A Parent Behavioral Intervention Targeting Sleep Among Preschool Aged Children at Elevated Risk for ADHD: A Pilot Effectiveness Trial in Pediatric Primary Care

针对多动症高风险学龄前儿童睡眠的家长行为干预：儿科初级保健的试点有效性试验

• 批准号: 10580397
• 负责人: Heather Marie Joseph
• 金额: $ 23.85万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-16 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10580397
• 关键词: 5 year old; Academic skills; Academy; Acute; Address; Affect; American; Attention deficit hyperactivity disorder; Behavior; Behavior Control; Behavior Therapy; Behavioral; Caregivers; Child; Child Behavior; Child Rearing; Childhood; Clinic; Clinical Trials; Coping Skills; Development; Disease; Early Intervention; Economic Burden; Education; Executive Dysfunction; Failure; Family; Feedback; Focus Groups; Hyperactivity; Impaired health; Impairment; Impulsivity; Individual; Intervention; Intervention Trial; Link; Mental Health; NIH Program Announcements; Needles; Neurodevelopmental Disorder; Nursery Schools; Outcome; Parents; Pediatrics; Population; Preschool Child; Prevalence; Primary Care; Protocols documentation; Provider; Randomized; Randomized, Controlled Trials; Recommendation; Resistance; Risk; Risk Factors; School-Age Population; Sleep; Sleep Deprivation; Sleep Disorders; Sleep disturbances; Social Development; Symptoms; Techniques; Training; Translating; Visit; Waiting Lists; Work; behavioral health; comparison intervention; coping; design; effectiveness trial; evidence base; executive function; experimental study; feasibility testing; high risk; improved; improved outcome; improvement on sleep; inattention; innovation; intervention delivery; intervention program; intervention refinement; medical specialties; pediatrician; pilot trial; primary care provider; primary care setting; reduce symptoms; response; satisfaction; skills; sleep difficulty; social

Project Summary/Abstract Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that presents as early as preschool. Inattention and hyperactivity in childhood interfere with the development of social and preacademic skills leading to lifelong impairment. Current treatments for children with ADHD have failed to make substantial changes in the trajectory of symptoms and impairment for individuals with ADHD. Sleep is a modifiable factor that is linked to ADHD symptom persistence and exacerbation. The most common sleep problems amongst preschool children (3-5 years old) are behavioral, including bedtime resistance and nighttime awakenings, and amenable to parent behavioral interventions (PBIs). The American Academy of Pediatrics recommends PBIs as the first line treatment for children with ADHD to address disruptive behaviors due to ADHD. However, sleep has not been included within PBIs to address ADHD symptoms in young children. In addition, interventions for childhood ADHD are typically challenging for families to access, as they are often delivered in specialty mental health clinics. Thus, in this innovative project we will adapt the COPEing with ADHD PBI program, that has been shown to address ADHD-associated disruptive behaviors, to target sleep disrupting behaviors for preschool aged children at elevated risk for ADHD, which will be delivered by behavioral health (BH) therapists embedded in pediatric primary care. In response to the R34 Program Announcement MH-21-230, Pilot Effectiveness Trials of Interventions for Preschoolers with ADHD, we will hold focus groups (Aim 1) with pediatricians (n=10), behavioral health therapists embedded in pediatric primary care (n=10), and caregivers of 3-5 year old children (n=10) to inform the integration and delivery of a brief, sleep-focused PBI (SF-PBI) in pediatric primary care. We will then conduct a pilot effectiveness trial (Aims 2 and 3) with a randomized, waitlist-control design for 50 families of children 3-5 year old children with early ADHD symptoms and sleep problems. This trial will (a) test the feasibility, acceptability, and appropriateness of the of the SF-PBI delivered in pediatric primary care; (b) examine change in target engagement (sleep) and ADHD symptoms; and (c) assess the relation between sleep and ADHD symptoms changes. Outcomes from this pilot effectiveness trial will inform a large-scale clinical trial to target sleep amongst preschool-aged children at elevated risk for ADHD via accessible, primary care-based intervention that harnesses parenting strategies. This work could ultimately improve outcomes for children at risk for ADHD by intervening early on sleep to reduce the prevalence, symptoms, and associated impairments of ADHD amongst children and families.

项目概要/摘要 注意力缺陷/多动障碍（ADHD）是一种常见的神经发育障碍，表现为 早在学前班。儿童时期的注意力不集中和多动会干扰社交能力和智力的发展 导致终身损害的学前技能。目前针对多动症儿童的治疗未能 显着改变多动症患者的症状和损伤轨迹。睡眠是一个 与 ADHD 症状持续和恶化相关的可改变因素。最常见的睡眠 学龄前儿童（3-5岁）的问题是行为问题，包括睡前抗拒和 夜间醒来，并且适合父母行为干预（PBI）。美国科学院 儿科建议 PBI 作为多动症儿童的一线治疗方法，以解决破坏性行为 由于多动症。然而，睡眠尚未纳入 PBI 中来解决年轻人的多动症症状 孩子们。此外，儿童多动症的干预措施对于家庭来说通常具有挑战性，因为他们 通常在专业心理健康诊所提供。因此，在这个创新项目中，我们将采用 COPEing 与 ADHD PBI 计划一起，该计划已被证明可以解决与 ADHD 相关的破坏性行为，以针对 患有 ADHD 风险较高的学龄前儿童的睡眠干扰行为，将由 参与儿科初级保健的行为健康（BH）治疗师。响应 R34 计划 公告 MH-21-230，对患有 ADHD 的学龄前儿童进行干预试点有效性试验，我们将举行 由儿科医生 (n=10) 和行为健康治疗师组成的焦点小组（目标 1）纳入儿科初级教育 照顾者 (n=10) 和 3-5 岁儿童的照顾者 (n=10)，以告知整合和交付简介， 儿科初级保健中以睡眠为中心的 PBI (SF-PBI)。然后我们将进行试点有效性试验（目标 2 3) 对 50 个 3-5 岁患有早期早衰的儿童家庭进行随机、候补对照设计 多动症症状和睡眠问题。该试验将 (a) 测试可行性、可接受性和适当性 SF-PBI 在儿科初级保健中的应用； (b) 检查目标参与度（睡眠）的变化以及 多动症症状； (c) 评估睡眠与多动症症状变化之间的关系。结果来自 这项试点有效性试验将为针对学龄前儿童睡眠的大规模临床试验提供信息 通过利用育儿方式进行易于获得的、基于初级保健的干预措施，对 ADHD 风险较高的儿童进行干预 策略。这项工作最终可以通过早期干预来改善有注意力缺陷多动症风险的儿童的结果 睡眠可减少儿童和儿童中 ADHD 的患病率、症状和相关损害 家庭。