Administrative Supplement to: Developing a Pediatrics-based Social Needs Intervention to Reduce Disparities in ADHD Outcomes for Low-income Children

行政补充：制定基于儿科的社会需求干预措施，以减少低收入儿童多动症结果的差异

• 批准号: 10623528
• 负责人: Andrea Spencer
• 金额: --
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2022-09-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10623528
• 关键词: Address; Administrative Supplement; Affect; Age; Attention deficit hyperactivity disorder; Caring; Child; Child Care; Child Health; Childhood; Chronic; Chronic Disease; Clinical; Clinical Trials Design; Development; Disease; Early Intervention; Education; Equation; Family; Food; Future; Goals; Health Services; Impairment; Infant; Intervention; Interview; Learning; Low income; Measurement; Mediator of activation protein; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; Modernization; Morbidity - disease rate; National Institute of Mental Health; Nursery Schools; Onset of illness; Outcome; Parents; Pediatrics; Prevalence; Primary Health Care; Psychiatric Social Work; Psychosocial Assessment and Care; Randomized; Reporting; Research; Research Personnel; Resources; Risk Factors; Statistical Models; Strategic Planning; Stress; Structure; Surveys; Symptoms; Target Populations; Training; Transportation; Visit; base; critical developmental period; disparity reduction; food insecurity; health disparity; housing instability; improved; lower income families; modifiable risk; novel; pilot trial; primary outcome; programs; screening; service intervention; side effect; social; social adversity; social determinants; socioeconomic adversity; socioeconomic disadvantage; socioeconomic disparity; therapy development

PROJECT SUMMARY. Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common chronic conditions in childhood, with significantly higher rates and worse outcomes among socioeconomically disadvantaged children. Social adversities including unmet basic needs such as food insecurity, housing instability, and lack of quality child care emerge as potent risk factors for ADHD symptoms as early as the preschool years. The development of early intervention strategies for young children with both ADHD and socioeconomic disadvantage is critical for mitigating future impairment. New research demonstrates that a low intensity, family-centered screening and referral program (WE CARE) at well infant visits is feasible and can increase receipt of resources for unmet social needs (e.g. food, transportation, and parent education). Adapting this strategy to target preschoolers with emerging ADHD, who are typically first identified in primary care, could significantly impact clinical symptoms and disease trajectory during a critical developmental period. Therefore, the objective of this project is develop an early intervention strategy, adapted from the WE CARE program, targeting unmet social needs for low-income families of preschool-age children with emerging ADHD. The WE CARE intervention will be adapted on 3 key domains (for a new target population, content, and primary outcomes) through the pursuit of 3 interrelated studies. These are: 1) Examine the association between specific unmet social needs and ADHD symptoms in 7,565 nationally representative children age 3-5 from the National Survey for Children's Health (NSCH) and explore potential mediators of this association (including parental stress, activation, and unmet need for care) via structural equation modeling (SEM); 2) Identify parent-reported mechanisms by which unmet social needs exacerbate ADHD symptoms in preschool age children and how an intervention addressing these needs could improve clinical outcomes by conducting semi-structured interviews with 25 parents of preschoolers with ADHD symptoms; and 3) Conduct an adaptive, randomized pilot trial of a novel treatment model addressing unmet social needs with parents of 60 low-income children age 3-5 with ADHD symptoms. This research plan reflects Objective 3.2 of the NIMH Strategic Plan, to develop ways to tailor existing and new interventions to optimize outcomes, and addresses an urgent need to reduce socioeconomic disparities in pediatric mental health outcomes by targeting modifiable risk factors in vulnerable young children. These research aims will also serve as vehicles for pragmatic learning of the following training goals: 1) Learn advanced statistical modeling and measurement methods for social determinants research; 2) Gain expertise in intervention development to reduce mental health disparities; and 3) Obtain training in modern clinical trial design for the study of psychosocial and health services interventions. This mentored K23 award will facilitate Dr. Spencer's long-term goal of becoming an independent investigator developing novel interventions to reduce socioeconomic inequities in pediatric psychiatric outcomes.

项目摘要。注意缺陷/多动症（ADHD）是最常见的慢性之一 童年的状况，在社会经济上的率明显更高和较差的结果 不利的孩子。社会逆境，包括未满足的基本需求，例如粮食不安全，住房 不稳定和缺乏优质的儿童保育作为ADHD症状的有效危险因素 学龄前年。为患有多动症和多动症的幼儿制定早期干预策略 社会经济劣势对于减轻未来损害至关重要。新研究表明低 婴儿访问时的强度，以家庭为中心的筛查和推荐计划（我们关心）是可行的，可以 增加收到未满足的社会需求的资源（例如食品，运输和父母教育）。 将此策略调整为针对学龄前儿童的新兴ADHD，通常是在初级中首次确定的 在关键的发育时期，护理可能会显着影响临床症状和疾病轨迹。 因此，该项目的目的是制定一种早期干预策略，适应我们的关心 计划，针对新兴ADHD的学龄前儿童的低收入家庭的未满足社会需求。 我们关心的干预措施将适用于3个关键领域（对于新的目标人群，内容和 主要结果）通过追求3个相互关联的研究。这些是：1）检查关联 在7,565名全国代表性儿童3-5岁的特定未满足的社会需求和多动症症状之间 从全国儿童健康调查（NSCH）探索该协会的潜在调解人 （包括父母的压力，激活和未满足的护理需求）通过结构方程建模（SEM）； 2） 确定未满足的社会需求加剧学龄前症状的父母报告的机制 年龄儿童以及解决这些需求的干预措施如何通过进行来改善临床结果 对25名患有多动症症状的学龄前儿童父母的半结构化访谈； 3）进行自适应， 一种新型治疗模型的随机试验试验，以解决60个低收入父母的未满足社会需求 患有多动症症状的3-5岁儿童。该研究计划反映了NIMH战略计划的目标3.2 开发方法来调整现有和新的干预措施以优化结果，并迫切需要 通过针对可修改的危险因素来减少儿科心理健康结果的社会经济差异 脆弱的幼儿。这些研究目的还将作为务实学习的工具 遵循培训目标：1）学习社会的高级统计建模和测量方法 决定因素研究； 2）在干预开发方面获得专业知识，以减少心理健康差异；和 3）获得现代临床试验设计的培训，以研究社会心理和卫生服务干预措施。 这项指导的K23奖将有助于Spencer博士成为独立研究员的长期目标 开发新的干预措施，以减少小儿精神病结局中的社会经济不平等。