告进行睡眠调节，并评估是否改善睡眠调节 与减少的核心多动症症状有关。这项研究的发现将为 足够动力的RCT评估通过 幼儿。从公共卫生的角度来看，在这个关键时期提高注意力和睡眠 发育时期可能会对多动症轨迹以及更广泛的心理健康产生长期影响。