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.
