Integrating Behavioral Sleep Medicine with Behavioral Parent Training for Preschool ADHD: Stakeholder Insights for an Early Childhood Intervention
Jessica R. Lunsford-Avery, Matthew J. Gibson, Brian Eichner, John T. Mitchell, Naomi O. DavisObjectives:
Behavioral Parenting Training (BPT), the gold-standard treatment for preschool attention-deficit/hyperactivity disorder (ADHD), does not consistently improve core symptoms of inattention and hyperactivity/impulsivity. Pairing BPT with complementary preventative therapies targeting biological mechanisms, such as sleep dysregulation, may improve treatment outcomes. This qualitative study with key stakeholders aims to inform the development of parent-based interventions that incorporate behavioral sleep medicine (BSM) strategies to improve ADHD-related outcomes in preschoolers.
Method:
Three stakeholder groups participated in two rounds of semi-structured focus group sessions: parents/caregivers of preschoolers with elevated ADHD symptoms (
Results:
Dominant themes across stakeholders concerned treatment content, structure, process, materials, and individualization. Stakeholders highlighted the importance of a 24-hr approach for improving preschool ADHD symptoms and emphasized needs for specific, practical, and developmentally-appropriate strategies; appropriate session pacing/time for troubleshooting skill use; sufficient support for caregiver skill implementation; validation of caregivers’ experiences; easy-to-use handouts; digital materials; and treatment tailored to family culture, structure, and household environment.
Conclusions:
Stakeholder input is essential for developing acceptable, feasible, and effective preschool ADHD interventions that incorporate BSM strategies and are adapted for real-world settings. Future research should evaluate whether the identified themes contribute to increased feasibility, scalability, and effectiveness of parent-based sleep treatments for improving sleep, ADHD, and functional outcomes among preschoolers at-risk for ADHD.