Refinement and Testing of Service-Ready Interventions for Preschool Attention-Deficit/Hyperactivity Disorder

Presenter:

Mary Rooney, Ph.D.
Division of Services and Intervention Research

Goal:

To solicit pilot effectiveness projects that apply a mechanism-based approach to the development and evaluation of deployment-focused preschool attention-deficit/hyperactivity disorder (ADHD) interventions. Relevant interventions could consider the unique challenges associated with treating ADHD symptoms and impairments in children under the age of six Interventions may also focus on preventing or forestalling the emergence of co-occurring disorders or additional ADHD symptoms and impairments that predictably emerge later in development.

Rationale:

ADHD is an impairing and chronic neurodevelopmental disorder with symptoms that often present during the preschool years. ADHD is estimated to affect 2-6% of preschoolers and demonstrates high continuity from preschool through the school-age years. Additionally, studies suggest that preschoolers with subthreshold ADHD symptoms are more likely to meet diagnostic criteria for ADHD in the future than they are to outgrow their symptoms. Early identification and intervention may be particularly important for children with ADHD given the well documented trajectory of the disorder and the comorbid conditions that emerge over time. Behavioral interventions are recommended as the first-line treatment for preschoolers with ADHD by the American Academy of Pediatrics. In addition, children and adolescents who receive evidence-based behavioral or pharmacological interventions for ADHD see near-term reduction in symptoms and impairments, but ultimately remain significantly impaired relative to their non-ADHD peers. Consistent with evidence suggesting that early treatment may be a necessary first step in normalizing symptoms across development and mitigating negative outcomes for individuals with ADHD, this initiative focuses on refining and testing developmentally relevant, deployment-focused interventions.

Theory-driven, mechanism-based approaches might be applied to test service-ready strategies that: (1) are tailored to meet the developmental and environmental needs of preschool-age children; (2) seek to monitor, prevent, or forestall the emergence of additional ADHD symptoms (e.g., inattention), impairments (e.g., poor organizational skills), and comorbidities; (3) target empirically identified moderators and mediators of adverse ADHD trajectories (e.g., maternal psychopathology, comorbidities, emotion regulation); or (4) incorporate pharmacotherapy as a second-line intervention though combined or sequenced behavioral and pharmacological interventions. NIMH encourages scalable approaches that can be substantially delivered in settings where youth are served (e.g., community care, primary care, childcare/preschool) and strategies that seek to feasibly promote intervention engagement and adherence within these setting contexts.